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Sample records for end-of-life irradiation performance

  1. End of Life Issues

    Science.gov (United States)

    Planning for the end of life can be difficult. But by deciding what end-of-life care best suits your needs when you are healthy, you can ... right choices when the time comes. End-of-life planning usually includes making choices about the following: ...

  2. [End-of-life care and end-of-life medical decisions: the ITAELD study].

    Science.gov (United States)

    Miccinesi, Guido; Puliti, Donella; Paci, Eugenio

    2011-01-01

    To describe the attitudes towards end of life care and the practice of end-of-life medical decisions with possible life-shortening effect among Italian physicians. Cross sectional study (last death among the assisted patients in the last 12 months was considered). In the year 2007, 5,710 GPs and 8,950 hospital physicians were invited all over Italy to participate in the ITAELDstudy through anonymous mail questionnaire. Proportion of agreement with statements on end-of-life care issues. Proportion of deaths with an end-of-life medical decision. The response rate was 19.2%. The 65% of respondents agreed with the duty to respect any non-treatment request of the competent patient, the 55% agreed with the same duty in case of advanced directives, the 39% in case of proxy's request. The 53% of respondents agreed with the ethical acceptability of active euthanasia in selected cases. Among 1,850 deaths the 57.7% did not receive any end-of-life medical decision. For a further 21.0% no decision was possible, being sudden and unexpected deaths. In the remaining 21.3% at least one end-of-life medical decision was reported: 0.8% was classified as physician assisted death, 20.5% as non-treatment decision. Among all deceased the 19.6% were reported to have been deeply sedated. Being favourable to the use of opioids in terminal patients was associated to non-treatment decisions with possible but non-intentional life shortening effect; agreeing with the duty to fully respect any actual non-treatment request of the competent patient was associated to end-of life medical decisions with intentional life-shortening effect (adjusted OR>10 in both cases). The life stance and ethical beliefs of physicians determine their behaviour at the end of life wherever specific statements of law are lacking. Therefore education and debate are needed on these issues.

  3. Accuracy and Reliability in the Prediction of End-of-Life Performance of Solar Generators

    Science.gov (United States)

    Rapp, Etienne

    2008-09-01

    The end-of-life power analysis of solar arrays is calculated using a combination of arithmetic and root square sums of loss factors. These loss factors are sometimes linked to degradations, sometimes linked to uncertainties. The uncertainties of the degradations are taken into account considering contractual "worst cases". This paper will put the first stones for a move "metrological" evaluation of the probable performance associated with a standard uncertainty. The turn from silicon to triple junction solar cells induces some changes in the degradation parameters of solar arrays: * The triple junction cells are more sensitive to UV darkening than silicon ones. * The cell voltage is higher and the current is lower. Then the cell strings are shorter, and there are more strings in parallel. This induces some changes in the reliability analyses and risk management. * The failure modes and failure rates of these cells have to be compared and discussed. We try to define improved rules to design solar arrays for end of life performance, for a better knowledge of the margins and a better reliability.

  4. Issues surrounding end-of-life decision-making

    Directory of Open Access Journals (Sweden)

    Tejwani V

    2013-08-01

    Full Text Available Vickram Tejwani,1,* YiFan Wu,1,* Sabrina Serrano,2 Luis Segura,2 Michael Bannon,3 Qi Qian1 1Department of Medicine, Division of Nephrology and Hypertension, 2Mayo Graduate School, 3Department of Trauma, Critical Care, and General Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA *These authors contributed equally to this work Abstract: End-of-life decision-making is a complex process that can be extremely challenging. We describe a 42-year-old woman in an irreversible coma without an advance directive. The case serves to illustrate the complications that can occur in end-of-life decision-making and challenges in resolving difficult futility disputes. We review the role of advance directives in planning end-of-life care, the responsibility and historical performance of patient surrogates, the genesis of futility disputes, and approaches to resolving disputes. Keywords: end-of-life care, advance directive, surrogate, futility dispute, conflict resolution

  5. Development of an End-plug Welding Technology for an Instrumented Fuel Irradiation Test

    International Nuclear Information System (INIS)

    Kim, Soo Sung; Lee, Chul Yong; Shin, Yoon Taek; Choo, Kee Nam

    2010-01-01

    The irradiation test of end-plug specimens was planned for the evaluation of nuclear fuels performance. To establish the fabrication process, and for satisfying the requirements of the irradiation test, an orbital-GTA weld machine for the specimens of the dual rods was developed, and the preliminary welding experiments for optimizing the process conditions of the specimens of the dual rods were performed. Dual rods with a 9.5mm diameter and a 0.6mm wall thickness of the cladding tubes and end-plugs have been used and the optimum conditions of the pin-hole welding have also been selected. This paper describes the experimental results of the GTA welds of the specimens of the dual rods and the metallography examinations of the GTA welded specimens for various welding conditions for the instrumented fuel irradiation test. These investigations satisfied the requirements of the instrumented irradiation test and the GTA welds for the specimens of the dual rods at the HANARO research reactor

  6. End-of-Life Nursing Care and Education: End-of-Life Nursing Education: Past and Present.

    Science.gov (United States)

    DʼAntonio, Jocelyn

    The dying experience is forever carried in the life story of those for whom the nurse cares. A goal of end-of-life nursing education is to produce nurses who are comfortable with death and dying and who have had the opportunity to reflect on their thoughts and feelings about end-of-life care. This article reviews the history, development, and teaching methods of end-of-life care, offering recommendations for future education.

  7. Performance assessment of the (Th,U)O2 HTI-Biso coated particle under PNP/HHT irradiation conditions

    International Nuclear Information System (INIS)

    Kania, M.J.; Nickel, H.

    1980-11-01

    The HTI Biso Particle, Variant-I: consisting of a dense 400 μm-diameter (Th,U)O 2 -kernel with a Biso coating using a methane derived pyrocarbon layer (HTI), is a candidate fuel for the advanced PNP/HHT High Temperature Reactor systems. This report presents the results of a comprehensive performance assessment of Variant-I represented by six relevant particle batches irradiated in 12 accelerated irradiation experiments. Fuel performance was judged based upon PNP/HHT qualification requirements with regard to in-reactor operating conditions and end-of-life (EOL) coated particle failure fraction. Fuel operating conditions in each irradiation experiment were obtained from two sources: 1) a thorough review of all available irradiation data on each experiment; and 2) a two-dimensional (R,theta) thermal modeling computer code, R2KTMP, was developed to calculate fuel operating temperature distributions within spherical elements. End-of-life particle failure fractions were determined from: gaseous fission product release, based on in-reactor R/B measurements and postirradiation annealing and room temperature investigations; solid fission product release, from single particle 137 Cs release into fuel element matrix and hot-gaseous chlorine leaching; and visual and ceramographic examinations. Failure fractions determined by solid fission product release yielded values 2-35 times higher than those determined by gaseous fission product release. (orig.) [de

  8. Early life hormetic treatments decrease irradiation-induced oxidative damage, increase longevity, and enhance sexual performance during old age in the Caribbean fruit fly

    International Nuclear Information System (INIS)

    López-Martínez, Giancarlo; Hahn, Daniel A.

    2014-01-01

    Early life events can have dramatic consequences on performance later in life. Exposure to stressors at a young age affects development, the rate of aging, risk of disease, and overall lifespan. In spite of this, mild stress exposure early in life can have beneficial effects on performance later in life. These positive effects of mild stress are referred to as physiological conditioning hormesis. In our current study we used anoxia conditioning hormesis as a pretreatment to reduce oxidative stress and improve organismal performance, lifespan, and healthspan of Caribbean fruit flies. We used gamma irradiation to induce mild oxidative damage in a low-dose experiment, and massive oxidative damage in a separate high-dose experiment, in pharate adult fruit flies just prior to adult emergence. Irradiation-induced oxidative stress leads to reduced adult emergence, flight ability, mating performance, and lifespan. We used a hormetic approach, one hour of exposure to anoxia plus irradiation in anoxia, to lower post-irradiation oxidative damage. We have previously shown that this anoxic-conditioning treatment elevates total antioxidant capacity and lowers post-irradiation oxidative damage to lipids and proteins. In this study, conditioned flies had lower mortality rates and longer lifespan compared to those irradiated without hormetic conditioning. As a metric of healthspan, we tracked mating both at a young age (10 d) and old age (30 d). We found that anoxia-conditioned male flies were more competitive at young ages when compared to unconditioned irradiation stressed male flies, and that the positive effects of anoxic conditioning hormesis on mating success were even more pronounced in older males. Our data shows that physiological conditioning hormesis at a young age, not only improves immediate metrics of organismal performance (emergence, flight, mating), but the beneficial effects also carry into old age by reducing late life oxidative damage and improving lifespan and

  9. Challenges in end-of-life communication.

    Science.gov (United States)

    Galushko, Maren; Romotzky, Vanessa; Voltz, Raymond

    2012-09-01

    The purpose of this review is to give an overview of challenges that have been addressed in recent research in end-of-life communication. Diversity of difficulties that may occur in communication about end-of-life issues has been showed. The emotional quality of this communication requires special skills from professionals involved. Studies showed that physicians and medical students are often overstrained and avoid end-of-life discussions. Health professionals and patients are often ambivalent about end-of-life discussions. Nevertheless, professionals are expected to initiate these in an honest, needs-oriented way. Patient preferences are difficult to infer and have to be assessed explicitly and regularly. Studies showed that the emotional impact of end-of-life discussions can lead to a high burden or avoidance of professionals. Interdisciplinary, multi-professional work can support health professionals in end-of-life care but often structural barriers obstruct possible benefits. Health professionals need to initiate end-of-life communication in a sensitive way. Specific demands for health professionals in end-of-life communication are to differentiate own emotions and life events from those of patients and to deal with both adequately. Moreover, structural aspects can lead to difficulties between different specialties, professions and sectors, which can have a negative impact on adequate care for patient and relatives. Special efforts for improvement are needed.

  10. End-of-Life Conversation Game Increases Confidence for Having End-of-Life Conversations for Chaplains-in-Training.

    Science.gov (United States)

    Van Scoy, Lauren Jodi; Watson-Martin, Elizabeth; Bohr, Tiffany A; Levi, Benjamin H; Green, Michael J

    2018-04-01

    Discussing end-of-life issues with patients is an essential role for chaplains. Few tools are available to help chaplains-in-training develop end-of-life communication skills. This study aimed to determine whether playing an end-of-life conversation game increases the confidence for chaplain-in-trainings to discuss end-of-life issues with patients. We used a convergent mixed methods design. Chaplains-in-training played the end-of-life conversation game twice over 2 weeks. For each game, pre- and postgame questionnaires measured confidence discussing end-of-life issues with patients and emotional affect. Between games, chaplains-in-training discussed end-of-life issues with an inpatient. One week after game 2, chaplains-in-training were individually interviewed. Quantitative data were analyzed using descriptive statistics and Wilcoxon rank-sum t tests. Content analysis identified interview themes. Quantitative and qualitative data sets were then integrated using a joint display. Twenty-three chaplains-in-training (52% female; 87% Caucasian; 70% were in year 1 of training) completed the study. Confidence scores (scale: 15-75; 75 = very confident) increased significantly after each game, increasing by 10.0 points from pregame 1 to postgame 2 ( P game, and shyness subscale scores decreased significantly after each game. Content analysis found that chaplains-in-training found the game to be a positive, useful experience and reported that playing twice was beneficial (not redundant). Mixed methods analysis suggest that an end-of-life conversation game is a useful tool that can increase chaplain-in-trainings' confidence for initiating end-of-life discussions with patients. A larger sample size is needed to confirm these findings.

  11. Improvement of shelf-life and quality of mangoes by gamma irradiation

    International Nuclear Information System (INIS)

    Thomas, Paul; Padwal Desai, S.R.

    1976-01-01

    Results of the studies on low dose gamma irradiation of mangoes in the dose range 10 to 200 krad alone or in combination with other physical and chemical treatments (i.e. hot water dipping and skin coating with 9 percent emulsion of acetylated monoglyceride) show that physiological, pathological and entomological factors can be controlled to extend the shelf-life of mangoes by one to two weeks. Organoleptic qualities of treated fruits are found to be comparable to those of unirradiated control mangoes. Texture qualities of the treated fruits are also retained at the end of 15 days after their transport over long distance. Irradiated fruits have the added advantage of disinfestation and reduction of stem end rot and anthracnose during ripening. Doses exceeding 75 krad are, however, found to be injurious to the fruits. (M.G.B.)

  12. End-of-life decisions: Christian perspectives.

    Science.gov (United States)

    Stempsey, William E

    1997-12-01

    While legal rights to make medical treatment decisions at the end of one's life have been recognized by the courts, particular religious traditions put axiological and metaphysical meat on the bare bones of legal rights. Mere legal rights do not capture the full reality, meaning and importance of death. End-of-life decisions reflect not only the meaning we find in dying, but also the meaning we have found in living. The Christian religions bring particular understandings of the vision of life as a gift from God, human responsibility for stewardship of that life, the wholeness of the person, and the importance of the dying process in preparing spiritually for life beyond earthly life, to bear on end-of-life decisions.

  13. End-of-Life Indicators for NIMA's High-Performance Cesium Frequency Standards

    National Research Council Canada - National Science Library

    Brock, C; Tolman, B. W; Taylor, R. E

    2002-01-01

    .... The mean lifetime of the cesium-beam tube (CBT) is approximately 6 years; failure or end-of-life of the CBT is a significant cause in the reduction of data used to produce the NIMA GPS precise ephemeris...

  14. Influence of physicians' life stances on attitudes to end-of-life decisions and actual end-of-life decision-making in six countries

    DEFF Research Database (Denmark)

    Cohen, J; van Delden, J; Mortier, F

    2008-01-01

    AIM: To examine how physicians' life stances affect their attitudes to end-of-life decisions and their actual end-of-life decision-making. METHODS: Practising physicians from various specialties involved in the care of dying patients in Belgium, Denmark, The Netherlands, Sweden, Switzerland......) and Protestants (up to 20.4% in The Netherlands) reported ever having made such a decision. DISCUSSION: The results suggest that religious teachings influence to some extent end-of-life decision-making, but are certainly not blankly accepted by physicians, especially when dealing with real patients...... large life-stance groups in each country. RESULTS: Only small differences in life stance were found in all countries in general attitudes and intended and actual behaviour with regard to various end-of-life decisions. However, with regard to the administration of drugs explicitly intended to hasten...

  15. DESIGN CONSIDERATIONS UPON PRODUCT END-OF-LIFE OPTIONS

    Directory of Open Access Journals (Sweden)

    BARSAN Lucian

    2016-11-01

    Full Text Available The paper presents some considerations about the necessity of evaluating the environmental impact of a product during its entire life. The present situation (economic, social and ecologic imposes solutions to reduce this impact as a result of an analysis performed during all stages of the life cycle. This paper focuses on design solutions with consequences in the last stage, the end-of-life. Reusing products, with, or without remanufacturing and recycling the materials from products that cannot be reused represent some options analysed in this paper. The end-of-life options should be known even from the beginning of the design process and should be included as design objectives or, at least as constrictions. Considering them as human needs would naturally include them in the requirements list.

  16. Pharmacotherapy at the end-of-life.

    LENUS (Irish Health Repository)

    O'Mahony, Denis

    2011-07-01

    Older people reaching end-of-life status are particularly at risk from inter-related adverse effects of pharmacotherapy, including polypharmacy, inappropriate medications and adverse drug events. These adverse effects of pharmacotherapy may be highly detrimental, as well as highly expensive. End-of-life pharmacotherapy is sometimes perceived to be complex and challenging, probably unnecessarily. This relates in part to the poorly developed evidence base and lack of high-quality research in this area. In this article, we deal with some of the key issues relating to pharmacotherapy in end-of-life patients, namely (i) the guiding principles of drug selection, (ii) the main drugs and drug classes that are best avoided, (iii) the benefits of \\'oligopharmacy\\' (i.e. deliberate avoidance of polypharmacy) in end-of-life patients.

  17. Life's end: Ethnographic perspectives.

    Science.gov (United States)

    Goodwin-Hawkins, Bryonny; Dawson, Andrew

    2018-01-01

    In this introduction to the special issue, Life's End: Ethnographic Perspectives, we review the field of anthropological studies of death and dying. We make the argument that, largely because of its sub-disciplining into the larger field of the anthropology of religion, ritual and symbolism, the focus of anthropological research on death has been predominantly on post- rather than pre-death events, on death's beginnings rather than life's ends. Additionally, we argue that an anthropological aversion to the study of dying may also lie in the intimacy of the discipline's principal method, ethnography. Contrastingly, we argue that this very methodological intimacy can be a source of insight, and we offer this as a rationale for the special issue as a whole, which comprises eight ethnographic studies of dying and social relations at life's end from across Africa, Australia, Europe, and North America. Each of these studies is then summarized, and a rationale for their presentation around the themes of "structures of dying," "care for the dying," "hope in dying," and "ending life" is presented.

  18. Studies on extension of shelf-life of rawa by gamma irradiation

    International Nuclear Information System (INIS)

    Sudha Rao, V.; Srirangarajan, A.N.; Kamat, A.S.; Adhikari, H.R.; Nair, P.M.

    1994-01-01

    Semolina, a wheat product, popularly termed as rawa, was packed in 500g pouches prepared individually from high density polyethylene (HDP), biaxially oriented polypropylene : low density polyethylene laminate (BOPP/LDP), polyester : low density polyethylene laminate (PET/LDP) and irradiated using a Cobalt-60 source at dose of 0.15 to 0.50 kGy. At the end of six months' storage at room temperature, the unirradiated rawa developed infestation, whereas the irradiated samples were completely free of any infestation, thereby indicating a complete destruction of all stages of the insects due to irradiation. There was no significant difference in the moisture content and the total bacterial as well as mould counts of the irradiated and unirradiated rawa. Gamma irradiation significantly decreased the gelatinization viscosity of rawa. In sensory evaluation tests, irradiated rawa scored the same on a 9-point Hedonic scale, thereby showing that overall acceptability of the rawa was not altered due to irradiation upto 0.25 kGy. Amongst the packaging materials used, BOPP/LDP was found to be better, because of its comparatively higher resistance to penetration by insects. Gamma irradiation at 0.25 kGy could thus be recommended for effectively extending the shelf-life of rawa, prepacked in pouches made from BOPP/LDP laminate, for six months. (author). 26 refs., 1 fig., 2 tabs

  19. Network modeling for reverse flows of end-of-life vehicles

    International Nuclear Information System (INIS)

    Ene, Seval; Öztürk, Nursel

    2015-01-01

    Highlights: • We developed a network model for reverse flows of end-of-life vehicles. • The model considers all recovery operations for end-of-life vehicles. • A scenario-based model is used for uncertainty to improve real case applications. • The model is adequate to real case applications for end-of-life vehicles recovery. • Considerable insights are gained from the model by sensitivity analyses. - Abstract: Product recovery operations are of critical importance for the automotive industry in complying with environmental regulations concerning end-of-life products management. Manufacturers must take responsibility for their products over the entire life cycle. In this context, there is a need for network design methods for effectively managing recovery operations and waste. The purpose of this study is to develop a mathematical programming model for managing reverse flows in end-of-life vehicles’ recovery network. A reverse flow is the collection of used products from consumers and the transportation of these products for the purpose of recycling, reuse or disposal. The proposed model includes all operations in a product recovery and waste management network for used vehicles and reuse for vehicle parts such as collection, disassembly, refurbishing, processing (shredding), recycling, disposal and reuse of vehicle parts. The scope of the network model is to determine the numbers and locations of facilities in the network and the material flows between these facilities. The results show the performance of the model and its applicability for use in the planning of recovery operations in the automotive industry. The main objective of recovery and waste management is to maximize revenue and minimize pollution in end-of-life product operations. This study shows that with an accurate model, these activities may provide economic benefits and incentives in addition to protecting the environment

  20. Network modeling for reverse flows of end-of-life vehicles

    Energy Technology Data Exchange (ETDEWEB)

    Ene, Seval; Öztürk, Nursel

    2015-04-15

    Highlights: • We developed a network model for reverse flows of end-of-life vehicles. • The model considers all recovery operations for end-of-life vehicles. • A scenario-based model is used for uncertainty to improve real case applications. • The model is adequate to real case applications for end-of-life vehicles recovery. • Considerable insights are gained from the model by sensitivity analyses. - Abstract: Product recovery operations are of critical importance for the automotive industry in complying with environmental regulations concerning end-of-life products management. Manufacturers must take responsibility for their products over the entire life cycle. In this context, there is a need for network design methods for effectively managing recovery operations and waste. The purpose of this study is to develop a mathematical programming model for managing reverse flows in end-of-life vehicles’ recovery network. A reverse flow is the collection of used products from consumers and the transportation of these products for the purpose of recycling, reuse or disposal. The proposed model includes all operations in a product recovery and waste management network for used vehicles and reuse for vehicle parts such as collection, disassembly, refurbishing, processing (shredding), recycling, disposal and reuse of vehicle parts. The scope of the network model is to determine the numbers and locations of facilities in the network and the material flows between these facilities. The results show the performance of the model and its applicability for use in the planning of recovery operations in the automotive industry. The main objective of recovery and waste management is to maximize revenue and minimize pollution in end-of-life product operations. This study shows that with an accurate model, these activities may provide economic benefits and incentives in addition to protecting the environment.

  1. End of Life: An Overview

    Science.gov (United States)

    Toner, Mary Ann; Shadden, Barbara B.

    2012-01-01

    Speech-language pathologists (SLPs) provide services to patients confronting the end of life (EOL) in a variety of settings. Instead of targeting improvement of health or sustaining life, EOL services focus primarily on quality of life. Although SLPs may not consider themselves core members of the health care team providing EOL services, the…

  2. Effects of gamma irradiation on the shelf-life of a dairy-like product

    Science.gov (United States)

    Odueke, Oluwakemi B.; Chadd, Stephen A.; Baines, Richard N.; Farag, Karim W.; Jansson, Jonathan

    2018-02-01

    This study was aimed to assess the effect of irradiation on the shelf-life of pseudo-dairy food product consisting of different concentration levels of the structural and energy-giving caloric component macronutrients (protein, fat and carbohydrate). Gamma irradiated products (1 kGy, 3 kGy, 5 kGy and 10 kGy) were compared to the current procedure used by the industry of non-irradiated dairy products. The study looked at the impact of different treatments on storage quality in respect to physicochemical (pH, acidity, macronutrients), and microbiological properties [total viable count (TVC)]. The products were aseptically packaged in plastic containers and analysed at regular weekly intervals up until 100 days during refrigerated storage at 4 ± 1 °C. The storage period did not bring about any significant change in physicochemical properties of the products throughout the period of study while the TVC displayed a linear regression for irradiated products stored at 4 ± 1 °C as well as the control (non-irradiated). At the end of the shelf-life trial (benchmarked at log 4.3 CFU/g), the total viable count did not exceed log 3.94 CFU/g for samples treated at 10 kGy after 100 days of analysis. These observations indicated that the product could be safely stored aerobically for > 100days (10 and 5 kGy), 56days at (3 kGy), 42 days at (1 kGy) for the irradiated samples' and 14-28 days for the non-irradiated samples without much change in physicochemical and microbiological properties using refrigerated storage.

  3. End of Life Care

    Science.gov (United States)

    ... Related Topics Choosing Wisely Join our e-newsletter! Aging & Health A to Z End of Life Care ... be used. Ice chips, popsicles, moist swabs, or artificial saliva can help prevent the mouth from becoming ...

  4. Irradiation performance of metallic fuels

    International Nuclear Information System (INIS)

    Pahl, R.G.; Lahm, C.E.; Porter, D.L.; Batte, G.L.; Hofman, G.L.

    1989-01-01

    Argonne National Laboratory has been working for the past five years to develop and demonstrate the Integral Fast Reactor (IFR) concept. The concept involves a closed system for fast-reactor power generation and on-site fuel reprocessing, both designed specifically around the use of metallic fuel. The Experimental Breeder Reactor-II (EBR-II) has used metallic fuel for all of its 25-year life. In 1985, tests were begun to examine the irradiation performance of advanced-design metallic fuel systems based on U-Zr or U-Pu-Zr fuels. These tests have demonstrated the viable performance of these fuel systems to high burnup. The initial testing program will be described in this paper. 2 figs

  5. Labelling of end-of-life decisions by physicians

    NARCIS (Netherlands)

    Deyaert, J.; Chambaere, K.; Cohen, J.; Roelands, M.; Deliens, L.

    2014-01-01

    Objectives: Potentially life-shortening medical end-oflife practices (end-of-life decisions (ELDs)) remain subject to conceptual vagueness. This study evaluates how physicians label these practices by examining which of their own practices (described according to the precise act, the intention, the

  6. Pharmacy Students' Attitudes Toward Death and End-of-life Care

    Science.gov (United States)

    Broeseker, Amy E.

    2010-01-01

    Objectives To assess pharmacy students' attitudes toward death and end-of-life care. Methods Third-year pharmacy students enrolled in the Ethics in Christianity and Health Care course were administered a survey instrument prior to introduction of the topic of end-of-life care. Students' attitudes toward different professions' roles in end-of-life care and their comfort in discussing end-of-life issues were assessed. The survey instrument was readministered to the same students at the end of their fourth year. Results On most survey items, female students responded more favorably toward death and end-of-life care than male students. One exception was the perceived emotional ability to be in the room of a dying patient or loved one. Post-experiential survey responses were generally more favorable toward death and end-of-life care than were pre-discussion responses. Conclusions In general, when surveyed concerning death and end-of-life care, female students responded more favorably than male students, and responses at the end of the fourth year were more favorable than at the beginning of the course. PMID:21045946

  7. Environmental assessment of end-of-life textiles in Denmark

    DEFF Research Database (Denmark)

    Koligkioni, Athina; Parajuly, Keshav; Sørensen, Birgitte Lilholt

    2018-01-01

    The European Union is on its way to a circular economy through eco-design, waste prevention, reuse and recycling of products and materials. This study analyzes the environmental effects of end-of-life textile management in Denmark. First, a Mass Flow Analysis was performed for textile flows from...... sales to consumers to end processes, which revealed that absolute consumption has grown significantly over the last years. Data on generation and management of used textiles indicated that around 40% are discarded with residual waste, another 40% are captured by collection for reuse channels, and around...

  8. Institutional disposition and management of end-of-life electronics.

    Science.gov (United States)

    Babbitt, Callie W; Williams, Eric; Kahhat, Ramzy

    2011-06-15

    Institutions both public and private face a challenge to develop policies to manage purchase, use, and disposal of electronics. Environmental considerations play an increasing role in addition to traditional factors of cost, performance and security. Characterizing current disposition practices for end-of-life electronics is a key step in developing policies that prevent negative environmental and health impacts while maximizing potential for positive social and economic benefits though reuse. To provide a baseline, we develop the first characterization of quantity, value, disposition, and flows of end-of-life electronics at a major U.S. educational institution. Results of the empirical study indicate that most end-of-first-life electronics were resold through public auction to individuals and small companies who refurbish working equipment for resale or sell unusable products for reclamation of scrap metal. Desktop and laptop computers sold for refurbishing and resale averaged U.S. $20-100 per unit, with computers sold directly to individuals for reuse reaching $250-350 per unit. This detailed assessment was coupled with a benchmarking survey of end-of-life electronics management practices at other U.S. universities. Survey results indicate that while auctions are still commonplace, an increasing number of institutions are responding to environmental concerns by creating partnerships with local recycling and resale entities and mandating domestic recycling. We use the analyses of current disposition practices as input to discuss institutional strategies for managing electronics. One key issue is the tension between benefits of used equipment sales, in terms of income for the institution and increased reuse for society, and the environmental risks because of unknown downstream practices.

  9. Uncharted terrain: preference construction at the end of life.

    Science.gov (United States)

    White, Mary T

    2014-01-01

    Respect for patients' self-determination has long been considered central to efforts to improve end-of-life care, yet efforts to promote advance directives or engage patients in end-of-life discussions are often unsuccessful. In this article, I contend that this is because the shared decision-making approach typically used in healthcare assumes patients' capacity to make rational choices, which is not always possible in end-of-life decisions. Drawing on decision theory, behavioral psychology, and related studies of end-of-life care, I present a growing body of evidence that suggests the novelty, complexity, and uncertainty of end-of-life circumstances make rational and stable preferences difficult to establish. I argue that an effective decision-making approach for the terminally ill must recognize and respond to the unique characteristics of end-of-life choices, including their nonrational dimensions. I conclude with a description of an initiative that appears to do so, resulting in increased patients' satisfaction. Copyright 2014 The Journal of Clinical Ethics. All rights reserved.

  10. Study on creep-fatigue life of irradiated austenitic stainless steel

    International Nuclear Information System (INIS)

    Ioka, Ikuo; Miwa, Yukio; Tsuji, Hirokazu; Yonekawa, Minoru; Takada, Fumiki; Hoshiya, Taiji

    2001-01-01

    The low cycle creep-fatigue test with tensile strain hold of the austenitic stainless steel irradiated to 2 dpa was carried out at 823K in vacuum. The applicability of creep-fatigue life prediction methods to the irradiated specimen was examined. The fatigue life on the irradiated specimen without tensile strain hold time was reduced by a factor of 2-5 in comparison with the unirradiated specimen. The decline in fatigue life of the irradiated specimen with tensile strain hold was almost equal to that of the unirradiated specimen. The creep damage of both unirradiated and irradiated specimens was underestimated by the time fraction rule or the ductility exhaustion rule. The creep damage calculated by the time fraction rule or the ductility exhaustion rule increased by the irradiation. The predictions derived from the linear damage rule are unsafe as compared with the experimental fatigue lives. (author)

  11. End-of-life decisions in the intensive care unit

    DEFF Research Database (Denmark)

    Jensen, Hanne Irene

    2012-01-01

    be interdisciplinary, but the literature shows that this is not always the case. Research on end-of-life issues in Danish ICUs is limited. Aim The aims of this thesis were to • Examine Danish practices regarding end-of-life decisions in the ICU. • Examine the opinions of nurses and physicians who work in Danish ICUs...... and decision-making. Hypotheses • Nurses, intensivists, and primary physicians have different experiences of interdisciplinary collaboration regarding end-of-life decision-making in the ICU. • Specific interventions targeting end-of-life decision-making in the ICU, such as interdisciplinary audits......Background When making end-of-life decisions in intensive care units, the different staff groups have different roles in the decision-making process and may not always assess the situation identically. Practice recommendations for withholding or withdrawing therapy state that decisions should...

  12. Pain relief at the end of life: nurses' experiences regarding end-of-life pain relief in patients with dementia.

    Science.gov (United States)

    Brorson, Hanna; Plymoth, Henrietta; Örmon, Karin; Bolmsjö, Ingrid

    2014-03-01

    Patients with dementia receive suboptimal palliative care, and this patient group is at risk to have pain at the end of life. Because communicative impairments are common in this patient group, nurses play an important caregiver role in identifying, assessing, and relieving patients' pain. This study aimed to describe nurses' experiences regarding end-of-life pain relief in patients with dementia. This descriptive exploratory qualitative study was based on seven semistructured interviews. Burnard's content analysis inspired the data analysis. Two main categories were identified: (1) nurses' experience of difficulties concerning pain relief and (2) nurses' experience of resources concerning pain relief. Nurses experienced difficulties, such as feeling of powerlessness because of difficulties in obtaining adequate prescriptions for analgesics, ethical dilemmas, feeling of inadequacy because analgesia did not have the desired effect, and a feeling of not being able to connect with the patient. Factors, including knowledge about the patient, professional experience, utilization of pain assessment tools, interpersonal relationships, and interprofessional cooperation, served as resources and enabled end-of-life pain relief. The results of this study highlight the complexity of pain relief in patients with dementia at the end of life from a nursing perspective. The inability of patients with dementia to verbally communicate their pain makes them a vulnerable patient group, dependent on their caregivers. Knowing the life story of the patient, professional experience, teamwork based on good communication, and use of a pain assessment tool were reported by the nurses to improve pain relief at the end of life for patients with dementia. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  13. Symptomatic Control in End-of-Life Patients

    Directory of Open Access Journals (Sweden)

    Mariana Alves

    2017-01-01

    Full Text Available End-of-life patients present a variety of symptoms that cause suffering for them and their respective families. Health professionals throughout their university, internship and medical careers are ill-prepared to manage and improve the quality of life of these patients. This article aims to provide basic skills in the symptomatic management of end-of-life patients, focusing in particular on the control of pain, dyspnoea, fatigue, nausea, vomiting and anorexia. It also aims to draw attention to basic concepts of control concerning refractory symptoms and palliative sedation.

  14. Life span of animals under acute and chronic irradiation

    International Nuclear Information System (INIS)

    Zapol'skaya, N.A.; Fedorova, A.V.; Borisova, V.V.

    1978-01-01

    The study has been designed to see to what extent a single and long-term external and internal irradiations shorten the life span of animals. LDsub(50/30) for certain radionuclides whose absorbed doses show different spatiotemporal distributions are considered. It has been found that as far as the average life span is concerned, 137 Cs and 90 Sr have approximately the same effect whether they enter the body on a single occasion or repeatedly. With chronic total-body external gamma-irradiation, the decrease in life span is 5 times smaller than than with single-occasion irradiation. The main reason for the observed differences are found to be differences in the rates with which the absorbed doses are formed

  15. [Vulnerations of Human Dignity At The End of Life].

    Science.gov (United States)

    Germán Zurriaráin, Roberto

    2017-01-01

    Death is constitutive of human nature and therefore it must happen naturally. But there are mainly two ways that falsify it: euthanasia and therapeutic obstinacy. Two wrong choices that do not accept the human reality of death (the first, anticipates death and the second, delays it). From the philosophical and ethical point of view, both options are rejected, because they are against human dignity at the end of life. Aside from these, this article also rejects the different names which are given to refer to euthanasia, that also go against human nature at the end of life. On the other hand, do not confuse euthanasia with sedation. Both have a common goal to prevent the patient from feeling pain and suffering. To achieve this goal, both options administer ″drugs″ to the patient. But in the administration of drugs in euthanasia involves ending patient's life. The administration of drugs in sedation aims for the patient's death to occur naturally. Finally, we briefly discuss the basic care necessary in these situations. The absence of basic care cannot become a covert euthanasia. The patient must die from his/her illness, never from a lack of care. All human actions (euthanasia, sedation, therapeutic obstinacy and basic care) should be an expression and manifestation of what human dignity demands. Such dignity is expressed in the actions performed by human beings.

  16. Perspectives on spirituality at the end of life: a meta-summary.

    Science.gov (United States)

    Williams, Anna-Leila

    2006-12-01

    A meta-summary of the qualitative literature on spiritual perspectives of adults who are at the end of life was undertaken to summarily analyze the research to date and identify areas for future research on the relationship of spirituality with physical, functional, and psychosocial outcomes in the health care setting. Included were all English language reports from 1966 to the present catalogued in PubMed, Medline, PsycInfo, and CINAHL, identifiable as qualitative investigations of the spiritual perspectives of adults at the end of life. The final sample includes 11 articles, collectively representing data from 217 adults. The preponderance of participants had a diagnosis of cancer; those with HIV/AIDS, cardiovascular disease, and ALS were also represented. Approximately half the studies were conducted in the United States; others were performed in Australia, Finland, Scotland, and Taiwan. Following a process of theme extraction and abstraction, thematic patterns emerged and effect sizes were calculated. A spectrum of spirituality at the end of life encompassing spiritual despair (alienation, loss of self, dissonance), spiritual work (forgiveness, self-exploration, search for balance), and spiritual well-being (connection, self-actualization, consonance) emerged. The findings from this meta-summary confirm the fundamental importance of spirituality at the end of life and highlight the shifts in spiritual health that are possible when a terminally ill person is able to do the necessary spiritual work. Existing end-of-life frameworks neglect spiritual work and consequently may be deficient in guiding research. The area of spiritual work is fertile ground for further investigation, especially interventions aimed at improving spiritual health and general quality of life among the dying.

  17. End-of-life content in treatment guidelines for life-limiting diseases.

    Science.gov (United States)

    Mast, Kimberly R; Salama, Marybeth; Silverman, Gabriel K; Arnold, Robert M

    2004-12-01

    Clinical guidelines are systematically developed statements that influence medical practice, education, and funding. Guidelines represent the consensus of leaders, often based on systematic reviews of the literature, regarding the "state of the art." To assess the degree to which end-of-life care is integrated into nationally developed guidelines for chronic, noncurable, life-limiting diseases. Four compendia were reviewed: The Healthcare Standards Directory ECRI, 2001; the Clinical Practice Guidelines Directory, 2000 edition; the National Guidelines Clearinghouse, (guideline.gov); and the National Library of Medicine's MEDLINE database on the OVID platform for guidelines on nine chronic diseases (chronic obstructive pulmonary disease, end-stage liver disease, amyotrophic lateral sclerosis, congestive heart failure, dementia, cerebrovascular accident, end-stage renal disease, cancer [breast, colon, prostate, lung], and human immunodeficiency virus). They were assessed by two reviewers for end-of-life content in 15 domains (e.g., epidemiology of death, symptom management, spiritual, family roles, and settings of care), the presence of eight specific terms dealing with palliative care, integration of palliative care information into the guideline, and descriptive variables. Not available. Each guideline was examined and rated on a 0-2 scale (0, absent content; 1, minimal content; 2, helpful content) using 15 end-of-life content domains. Scores from domains were summed and classified into 3 categories: 4 or less, minimal; 5-12, moderate; and more than 12, significant content. Ten percent of guidelines had significant palliative care content, 64% had minimal content, and 26% had moderate content. The least addressed domains dealt with spirituality, ethics, advocacy and family roles. When guidelines that dealt solely with prevention, acute exacerbations or complications of an illness, or specific treatment modalities were excluded 28% and 16% of these general guidelines

  18. End of Life: Suicide Grief

    Science.gov (United States)

    Healthy Lifestyle End of life A loved one's suicide can be emotionally devastating. Use healthy coping strategies — ... Clinic Staff When a loved one dies by suicide, overwhelming emotions can leave you reeling. Your grief ...

  19. 47 CFR 25.283 - End-of-life disposal.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 2 2010-10-01 2010-10-01 false End-of-life disposal. 25.283 Section 25.283 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES SATELLITE COMMUNICATIONS... satellite orbit under this part shall be relocated, at the end of its useful life, barring catastrophic...

  20. RERTR-12 Insertion 1 Irradiation Summary Report

    International Nuclear Information System (INIS)

    Perez, D.M.; Lillo, M.A.; Chang, G.S.; Woolstenhulme, N.E.; Roth, G.A.; Wachs, D.M.

    2012-01-01

    The Reduced Enrichment for Research and Test Reactor (RERTR) experiment RERTR-12 was designed to provide comprehensive information on the performance of uranium-molybdenum (U-Mo) based monolithic fuels for research reactor applications. RERTR-12 insertion 1 includes the capsules irradiated during the first two irradiation cycles. These capsules include Z, X1, X2 and X3 capsules. The following report summarizes the life of the RERTR-12 insertion 1 experiment through end of irradiation, including as-run neutronic analysis results, thermal analysis results and hydraulic testing results.

  1. RERTR-12 Insertion 2 Irradiation Summary Report

    International Nuclear Information System (INIS)

    Perez, D.M.; Chang, G.S.; Wachs, D.M.; Roth, G.A.; Woolstenhulme, N.E.

    2012-01-01

    The Reduced Enrichment for Research and Test Reactor (RERTR) experiment RERTR-12 was designed to provide comprehensive information on the performance of uranium-molybdenum (U-Mo) based monolithic fuels for research reactor applications.1 RERTR-12 insertion 2 includes the capsules irradiated during the last three irradiation cycles. These capsules include Z, Y1, Y2 and Y3 type capsules. The following report summarizes the life of the RERTR-12 insertion 2 experiment through end of irradiation, including as-run neutronic analysis results, thermal analysis results and hydraulic testing results.

  2. Death ends a life, not a relationship

    DEFF Research Database (Denmark)

    Christensen, Dorthe Refslund; Sandvik, Kjetil

    2014-01-01

    In the final chapter, “Death Ends a Life, not a Relationship: objects as media on children’s graves”, Dorthe Refslund Christensen and Kjetil Sandvik investigate the relational affordances offered by objects as media in practices of death and commemoration on children’s graves. The authors argue t...... – mirrored in online memorial sites – that transform the dead child into a being with whom an altered relationship may be built, maintained and developed so that the bereaved can, eventually, integrate the dead into his or her ongoing life.......In the final chapter, “Death Ends a Life, not a Relationship: objects as media on children’s graves”, Dorthe Refslund Christensen and Kjetil Sandvik investigate the relational affordances offered by objects as media in practices of death and commemoration on children’s graves. The authors argue...... that when it comes to bereavement practices as they materialize on children’s graves, it is the accommodation and decoration of the grave itself that function as media with their variety of physical objects as ritual and relational tools for communication. The bereaved perform practices on children’s graves...

  3. 'End of life could be on any ward really': A qualitative study of hospital volunteers' end-of-life care training needs and learning preferences.

    Science.gov (United States)

    Brighton, Lisa Jane; Koffman, Jonathan; Robinson, Vicky; Khan, Shaheen A; George, Rob; Burman, Rachel; Selman, Lucy Ellen

    2017-10-01

    Over half of all deaths in Europe occur in hospital, a location associated with many complaints. Initiatives to improve inpatient end-of-life care are therefore a priority. In England, over 78,000 volunteers provide a potentially cost-effective resource to hospitals. Many work with people who are dying and their families, yet little is known about their training in end-of-life care. To explore hospital volunteers' end-of-life care training needs and learning preferences, and the acceptability of training evaluation methods. Qualitative focus groups. Volunteers from a large teaching hospital were purposively sampled. Five focus groups were conducted with 25 hospital volunteers (aged 19-80 years). Four themes emerged as follows: preparation for the volunteering role, training needs, training preferences and evaluation preferences. Many described encounters with patients with life-threatening illness and their families. Perceived training needs in end-of-life care included communication skills, grief and bereavement, spiritual diversity, common symptoms, and self-care. Volunteers valued learning from peers and end-of-life care specialists using interactive teaching methods including real-case examples and role plays. A chance to 'refresh' training at a later date was suggested to enhance learning. Evaluation through self-reports or observations were acceptable, but ratings by patients, families and staff were thought to be pragmatically unsuitable owing to sporadic contact with each. Gaps in end-of-life care training for hospital volunteers indicate scope to maximise on this resource. This evidence will inform development of training and evaluations which could better enable volunteers to make positive, cost-effective contributions to end-of-life care in hospitals.

  4. Pleurodesis for effusions in pediatric oncology patients at end of life

    International Nuclear Information System (INIS)

    Hoffer, Fredric A.; Hancock, Michael L.; Rai, Shesh N.; Hinds, Pamela S.; Oigbokie, Nikita; Rao, Bhaskar

    2007-01-01

    Pleurodesis for end-of-life care has been used in adults for decades, but little is known about the usefulness of this technique in improving the quality of care for pediatric patients. To assess whether intractable pleural effusions in pediatric oncology patients at end of life could be sufficiently relieved by pleurodesis. Eleven pleurodeses were performed with doxycycline in seven pediatric cancer patients (age 3-21 years) with intractable pleural effusions at the end of life. Five patients had unilateral pleurodeses and two had a unilateral followed by bilateral pleurodeses. Respiratory rates decreased in all seven patients (P = 0.016) and aeration improved significantly after chest tube placement (P = 0.033). The chest tubes were placed a median of 1 day before pleurodesis. Eight of nine chest tubes (89%) were removed before discharge at a median of 3 days after pleurodesis. Pain secondary to the pleurodesis lasted 1 day or less. Improvement in the respiratory rate remained after pleurodesis and chest tube removal (P = 0.031). Five of seven patients (70%) were able to leave the hospital to return home. The five patients discharged lived 10 to 49 days (median 19 days) after discharge. Pediatric oncology patients with intractable effusions at end of life can have respiratory benefit from pleurodeses and, as a result, are more likely to return home for terminal care. (orig.)

  5. Pleurodesis for effusions in pediatric oncology patients at end of life

    Energy Technology Data Exchange (ETDEWEB)

    Hoffer, Fredric A. [St. Jude Children' s Research Hospital, Department of Radiological Sciences, Memphis, TN (United States); Children' s Hospital and Regional Medical Center, Department of Radiology, R-5438, Seattle, WA (United States); Hancock, Michael L.; Rai, Shesh N. [St. Jude Children' s Research Hospital, Department of Biostatistics, Memphis, TN (United States); Hinds, Pamela S. [St. Jude Children' s Research Hospital, Division of Nursing Research, Memphis, TN (United States); Oigbokie, Nikita [St. Jude Children' s Research Hospital, Department of Radiological Sciences, Memphis, TN (United States); Rao, Bhaskar [St. Jude Children' s Research Hospital, Department of Surgery, Memphis, TN (United States)

    2007-03-15

    Pleurodesis for end-of-life care has been used in adults for decades, but little is known about the usefulness of this technique in improving the quality of care for pediatric patients. To assess whether intractable pleural effusions in pediatric oncology patients at end of life could be sufficiently relieved by pleurodesis. Eleven pleurodeses were performed with doxycycline in seven pediatric cancer patients (age 3-21 years) with intractable pleural effusions at the end of life. Five patients had unilateral pleurodeses and two had a unilateral followed by bilateral pleurodeses. Respiratory rates decreased in all seven patients (P = 0.016) and aeration improved significantly after chest tube placement (P = 0.033). The chest tubes were placed a median of 1 day before pleurodesis. Eight of nine chest tubes (89%) were removed before discharge at a median of 3 days after pleurodesis. Pain secondary to the pleurodesis lasted 1 day or less. Improvement in the respiratory rate remained after pleurodesis and chest tube removal (P = 0.031). Five of seven patients (70%) were able to leave the hospital to return home. The five patients discharged lived 10 to 49 days (median 19 days) after discharge. Pediatric oncology patients with intractable effusions at end of life can have respiratory benefit from pleurodeses and, as a result, are more likely to return home for terminal care. (orig.)

  6. Life cycle and nano-products: end-of-life assessment

    International Nuclear Information System (INIS)

    Asmatulu, Eylem; Twomey, Janet; Overcash, Michael

    2012-01-01

    Understanding environmental impacts of nanomaterials necessitates analyzing the life cycle profile. The initial emphasis of nanomaterial life cycle studies has been on the environmental and health effects of nanoproducts during the production and usage stages. Analyzing the end-of-life (eol) stage of nanomaterials is also critical because significant impacts or benefits for the environment may arise at that particular stage. In this article, the Woodrow Wilson Center’s Project on Emerging Nanotechnologies (PEN) Consumer Products Inventory (CPI) model was used, which contains a relatively large and complete nanoproduct list (1,014) as of 2010. The consumer products have wide range of applications, such as clothing, sports goods, personal care products, medicine, as well as contributing to faster cars and planes, more powerful computers and satellites, better micro and nanochips, and long-lasting batteries. In order to understand the eol cycle concept, we allocated 1,014 nanoproducts into the nine end-of-life categories (e.g., recyclability, ingestion, absorption by skin/public sewer, public sewer, burning/landfill, landfill, air release, air release/public sewer, and other) based on probable final destinations of the nanoproducts. This article highlights the results of this preliminary assessment of end-of-life stage of nanoproducts. The largest potential eol fate was found to be recyclability, however little literature appears to have evolved around nanoproduct recycling. At lower frequency is dermal and ingestion human uptake and then landfill. Release to water and air are much lower potential eol fates for current nanoproducts. In addition, an analysis of nano-product categories with the largest number of products listed indicated that clothes, followed by dermal-related products and then sports equipment were the most represented in the PEN CPI (http

  7. Life cycle and nano-products: end-of-life assessment

    Energy Technology Data Exchange (ETDEWEB)

    Asmatulu, Eylem; Twomey, Janet; Overcash, Michael, E-mail: mrovercash@earthlink.net [Wichita State University, Department of Industrial and Manufacturing Engineering (United States)

    2012-03-15

    Understanding environmental impacts of nanomaterials necessitates analyzing the life cycle profile. The initial emphasis of nanomaterial life cycle studies has been on the environmental and health effects of nanoproducts during the production and usage stages. Analyzing the end-of-life (eol) stage of nanomaterials is also critical because significant impacts or benefits for the environment may arise at that particular stage. In this article, the Woodrow Wilson Center's Project on Emerging Nanotechnologies (PEN) Consumer Products Inventory (CPI) model was used, which contains a relatively large and complete nanoproduct list (1,014) as of 2010. The consumer products have wide range of applications, such as clothing, sports goods, personal care products, medicine, as well as contributing to faster cars and planes, more powerful computers and satellites, better micro and nanochips, and long-lasting batteries. In order to understand the eol cycle concept, we allocated 1,014 nanoproducts into the nine end-of-life categories (e.g., recyclability, ingestion, absorption by skin/public sewer, public sewer, burning/landfill, landfill, air release, air release/public sewer, and other) based on probable final destinations of the nanoproducts. This article highlights the results of this preliminary assessment of end-of-life stage of nanoproducts. The largest potential eol fate was found to be recyclability, however little literature appears to have evolved around nanoproduct recycling. At lower frequency is dermal and ingestion human uptake and then landfill. Release to water and air are much lower potential eol fates for current nanoproducts. In addition, an analysis of nano-product categories with the largest number of products listed indicated that clothes, followed by dermal-related products and then sports equipment were the most represented in the PEN CPI (http

  8. Network modeling for reverse flows of end-of-life vehicles.

    Science.gov (United States)

    Ene, Seval; Öztürk, Nursel

    2015-04-01

    Product recovery operations are of critical importance for the automotive industry in complying with environmental regulations concerning end-of-life products management. Manufacturers must take responsibility for their products over the entire life cycle. In this context, there is a need for network design methods for effectively managing recovery operations and waste. The purpose of this study is to develop a mathematical programming model for managing reverse flows in end-of-life vehicles' recovery network. A reverse flow is the collection of used products from consumers and the transportation of these products for the purpose of recycling, reuse or disposal. The proposed model includes all operations in a product recovery and waste management network for used vehicles and reuse for vehicle parts such as collection, disassembly, refurbishing, processing (shredding), recycling, disposal and reuse of vehicle parts. The scope of the network model is to determine the numbers and locations of facilities in the network and the material flows between these facilities. The results show the performance of the model and its applicability for use in the planning of recovery operations in the automotive industry. The main objective of recovery and waste management is to maximize revenue and minimize pollution in end-of-life product operations. This study shows that with an accurate model, these activities may provide economic benefits and incentives in addition to protecting the environment. Copyright © 2015 Elsevier Ltd. All rights reserved.

  9. End of life and life after death - issues to be addressed

    Directory of Open Access Journals (Sweden)

    Poojar Sridhar

    2012-01-01

    Full Text Available Being an Oncologist, I have seen many patients suffering from cancer. It pains a lot looking at them fighting the battle of life, though knowing that they would lose miserably and surrender meekly as majority of the patients report to the hospital at an advanced stage of disease and only palliative care may be the option. There is an urgent need to create - Cancer Awareness in the villages and also about the end of life care in all terminally ill patients. 20 patients in the terminal phase were questioned regarding end of life care. The common questions they asked are, why has God punished me like this? Why me on earth? Should I die so early? Why should I leave my near and dear ones and go far away, from the point of no return? Do I ever see them again? With deep sorrow and sigh, they suffer till the last breath, having the feeling of insecurity as what would happen to their dear ones. In the terminal phase, the patients wishes must be respected and their needs must be fulfilled. The health care professionals should plan an appropriate care for each patient. Most of them feel that the best place to be in end of life is the home. Research has shown that Hospice care may improve the quality of life of a patient who is dying and of the patient′s family. Communication about end of life care and decision making during the final moments of a person′s life are very important. The patients suffering are mainly due to the physical, psychological, social and spiritual issues. Death of a terminally ill patient should never be a sudden loss. All healthcare professionals, Social workers and Non-Governmental Organisations must install the life after death of the person, who has struggled for every breath and assure that he/she shall rest in peace and shall smile seeing their near and dear ones living with dignity and pride in the society. Ultimately, the patient must have dignity in dying.

  10. Assessment of end-of-life design in solid-state lighting

    Science.gov (United States)

    Dzombak, Rachel; Padon, Jack; Salsbury, Josh; Dillon, Heather

    2017-08-01

    Consumers in the US market and across the globe are beginning to widely adopt light emitting diode (LED) lighting products while the technology continues to undergo significant changes. While LED products are evolving to consume less energy, they are also more complex than traditional lighting products with a higher number of parts and a larger number of electronic components. Enthusiasm around the efficiency and long expected life span of LED lighting products is valid, but research to optimize product characteristics and design is needed. This study seeks to address that gap by characterizing LED lighting products' suitability for end of life (EOL) recycling and disposal. The authors disassembled and assessed 17 different lighting products to understand how designs differ between brands and manufacture year. Products were evaluated based on six parameters to quantify the design. The analysis indicates that while the efficiency of LED products has improved dramatically in the recent past, product designers and manufacturers could incorporate design strategies to improve environmental performance of lighting products at end-of-life.

  11. Disinfestation and vase-life extension of orchids by irradiation

    International Nuclear Information System (INIS)

    Piriyathamrong, S.; Chouvalitvongporn, P.; Sudathit, B.

    1985-01-01

    Studies on disinfestation and vase-life extension of orchids by irradiation were conducted to determine whether gamma-radiation can be effectively used to eliminate thrips and prolong the vase life of cut flowers. Cut flowers of Dendrobium Pompadour were subjected to Co-60 irradiation at 0, 50, l00, l50, and 200 krd doses 5 to 6 hours after picking. The flowers were separated into two groups. The first group was used to count the number of thrips. The other group was held at controlled room temperature (20 0 C and 80 percent RH) for 36 hours before being unpacked and placed in water. The results of two experiments illustrated that at 2 days after irradiation at l50 and 200 krad no thrips were found on the flowers, whereas on flowers untreated and those treated at 50 and l00 krad, a higher number of thrips were detected. As far as the vase life is concerned, treated flowers have a shorter life. Irradiation at 0, 50, l00, l05, and 200 krad doses resulted in average vase life of l8.75, l2.l5, l0.85, 8.85, and 6.20 days, respectively, in the first test and l4.60, l0.05, 8.75, 7.35, and 6.85, respectively, in the second test. Increased doses of radiation caused flowers to wilt and drop off within a few days. Further study is being conducted

  12. Evaluation of different end-of-life management alternatives for used natural cork stoppers through life cycle assessment.

    Science.gov (United States)

    Demertzi, Martha; Dias, Ana Cláudia; Matos, Arlindo; Arroja, Luís Manuel

    2015-12-01

    An important aspect of sustainable development is the implementation of effective and sustainable waste management strategies. The present study focuses on a Life Cycle Assessment (LCA) approach to different waste management strategies for natural cork stoppers, namely incineration at a municipal solid waste incinerator, landfilling in a sanitary landfill, and recycling. In the literature, there are no LCA studies analyzing in detail the end-of-life stage of natural cork stoppers as well as other cork products. In addition, cork is usually treated as wood at the end-of-life stage. Thus, the outcome of this study can provide an important insight into this matter. The results showed that different management alternatives, namely incineration and recycling, could be chosen depending on the impact category considered. The former alternative presented the best environmental results in the impact categories of climate change, ozone depletion and acidification, while the latter for photochemical ozone formation and mineral and fossil resource depletion. The landfilling alternative did not present the best environmental performance in any of the impact categories. However, when the biogenic carbon dioxide emission was assessed for the climate change category, the landfilling alternative was found to be the most effective since most of the biogenic carbon would be permanently stored in the cork products and not emitted into the atmosphere. A sensitivity analysis was performed and the results showed that there are various parameters that can significantly influence the results (e.g., carbon content in cork and decay rate of cork in the landfill). Thus, LCA studies should include a detailed description concerning their assumptions when the end-of-life stage is included in the boundaries since they can influence the results, and furthermore, to facilitate the comparison of different end-of-life scenarios. The present study and the obtained results could be useful for the

  13. The new challenges of end-of-life tyres management systems: A Spanish case study

    Energy Technology Data Exchange (ETDEWEB)

    Uruburu, Ángel, E-mail: angel.uruburu@upm.es [Industrial Management Department, Technical University of Madrid, C/José Gutiérrez Abascal, 2, 28006 Madrid (Spain); Ponce-Cueto, Eva, E-mail: eva.ponce@upm.es [Industrial Management Department, Technical University of Madrid, C/José Gutiérrez Abascal, 2, 28006 Madrid (Spain); Center for Transportation and Logistics, Massachusetts Institute of Technology, Cambridge, MA (United States); Cobo-Benita, José Ramón, E-mail: joseramon.cobo@upm.es [Industrial Management Department, Technical University of Madrid, C/José Gutiérrez Abascal, 2, 28006 Madrid (Spain); Ordieres-Meré, Joaquín, E-mail: j.ordieres@upm.es [Industrial Management Department, Technical University of Madrid, C/José Gutiérrez Abascal, 2, 28006 Madrid (Spain)

    2013-03-15

    Highlights: ► Impact of the implementation of the Directive 2008/98/EC in Spain for end-of-life tyres. ► Characterization of the reverse supply chain for collecting, recovering, and treating end-of-life tyres. ► Identification of challenges to be coped and issues to be covered. ► Potential new applications for end-of-life tyres and development of new management related strategies. - Abstract: Directive 2008/98/EC released by the European Union represents a significant step forward in all relevant aspects of waste management. Under the already established, extended produced responsibility (EPR) principle, new policies have been enunciated to continuously achieve better overall environmental performance of key products throughout their life phases. This paper discusses how the directive is being articulated in Spain by the main integrated management system (IMS) for end-of-life (EOL) tyres since its creation in 2006. Focusing on the IMS technological, economic and legal aspects, the study provides a global perspective and evaluation of how the IMS is facing the current issues to resolve, the new challenges that have appeared and the management vision for the coming years.

  14. The new challenges of end-of-life tyres management systems: A Spanish case study

    International Nuclear Information System (INIS)

    Uruburu, Ángel; Ponce-Cueto, Eva; Cobo-Benita, José Ramón; Ordieres-Meré, Joaquín

    2013-01-01

    Highlights: ► Impact of the implementation of the Directive 2008/98/EC in Spain for end-of-life tyres. ► Characterization of the reverse supply chain for collecting, recovering, and treating end-of-life tyres. ► Identification of challenges to be coped and issues to be covered. ► Potential new applications for end-of-life tyres and development of new management related strategies. - Abstract: Directive 2008/98/EC released by the European Union represents a significant step forward in all relevant aspects of waste management. Under the already established, extended produced responsibility (EPR) principle, new policies have been enunciated to continuously achieve better overall environmental performance of key products throughout their life phases. This paper discusses how the directive is being articulated in Spain by the main integrated management system (IMS) for end-of-life (EOL) tyres since its creation in 2006. Focusing on the IMS technological, economic and legal aspects, the study provides a global perspective and evaluation of how the IMS is facing the current issues to resolve, the new challenges that have appeared and the management vision for the coming years

  15. End-of-Life Decisions and Advanced Old Age

    Directory of Open Access Journals (Sweden)

    Stoyles

    2014-07-01

    Full Text Available Despite the fact that most people die in advanced old age, little attention is given to cases involving older people in debates about the moral and legal dimensions of end-of-life decision making. The purpose of this paper is to establish some of the ways our discussions should change as we pay attention to important factors influencing end-of-life decisions for people in advanced old age. Focusing on the prevalence of comorbidities and the likelihood that people in advanced old age will experience an extended period of declining function before death, I argue that our debates should be expanded to include greater consideration of how we want to live in the final stages of life. With this, I am arguing against the tendency to think that “end-of-life” decision making concerns only making decisions about when and how it is appropriate to terminate a person’s life. I argue, further, that we should move away from the medicalization of dying.

  16. End of life could be on any ward really’: A qualitative study of hospital volunteers’ end-of-life care training needs and learning preferences

    Science.gov (United States)

    Brighton, Lisa Jane; Koffman, Jonathan; Robinson, Vicky; Khan, Shaheen A; George, Rob; Burman, Rachel; Selman, Lucy Ellen

    2017-01-01

    Background: Over half of all deaths in Europe occur in hospital, a location associated with many complaints. Initiatives to improve inpatient end-of-life care are therefore a priority. In England, over 78,000 volunteers provide a potentially cost-effective resource to hospitals. Many work with people who are dying and their families, yet little is known about their training in end-of-life care. Aims: To explore hospital volunteers’ end-of-life care training needs and learning preferences, and the acceptability of training evaluation methods. Design: Qualitative focus groups. Setting/participants: Volunteers from a large teaching hospital were purposively sampled. Results: Five focus groups were conducted with 25 hospital volunteers (aged 19–80 years). Four themes emerged as follows: preparation for the volunteering role, training needs, training preferences and evaluation preferences. Many described encounters with patients with life-threatening illness and their families. Perceived training needs in end-of-life care included communication skills, grief and bereavement, spiritual diversity, common symptoms, and self-care. Volunteers valued learning from peers and end-of-life care specialists using interactive teaching methods including real-case examples and role plays. A chance to ‘refresh’ training at a later date was suggested to enhance learning. Evaluation through self-reports or observations were acceptable, but ratings by patients, families and staff were thought to be pragmatically unsuitable owing to sporadic contact with each. Conclusion: Gaps in end-of-life care training for hospital volunteers indicate scope to maximise on this resource. This evidence will inform development of training and evaluations which could better enable volunteers to make positive, cost-effective contributions to end-of-life care in hospitals. PMID:28056642

  17. [End-of-life decisions: results of the expert-validated questionnaire].

    Science.gov (United States)

    Ortiz-Gonçalves, Belén; Albarrán Juan, Elena; Labajo González, Elena; Santiago-Sáez, Andrés; Perea-Pérez, Bernardo

    2018-02-02

    To assess the attitudes and knowledge in the life's end about palliative care, advance directives, psychological-physical care, medically assisted suicide and spiritual accompaniment. A cross-sectional study performed in the population at primary health care center of the Autonomous Region of Madrid (Spain). It participated 425 selected people that a simple random was applied in the consultation sheets of health professionals. They analyzed 42 variables of self-administered questionnaire. The surveyed population of Madrid displayed the following characteristics: university studies 58%, 51-70 years 47%, married 60%, and women 61%. 91% would like to decide about their care at life's end. 58% of respondents are aware of palliative care and 53% would request spiritual accompaniment. They know advance directives (50%) but have not made the document. 54% are in favor of legalizing the euthanasia and 42% the assisted suicide. Madrid's people state they would like to decide what care they will receive at life's end and request spiritual accompaniment. Outstanding advocates of euthanasia against assisted suicide. They would like to receive palliative care and complete advance directives documents. To draw comparisons within the population, thereby increasing awareness about social health care resources in Autonomous Region of Madrid, surveys should be conducted in different primary health care centers areas of Madrid. Copyright © 2018 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. Three factors critical for end-of-life care.

    Science.gov (United States)

    Franey, S G

    1996-01-01

    Appropriate care of persons with life-threatening illnesses requires a different, perhaps higher level of response from organized healthcare than has been typical in the past. This involves three critical components: Leaders must be committed, visible advocates of high-quality end-of-life care. This enables them to plan changes, deploy resources, and integrate this commitment throughout the organization's strategic plan. Ensuring appropriate care of the dying requires adequate human and financial resources. First, the organization must fully identify the educational and service needs of patients, families, and care givers experiencing life-threatening illnesses. The organization must work well with other community-based organizations to address identified needs. Senior managers can improve care by personally commissioning teams, acknowledging success, and rewarding performance. Finally, organizational goals, strategies, and performance objectives must be shaped by a commitment to ensure appropriate care of the dying. Our commitment to the dying must be based on our values. An organizational "statement of rights and responsibilities" is one way of providing a visible expression of the mission, core values, and mutual responsibilities among care givers and patients, residents, HMO members, and clients.

  19. The enactment stage of end-of-life decision-making for children.

    Science.gov (United States)

    Sullivan, Jane Elizabeth; Gillam, Lynn Heather; Monagle, Paul Terence

    2018-01-11

    Typically pediatric end-of-life decision-making studies have examined the decision-making process, factors, and doctors' and parents' roles. Less attention has focussed on what happens after an end-of-life decision is made; that is, decision enactment and its outcome. This study explored the views and experiences of bereaved parents in end-of-life decision-making for their child. Findings reported relate to parents' experiences of acting on their decision. It is argued that this is one significant stage of the decision-making process. A qualitative methodology was used. Semi-structured interviews were conducted with bereaved parents, who had discussed end-of-life decisions for their child who had a life-limiting condition and who had died. Data were thematically analysed. Twenty-five bereaved parents participated. Findings indicate that, despite differences in context, including the child's condition and age, end-of-life decision-making did not end when an end-of-life decision was made. Enacting the decision was the next stage in a process. Time intervals between stages and enactment pathways varied, but the enactment was always distinguishable as a separate stage. Decision enactment involved making further decisions - parents needed to discern the appropriate time to implement their decision to withdraw or withhold life-sustaining medical treatment. Unexpected events, including other people's actions, impacted on parents enacting their decision in the way they had planned. Several parents had to re-implement decisions when their child recovered from serious health issues without medical intervention. Significance of results A novel, critical finding was that parents experienced end-of-life decision-making as a sequence of interconnected stages, the final stage being enactment. The enactment stage involved further decision-making. End-of-life decision-making is better understood as a process rather than a discrete once-off event. The enactment stage has particular

  20. Fatigue performance of copper and copper alloys before and after irradiation with fission neutrons

    International Nuclear Information System (INIS)

    Singh, B.N.; Toft, P.; Stubbins, J.F.

    1997-05-01

    The fatigue performance of pure copper of the oxygen free, high conductivity (OFHC) grade and two copper alloys (CuCrZr and CuAl-25) was investigated. Mechanical testing and microstructural analysis were carried out to establish the fatigue life of these materials in the unirradiated and irradiated states. The present report provides the first information on the ability of these copper alloys to perform under cyclic loading conditions when they have undergone significant irradiation exposure. Fatigue specimens of OFHC-Cu, CuCrZr and CuAl-25 were irradiated with fission neutrons in the DR-3 reactor at Risoe with a flux of ∼2.5 x 10 17 n/m 2 s (E > 1 MeV) to fluence levels of 1.5 - 2.5 x 10 24 n/m 2 s (E > 1 MeV) at ∼47 and 100 deg. C. Specimens irradiated at 47 deg. C were fatigue tested at 22 deg. C, whereas those irradiated at 100 deg. C were tested at the irradiation temperature. The major conclusion of the present work is that although irradiation causes significant hardening of copper and copper alloys, it does not appear to be a problem for the fatigue life of these materials. In fact, the present experimental results clearly demonstrate that the fatigue performance of the irradiated CuAl-25 alloy is considerably better in the irradiated than that in the unirradiated state tested both at 22 and 100 deg. C. This improvement, however, is not so significant in the case of the irradiated OFHC-copper and CuCrZr alloy tested at 22 deg. C. These conclusions are supported by the microstructural observations and cyclic hardening experiments. (au) 4 tabs., 26 ills., 10 refs

  1. TU-D-201-00: Use of End-Of-Life Brachytherapy Devices

    International Nuclear Information System (INIS)

    2015-01-01

    Brachytherapy devices and software are designed to last for a certain period of time. Due to a number of considerations, such as material factors, wear-and-tear, backwards compatibility, and others, they all reach a date when they are no longer supported by the manufacturer. Most of these products have a limited duration for their use, and the information is provided to the user at time of purchase. Because of issues or concerns determined by the manufacturer, certain products are retired sooner than the anticipated date, and the user is immediately notified. In these situations, the institution is facing some difficult choices: remove these products from the clinic or perform tests and continue their usage. Both of these choices come with a financial burden: replacing the product or assuming a potential medicolegal liability. This session will provide attendees with the knowledge and tools to make better decisions when facing these issues. Learning Objectives: Understand the meaning ofend-of-life or “life expectancy” for brachytherapy devices and software Review items (devices and software) affected by “end-of-life” restrictions Learn how to effectively formulate “end-of-life” policies at your institution Learn about possible implications ofend-of-life” policy Review other possible approaches to “end-of-life” issue

  2. Alloy development for irradiation performance: program strategy

    International Nuclear Information System (INIS)

    Bloom, E.E.; Stiegler, J.O.; Wiffen, F.W.; Dalder, E.N.C.; Reuther, T.C.; Gold, R.E.; Holmes, J.J.; Kummer, D.L.; Nolfi, F.V.

    1978-01-01

    The objective of the Alloy Development for Irradiation Performance Program is the development of structural materials for use in the first wall and blanket region of fusion reactors. The goal of the program is a material that will survive an exposure of 40 MWyr/m 2 at a temperature which will allow use of a liquid-H 2 O heat transport system. Although the ultimate aim of the program is development of materials for commercial reactors by the end of this century, activities are organized to provide materials data for the relatively low performance interim machines that will precede commercial reactors

  3. Physician Communication in Pediatric End-of-Life Care: A Simulation Study.

    Science.gov (United States)

    Bateman, Lori Brand; Tofil, Nancy M; White, Marjorie Lee; Dure, Leon S; Clair, Jeffrey Michael; Needham, Belinda L

    2016-12-01

    The objective of this exploratory study is to describe communication between physicians and the actor parent of a standardized 8-year-old patient in respiratory distress who was nearing the end of life. Thirteen pediatric emergency medicine and pediatric critical care fellows and attendings participated in a high-fidelity simulation to assess physician communication with an actor-parent. Fifteen percent of the participants decided not to initiate life-sustaining technology (intubation), and 23% of participants offered alternatives to life-sustaining care, such as comfort measures. Although 92% of the participants initiated an end-of-life conversation, the quality of that discussion varied widely. Findings indicate that effective physician-parent communication may not consistently occur in cases involving the treatment of pediatric patients at the end of life in emergency and critical care units. The findings in this study, particularly that physician-parent end-of-life communication is often unclear and that alternatives to life-sustaining technology are often not offered, suggest that physicians need more training in both communication and end-of-life care. © The Author(s) 2015.

  4. Preliminary study of the effect of gamma irradiation on the vase life of Iridaceae Hollandica

    Science.gov (United States)

    Dennis, S.; Fisher, L.; Ware, C.; Giraldo, C. H. C.

    2018-03-01

    The vase life of irises (Iridaceae Hollandica 'Telstar') was determined before and after gamma irradiation in the Missouri S&T Research Reactor (MSTR) at 20, 80, 457, 1060, and 1473 Gy. It was determined that vase life improves by as much as 7% for the 20 Gy irradiation. At about 100 Gy the vase life is comparable to non-irradiated flowers. Unfortunately pest control requires 200-300 Gy. At 457 Gy the vase life is about 15% shorter, and it gets worse at higher doses (30% lower vase life at 1 kGy). Gamma irradiation of irises can be a viable method of pest control, but the irradiation dose should be kept as low as possible while still achieving the phytosanitary objectives depending on the type of pest to control.

  5. Wind Turbine Blades: An End of Life Perspective

    DEFF Research Database (Denmark)

    Beauson, Justine; Brøndsted, Povl

    2016-01-01

    In 2016, the first offshore windfarm constructed in the world—located in Denmark, near Ravnsborg—is turning 25 years old, and will soon be decommissioned. After decommissioning, most of the material of the turbine can be recycled; only the composite materials found in the blades represent...... a challenge. This part looks at end of life solutions for this material. Wind turbine blade structure and material are described. The ends of life solutions existing and under development are detailed....

  6. Personality trait development at the end of life: Antecedents and correlates of mean-level trajectories.

    Science.gov (United States)

    Wagner, Jenny; Ram, Nilam; Smith, Jacqui; Gerstorf, Denis

    2016-09-01

    Empirical evidence over the past 20 years has documented that key aspects of personality traits change during adulthood. However, it is essentially an open question whether and how traits change at the very end of life and what role health, cognitive performance, perceived control, and social factors play in those changes. To examine these questions, we applied growth models to 13-year longitudinal data obtained from now-deceased participants in the Berlin Aging Study (N = 463; age at baseline M = 85.9 years, SD = 8.4; 51% men). Results revealed that neuroticism, on average, increases (about 0.3 SD in the last 10 years) and that this increase becomes even steeper at the end of life. In contrast, extraversion and openness decline rather steadily at the end of life (about -0.5 SD in the last 10 years). Additionally, poor health manifested as a risk factor for declines in extraversion and openness late in life but not neuroticism. Similar to earlier phases of life, better cognitive performance related to more openness. More loneliness was associated with higher neuroticism, whereas more social activity was associated with higher levels of extraversion and openness. Intriguing additional insights indicated that more personal control was associated with higher levels of extraversion and openness, whereas the feeling that one's life is controlled by others was associated with higher neuroticism but also with higher openness closer to death. We discuss potential pathways by which health, cognitive performance, control, and social inclusion resources and risk factors affect personality development late in life. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  7. TU-D-201-03: Proposed Solutions to End-Of-Life Issue

    International Nuclear Information System (INIS)

    Ouhib, Z.

    2015-01-01

    Brachytherapy devices and software are designed to last for a certain period of time. Due to a number of considerations, such as material factors, wear-and-tear, backwards compatibility, and others, they all reach a date when they are no longer supported by the manufacturer. Most of these products have a limited duration for their use, and the information is provided to the user at time of purchase. Because of issues or concerns determined by the manufacturer, certain products are retired sooner than the anticipated date, and the user is immediately notified. In these situations, the institution is facing some difficult choices: remove these products from the clinic or perform tests and continue their usage. Both of these choices come with a financial burden: replacing the product or assuming a potential medicolegal liability. This session will provide attendees with the knowledge and tools to make better decisions when facing these issues. Learning Objectives: Understand the meaning ofend-of-life or “life expectancy” for brachytherapy devices and software Review items (devices and software) affected by “end-of-life” restrictions Learn how to effectively formulate “end-of-life” policies at your institution Learn about possible implications ofend-of-life” policy Review other possible approaches to “end-of-life” issue

  8. Sustainable Logistics of End-of-life Vehicles – Trends in Europe

    Directory of Open Access Journals (Sweden)

    Agata Mesjasz-Lech

    2017-06-01

    Full Text Available Purpose of the article: In the article we have focused on the trends determining the development of reverse logistics of end-of-life vehicles in selected European countries. The analysis concentrates on quantity of end-of-life vehicles which are especially interesting for reverse logistics because of their fitness for recovery or reuse. End-of-life products contain fully valuable elements which, according to the idea of sustainable use of resources, should be recovered. Accordingly, reverse logistics aims at protecting natural resources and the environment through reintroduction of processed waste materials into the economic cycle as valuable products and materials. Methodology/methods: The aim of the article was achieved on the basis of a critical analysis of subject literature and the analysis of statistical data. In the article the method of descriptive and mathematical statistics and dynamic analysis were used. The 2006–2014 years were analyzed. The data come from the data base of the Eurostat, the statistical office of the European Union. The following variables were taken into account: the amount of end-of-life vehicles (in tonnes and in number of cars, reuse level (in tonnes, recovery level (in tonnes, and recycling level (in tonnes. The analysis was based on a t-Student test for two average values of dependent samples, sign test and the Wilcoxon signed rank test. In order to see if the reverse logistics actions implemented in European countries were effective, the analysis compares the average values of individual variables from the year 2014 and 2006. Measurements were done for the same countries on the same element of population. The chain indexes and the average change tempo for specified variables were calculated. The similarity of the formation of specified variables in each year was compared on the basis of the index of similarity structures. Scientific aim: The scientific aim of the article is to identify the basic trends

  9. Research design in end-of-life research: state of science.

    Science.gov (United States)

    George, Linda K

    2002-10-01

    The volume of research on end-of-life care, death, and dying has exploded during the past decade. This article reviews the conceptual and methodological adequacy of end-of-life research to date, focusing on limitations of research to date and ways of improving future research. A systematic search was conducted to identify the base of end-of-life research. Approximately 400 empirical articles were identified and are the basis of this review. Although much has been learned from research to date, limitations in the knowledge base are substantial. The most fundamental problems identified are conceptual and include failure to define dying; neglect of the distinctions among quality of life, quality of death, and quality of end-of-life care. Methodologically, the single greatest problem is the lack of longitudinal studies that cover more than the time period immediately before death. Gaps in the research base include insufficient attention to psychological and spiritual issues, the prevalence of psychiatric disorder and the effectiveness of the treatment of such disorders among dying persons, provider and health system variables, social and cultural diversity, and the effects of comorbidity on trajectories of dying.

  10. Effect of irradiation on the post-harvest life of potatoes

    International Nuclear Information System (INIS)

    Mahboob, F.; Badshah, N.; Jabeen, N.; Ayub, G.

    2004-01-01

    Research work was conducted to find out the effect of irradiation on the post-harvest life of potatoes. Cultivar Raja was obtained from Agricultural Research Institute, Tarnab, and irradiated by Cobalt-60 source at different doses 0, 5, 7.5, 10 and 15 Krad at the Nuclear Institute for Food and Agriculture (NIFA), Tarnab during the year 2002. The samples were then stored for three months at the Horticultural Research Farm, Malakandher, at a room temperature of 30-39 degree C and relative humidity of 29-63%. Various tests carried out at Food Science laboratory revealed that irradiation significantly affected the weight loss, sugars, starch, ascorbic acid, sprouting and specific gravity. It was observed that maximum sprouting has occurred in control (42.1%) followed by 5 Krad irradiated tubers (6.4%). While irradiation doses of 7.5, 10 and 15 Krad completely inhibited sprouting. Maximum percent decrease in weight (42.66%), reducing sugars (0.57%), non reducing sugars (0.87%), starch (12%), ascorbic acid (32%) and specific gravity (4%) were recorded for control while minimum percent decrease in weight (31.40%), reducing sugars (0.19%), non-reducing sugars (0.27%), starch (8.0%), ascorbic acid (12%) and specific gravity (1.7%) were noted for IS Krad irradiated tubers. Irradiation dose of 7.5 Krad seems to be better for the extension of shelf life of potatoes

  11. [End of life and vulnerability, a public health issue].

    Science.gov (United States)

    Boucomont, Aude

    2016-02-01

    End of life and precarity, two words which were linked by the French national observatory for end of life care in its work carried out in 2014. The study provided an overview of current support practices in different areas, highlighting certain lessons to be learned and making recommendations to the different partners involved. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  12. Coating effect of chitosan irradiation on performance of strawberries (Fragaria x ananassa Duchesne)

    International Nuclear Information System (INIS)

    Gatot Trimulyadi Rekso; Adjat Sudradjat

    2016-01-01

    Strawberry is a horticultural product which has high economic value, however, strawberries are easily damaged. Therefore, required proper post harvest handling for keep up the appearances of strawberries, one of them is the edible coating technique using chitosan. The purpose of this research was to maintaining the appearance of strawberry. Chitosan is irradiated at a dose of 0 kGy, 5 kGy, and 10 kGy, and then characterized. Observations were carried on for five days at room temperature including: the testing of the performance of the fruit that was observed visually and analysis of fruit weight loss. The results showed that the performance of strawberries is coating with irradiated chitosan of 10 kGy is still good. The percentage of weight loss strawberries coated with irradiated chitosan smaller than the strawberries without coating with chitosan (control). Strawberries coated with irradiated chitosan has a shelf life and weight loss better than control. (author)

  13. Communication as care at end of life: an emerging issue from an exploratory action research study of renal end-of-life care for ethnic minorities in the UK.

    Science.gov (United States)

    Wilkinson, Emma; Randhawa, Gurch; Brown, Edwina A; Da Silva Gane, Maria; Stoves, John; Warwick, Graham; Akhtar, Tahira; Magee, Regina; Sharman, Sue; Farrington, Ken

    2014-09-01

    South Asian people have a higher risk of developing kidney disease, are disproportionately represented in the patient population requiring renal replacement therapy and wait longer to receive a kidney transplant, compared with white Europeans. As a result, there is a demand for end-of-life care, which meets the needs of this group of patients. Providing end-of-life care to patients from different cultures is a challenge for renal services as there can be barriers to communication in the form of language, delegated decision-making within families and reluctance to discuss death. To explore end-of-life care for South Asians with kidney disease, 16 interviews with patients and 14 focus groups with care providers were conducted at four research sites in the UK with large South Asian populations. Using an action research design the data were analysed thematically and fed back to inform the research in a cyclical manner. If patients are not fully aware of their condition or of what end-of-life care is, it is less likely that they will be able to be involved in decision-making about their care and this is compounded where there are communication barriers. Variations in care provider awareness and experience of providing end-of-life care to South Asian patients, in turn, contributes to lack of patient awareness of end-of-life care. Communication as care at the end of life should be explored further. Researching the South Asian patient experience of end of life highlights many relevant and generalisable issues. © 2014 European Dialysis and Transplant Nurses Association/European Renal Care Association.

  14. End-of-life decision making in the ICU.

    Science.gov (United States)

    Siegel, Mark D

    2009-03-01

    A large proportion of deaths, particularly in the developed world, follows admission to an ICU. Therefore, end-of life decision making is an essential facet of critical care practice. For intensivists, managing death in the critically ill has become a key professional skill. They must be thoroughly familiar with the ethical framework that guides end-of-life decision making. Decisions should generally be made collaboratively by clinicians partnering with patients' families. Treatment choices should be crafted to meet specific, achievable goals. A rational, empathic approach to working with families should encourage appropriate, mutually satisfactory outcomes.

  15. End of life care - the importance of culture and ethnicity.

    Science.gov (United States)

    Clark, Katherine; Phillips, Jane

    2010-04-01

    Australia is a culturally and ethnically diverse country. Within such diversity there will be differing beliefs systems about death and dying. This may be a challenging prospect for health professionals. This article discusses how cultural diversity may impact care and provides some strategies for the general practitioner when considering the provision of end of life care. This article does not attempt to provide GPs with a prescriptive approach to multicultural care, as this would run the risk of stereotyping individuals. Rather, it discusses the barriers to end of life care among different cultural and ethnic groups, and suggests ways in which to improve understanding of different cultural needs in end of life care.

  16. A model for emergency department end-of-life communications after acute devastating events--part II: moving from resuscitative to end-of-life or palliative treatment.

    Science.gov (United States)

    Limehouse, Walter E; Feeser, V Ramana; Bookman, Kelly J; Derse, Arthur

    2012-11-01

    The model for emergency department (ED) end-of-life communications after acute devastating events addresses decision-making capacity, surrogates, and advance directives, including legal definitions and application of these steps. Part II concerns communications moving from resuscitative to palliative and end-of-life treatments. After completing the steps involved in determining decision-making, emergency physicians (EPs) should consider starting palliative measures versus continuing resuscitative treatment. As communications related to these end-of-life decisions increasingly fall within the scope of emergency medicine (EM) practice, we need to become educated about and comfortable with them. © 2012 by the Society for Academic Emergency Medicine.

  17. Design for life-cycle profit with simultaneous consideration of initial manufacturing and end-of-life remanufacturing

    Science.gov (United States)

    Kwak, Minjung; Kim, Harrison

    2015-01-01

    Remanufacturing is emerging as a promising solution for achieving green, profitable businesses. This article considers a manufacturer that produces new products and also remanufactured versions of the new products that become available at the end of their life cycle. For such a manufacturer, design decisions at the initial design stage determine both the current profit from manufacturing and future profit from remanufacturing. To maximize the total profit, design decisions must carefully consider both ends of product life cycle, i.e. manufacturing and end-of-life stages. This article proposes a decision-support model for the life-cycle design using mixed-integer nonlinear programming. With an aim to maximize the total life-cycle profit, the proposed model searches for an (at least locally) optimal product design (i.e. design specifications and the selling price) for the new and remanufactured products. It optimizes both the initial design and design upgrades at the end-of-life stage and also provides corresponding production strategies, including production quantities and take-back rate. The model is extended to a multi-objective model that maximizes both economic profit and environmental-impact saving. To illustrate, the developed model is demonstrated with an example of a desktop computer.

  18. Electrical performance of ATLAS-SCT KB end-cap modules

    CERN Document Server

    D'Onofrio, M; Donegà, M; Ferrère, D; Mangin-Brinet, M; Mikulec, B; Weber, M; Ikegami, Y; Kohriki, T; Kondo, T; Terada, S; Unno, Y; Pernegger, H; Roe, S; Wallny, R; Moorhead, G F; Taylor, G; García, J E; Gonzáles, S; Vos, M A; Toczek, B

    2003-01-01

    The Semiconductor Tracker (SCT) is one of the ATLAS Inner Detector elements which aims to track charged particles in the ATLAS experiment. It consists of four cylindrical layers (barrels) of silicon strip detectors, with nine disks in each of the forward and backward directions. Carbon fibre structures will support a total of 4088 modules, which are the basic functional sub-unit of the SCT. Each module consists of single sided silicon micro-strip detectors glued back to back with a 40 mrad stereo-angle, and attached to a hybrid. The scope of this document is to present the electrical performances of prototype end-cap modules proposed for the ATLAS-SCT, as an alternative to the baseline. The layout of these modules is based on the implementation of the barrel module hybrid in the end-cap geometry. A complete set of electrical measurements is summarized in this paper, including irradiated module tests and beam tests.

  19. Multi-dimensional approach of MARS-LMR for the analysis of Phenix End-of-Life natural circulation test

    International Nuclear Information System (INIS)

    Jeong, Hae Yong; Ha, Kwi Seok; Chang, Won Pyo; Lee, Kwi Lim

    2012-01-01

    Phenix is one of the important prototype sodium-cooled fast reactors (SFR) in nuclear reactor development history. It had been operated successfully for 35 years by the French Commissariat a l'energie atomique (CEA) and the Electricite de France (EdF) achieving its original objectives of demonstrating a fast breeder reactor technology and of playing the role of irradiation facility for innovative fuels and materials. After its final shutdown in 2009, CEA launched the Phenix End-of-life (EOL) test program. It provided a unique opportunity to generate reliable test data which is inevitable in the validation and verification of a SFR system analysis code. KAERI joined this international collaboration program of IAEA CRP and has performed the pretest analysis and post-test analysis utilizing the one-dimensional modeling of the MARS-LMR code, which had been developed by KAERI for the transient analysis of SFR systems. Through the previous studies, it has been identified that there are some limitations in the modeling of complicated thermal-hydraulic behaviors in the large pool volumes with the one-dimensional modeling. Recently, KAERI performed the analysis of Phenix EOL natural circulation test with multi-dimensional pool modeling, which is detailed below

  20. Multi-dimensional approach of MARS-LMR for the analysis of Phenix End-of-Life natural circulation test

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Hae Yong; Ha, Kwi Seok; Chang, Won Pyo; Lee, Kwi Lim [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

    2012-05-15

    Phenix is one of the important prototype sodium-cooled fast reactors (SFR) in nuclear reactor development history. It had been operated successfully for 35 years by the French Commissariat a l'energie atomique (CEA) and the Electricite de France (EdF) achieving its original objectives of demonstrating a fast breeder reactor technology and of playing the role of irradiation facility for innovative fuels and materials. After its final shutdown in 2009, CEA launched the Phenix End-of-life (EOL) test program. It provided a unique opportunity to generate reliable test data which is inevitable in the validation and verification of a SFR system analysis code. KAERI joined this international collaboration program of IAEA CRP and has performed the pretest analysis and post-test analysis utilizing the one-dimensional modeling of the MARS-LMR code, which had been developed by KAERI for the transient analysis of SFR systems. Through the previous studies, it has been identified that there are some limitations in the modeling of complicated thermal-hydraulic behaviors in the large pool volumes with the one-dimensional modeling. Recently, KAERI performed the analysis of Phenix EOL natural circulation test with multi-dimensional pool modeling, which is detailed below

  1. Shelf life of irradiated minimally processed (MP) watercress (Nasturtium officinale)

    International Nuclear Information System (INIS)

    Martins, C.G.; Behrens, J.H.; Aragon-Alegro, L.C.; Vieira, V.S.; Costa-Sobrinho, P.S.; Vizeu, D.M.; Hutzler, B.; Franco, B.D.G. de M.; Destro, M.T.; Landgraf, M.

    2007-01-01

    This study was carried out to evaluate the shelf life of minimally processed (MP) watercress exposed to gamma radiation with doses of 1.0; 3.0; 4.0 kGy. Packaged irradiated and non-irradiated MP watercress was subject to sensory analysis. A panel consisting of 25-30 non-trained members, aged 20-55 years, was used. Sensory evaluation was carried out on days 0, 2, 5, 7, 9 and 12 after treatment with packages maintained at 7 °C. The members of the panel rated each sample for overall liking on a hybrid 10 hedonic scale (0 = extremely dislike; 10 = extremely like). Microbiological analyses were also conducted. Compared to the non-irradiated sample, 1 kGy irradiated watercress increased its shelf life by one day (16 days). Shelf lives of samples exposed to higher doses were reduced to 9 days (3 kGy) and 6 days (4 kGy) due to changes in appearance. The microbiological quality was good throughout the experiment

  2. End of life care preferences among people of advanced age: LiLACS NZ.

    Science.gov (United States)

    Gott, Merryn; Frey, Rosemary; Wiles, Janine; Rolleston, Anna; Teh, Ruth; Moeke-Maxwell, Tess; Kerse, Ngaire

    2017-12-19

    Understanding end of life preferences amongst the oldest old is crucial to informing appropriate palliative and end of life care internationally. However, little has been reported in the academic literature about the end of life preferences of people in advanced age, particularly the preferences of indigenous older people, including New Zealand Māori. Data on end of life preferences were gathered from 147 Māori (aged >80 years) and 291 non- Māori aged (>85 years), during three waves of Te Puawaitangi O Nga Tapuwae Kia Ora Tonu, Life and Living in Advanced Age (LiLACs NZ). An interviewer-led questionnaire using standardised tools and including Māori specific subsections was used. The top priority for both Māori and non-Māori participants at end of life was 'not being a burden to my family'. Interestingly, a home death was not a high priority for either group. End of life preferences differed by gender, however these differences were culturally contingent. More female Māori participants wanted spiritual practices at end of life than male Māori participants. More male non-Māori participants wanted to be resuscitated than female non- Māori participants. That a home death was not in the top three end of life priorities for our participants is not consistent with palliative care policy in most developed countries where place of death, and particularly home death, is a central concern. Conversely our participants' top concern - namely not being a burden - has received little research or policy attention. Our results also indicate a need to pay attention to diversity in end of life preferences amongst people of advanced age, as well as the socio-cultural context within which preferences are formulated.

  3. Effect of irradiation on shelf life and nutritional quality of sauce buck

    International Nuclear Information System (INIS)

    Cao Hong; Zhai Jianqing; Han Yan; Wang Xinghai; Bao Jianzhong; Wang Jinrong; Chen Xiulan

    2010-01-01

    Vacuum-packed sauce duck were irradiated by 60 Co γ-rays, and total bacteria number and nutrition contents of treated samples were determined. The results showed that the sauce duck was irradiated at 6 kGy, and stored at 25 degree C ± 0.5 degree C, it could be stored for 90 days; and if the sauce duck was firstly processed by pasteurization at 90 degree C ∼ 95 degree C for 30 min, then irradiated at 6 kGy, the shelf life could be prolonged to 120 days at 25 degree C ± 0.5 degree C. Irradiation could make the sauce duck to meet the commercial hygienic requirement within the shelf life, and would not impact the nutritive value significantly. It is concluded that irradiated sauce duck has the potential commercial application. (authors)

  4. The trajectory of experience of critical care nurses in providing end-of-life care: A qualitative descriptive study.

    Science.gov (United States)

    Ong, Keh Kiong; Ting, Kit Cheng; Chow, Yeow Leng

    2018-01-01

    To understand the perceptions of critical care nurses towards providing end-of-life care. There has been an increasing interest in end-of-life care in the critical care setting. In Singapore, approximately half of deaths in the hospital occur during critical care. While nurses are well positioned to provide end-of-life care to patients and their family members, they faced barriers to providing end-of-life care. Also, providing end-of-life care has profound positive and negative psychological effects on nurses, with the latter being more prominent. Qualitative descriptive design. Data collection was performed in a medical intensive care unit of a public tertiary hospital in Singapore. Ten registered nurses were purposively sampled and interviewed individually using a semi-structured interview guide. A codebook was developed to guide coding, and data were thematically analysed. Rigour was maintained. Nurses went through a trajectory of experience. They experienced the culture of care and developed dissatisfaction with it. The tension shaped their perception and meaning of life and death, and they developed mechanisms to reach resolution. This study provides insight on nurses' perception as a trajectory of experience and raised several implications on clinical practice, policy and research. There is a need to alleviate the tension nurses face and to facilitate coming to terms with the tension by improving the culture of care and supporting nurses. Nurses could be involved more in decision-making and empowered to start end-of-life care conversations within the team and with family members. Communication with family members and between nurses and doctors could be improved. Support for nurses providing end-of-life care could be enhanced through promoting social networks, education and bereavement support. Further research is needed to explore ways to support and empower nurses to provide end-of-life care in critical care. © 2017 John Wiley & Sons Ltd.

  5. Life cycle assessment of the end-of-life phase of a residential building.

    Science.gov (United States)

    Vitale, Pierluca; Arena, Noemi; Di Gregorio, Fabrizio; Arena, Umberto

    2017-02-01

    The study investigates the potential environmental impacts related to the end-of-life phase of a residential building, identified in a multifamily dwelling of three levels, constructed in the South of Italy by utilizing conventional materials and up-to-date procedures. An attributional life cycle assessment has been utilised to quantify the contributions of each stage of the end-of-life phase, with a particular attention to the management of the demolition waste. The investigation takes into account the selective demolition, preliminary sorting and collection of main components of the building, together with the processes of sorting, recycling and/or disposal of main fractions of the demolition waste. It quantifies the connections between these on-site and off-site processes as well as the main streams of materials sent to recycling, energy recovery, and final disposal. A sensitivity analysis has been eventually carried out by comparing the overall environmental performances of some alternative scenarios, characterised by different criteria for the demolition of the reference building, management of demolition waste and assessment of avoided burdens of the main recycled materials. The results quantify the advantage of an appropriate technique of selective demolition, which could increase the quality and quantity of residues sent to the treatment of resource recovery and safe disposal. They also highlight the contributions to the positive or negative environmental impact of each stage of the investigated waste management system. The recycling of reinforcing steel appears to play a paramount role, accounting for 65% of the total avoided impacts related to respiratory inorganics, 89% of those for global warming and 73% of those for mineral extraction. Copyright © 2016 Elsevier Ltd. All rights reserved.

  6. Death ends a life, not a relationship

    DEFF Research Database (Denmark)

    Christensen, Dorthe Refslund; Sandvik, Kjetil

    2014-01-01

    In the final chapter, “Death Ends a Life, not a Relationship: objects as media on children’s graves”, Dorthe Refslund Christensen and Kjetil Sandvik investigate the relational affordances offered by objects as media in practices of death and commemoration on children’s graves. The authors argue...... that when it comes to bereavement practices as they materialize on children’s graves, it is the accommodation and decoration of the grave itself that function as media with their variety of physical objects as ritual and relational tools for communication. The bereaved perform practices on children’s graves...... – mirrored in online memorial sites – that transform the dead child into a being with whom an altered relationship may be built, maintained and developed so that the bereaved can, eventually, integrate the dead into his or her ongoing life....

  7. Continuous subcutaneous infusion of opiates at end-of-life.

    Science.gov (United States)

    Anderson, Stacey L; Shreve, Scott T

    2004-06-01

    To review pertinent controlled trials using the continuous subcutaneous infusion of opioids (CSIO) at end-of-life and offer insight to pharmacists and clinicians into the appropriate use of this route of administration. A MEDLINE search for information regarding the subcutaneous administration of opioids in terminally ill patients (1975-December 2002) was conducted using the key words subcutaneous, narcotics, morphine, hydromorphone, fentanyl, pain, hospices, and palliative care. Additional references were located through review of bibliographies of the articles cited. Case reports and postsurgical studies were excluded. Searches were limited to English-language studies using humans. Experimental and observational studies were evaluated, using prospective trials as the evidence base for conclusions and including pertinent retrospective trials as they relate to the subcutaneous infusion of opioids at end-of-life. CSIO is effective and safe for use in terminal illness. Appropriate situations for consideration of CSIO are when difficulties arise in using the oral route, standard oral opiate therapy has failed adequate trials, the patient has limited intravenous access, adequate supervision of the CSIO is present, and CSIO will not unduly limit the functional activity of the patient. CSIO has a proven role in the management of pain at end-of-life. CSIO should not be considered the first route for administration of opiates, but does offer distinct advantages in the appropriate setting. CSIO continues to be a choice for end-of-life patients and is gradually becoming a standard practice in palliative medicine.

  8. Effects of low dose rate irradiation on life span prolongation of human premature-aging syndrome model mice

    International Nuclear Information System (INIS)

    Nomura, Takaharu

    2006-01-01

    We previously showed that Type II diabetes model mice prolonged of their life span by life long low dose rate irradiation. We also found that antioxidant function in variety tissues of some strain of mice were enhancement after low dose/low dose rate irradiation. The prolongation of life span might depend on certain damaged level of reactive oxygen species. We thought the effect of the prolongation was due to the enhancement of the antioxidant activities after irradiation. We investigated whether the enhancement of antioxidant activities after low dose rate irradiation had an effect on life span prolongation. Four-week-old female human premature-aging syndrome model mice, kl/kl (klotho) mice, which the life span of this model mouse is about 65 days, were irradiated with gamma rays at 0.35, 0.70 or 1.2 mGy/hr. The 0.70 mGy/hr-irradiated group remarkably effected on the prolongation of their life span. Some mice of the group were extremely survived for about and more 100 days. Antioxidant activities in the irradiated groups were enhancement by low dose rate irradiation, however the dependence of the dose rates were not clearly difference. These results suggest that the antioxidant activities in this model mouse were enhanced by the low dose rate irradiation, and may make it possible to prolong the life span of this mouse. (author)

  9. Do Older Korean Immigrants Engage in End-of-Life Communication?

    Science.gov (United States)

    Ko, Eunjeong; Roh, Soonhee; Higgins, Doreen

    2013-01-01

    End-of-life communication is an important process as it allows individuals' treatment preferences to be known, yet not every culture is receptive to such discussions. Planning for end-of-life care is not readily supported in Asian culture, and little is known about individuals' communication with family and health care professionals among older…

  10. Disinfestation of litchi stem-end borer Conopomorpha sinensis Bradley with irradiation for export of litchi fruits

    International Nuclear Information System (INIS)

    Hu Meiying; Liu Xiuqiong; Hou Renhuan; Li Xiaodong; Yao Zhenwei; Lou Xuemei; Weng Qunfang

    1999-01-01

    Larvae of the litchi stem-end borer, Conopomorpha sinensis Bradley, in litchi fruits were exposed to 60 Co gamma irradiation doses ranging from 0-400 Gy as a quarantine treatment. Criterion of effectiveness of the irradiation dose was based on preventing adults emerging from treated fruits infested with the larvae. Probit analysis showed that the irradiation dose that caused 99.5% mortality of larvae was 254 Gy (220-289 Gy) and 99.9968% mortality of the 3rd instars was 267 Gy (184-351 Gy) with 95% fiducial limits. The mortality of litchi stem-end borer increased when the irradiation treatment was coupled with extended cool storage (76 deg. C). Hatching of eggs was decreased with increasing dosages to the eggs of 250-600 Gy. Prepupae treated at 300-600 Gy were more radiosensitive than 4-5 days old pupae. The results of visual quality observation indicated that the rotten fruit rate of litchi fruits was reduced by 250-350 Gy treatment. (author)

  11. Effects of a Simulation Exercise on Nursing Students' End-of-Life Care Attitudes.

    Science.gov (United States)

    Dame, Linda; Hoebeke, Roberta

    2016-12-01

    Students consider end-of-life care content in their nursing curricula to be inadequate and deficient in promoting the development of the necessary attitudes to care for dying patients. Research identifies simulation as an effective teaching strategy to examine nursing students' attitudes toward end-of-life care. An end-of-life care simulation was developed, implemented, and evaluated. Attitudes toward caring for dying patients were measured pre- and postsimulation on a convenience sample of 57 sophomore nursing students using the Frommelt Attitudes Toward Care of the Dying Scale-Form B. Repeated measures of ANOVA on outcome variables evaluated student attitudes toward end-of-life care. Participation in an end-of-life care simulation resulted in more positive student attitudes toward caring for dying patients (p life care in nursing curricula and improve student attitudes toward caring for dying patients. [J Nurs Educ. 2016;55(12):701-705.]. Copyright 2016, SLACK Incorporated.

  12. The Evolution of End-of-Life Care: Ethical Implications for Case Management.

    Science.gov (United States)

    Fink-Samnick, Ellen

    2016-01-01

    This article: : Applicable to all health care sectors where case management is practiced. Few topics are more intimate and multifaceted for case managers than engaging with today's culturally diverse patient populations around end-of-life processes. The already prominent focus of this issue has been further elevated by a series of events to receive public attention. These include the Institute of Medicine's 2014 report-Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life, rising numbers of patients around the globe requesting to end life on their own terms, and corresponding death with dignity initiatives and legislation.Another vital factor in the end-of-life equation involves how the latest generation of shared decision making influences the management of treatment dialogues among practitioners, patients, as well as insurance companies. Case managers are at the intersection of these complex interactions, working to achieve ethical, as well as legal accountability to the patient, employer, and profession while balancing personal perspectives. Professionals strive to effectively intervene with patients and their support systems facing end-of-life care decisions. It is essential case managers actively consider the intricacies of ethical practice and current contexts including death with dignity legislation, shared decision making, and shifts in regulations and reimbursement for end-of-life care.Case management's ethical envelope will continue to be pushed. To that end amid shifting societal constructs, professionals must have mastery of applicable codes, standards, principles, and rules essential for adherence to ethical practice.

  13. Effects of electron beam irradiation combined with hot water immersion treatment for shelf life extension of bananas

    International Nuclear Information System (INIS)

    Russly Abdul Rahman

    1996-01-01

    A study of the effects of minimal processing treatments, both individually or in combinations, was carried out in order to extend the shelf life and to improve the quality of bananas. Pre climacteric bananas at light full three-quarter grade, were either treated with hot water immersion for 1-30 min at 45-55 degree C, or irradiated with electron beams (2.0 MeV, Van de Graaff accelerator), to a dose of 0.1-1.5 kGy. All fruit was stored at 21 ± 1 degree C and relative humidity of 85-95 %. There was no significant delay in ripening of fruit treated with hot water immersion at the above temperatures. Some damage to fruit particularly peel scalding at ends occurred at the higher temperatures (>50 degree C). The 50 degree C, 5 minutes immersion was selected for further study. Irradiation to 0.1-0.3 kGy delayed the ripening (up to 3 days) without affecting fruit quality. Doses greater than 0.4 kGy resulted in extensive discoloration and fruit splitting. No significant differences could be detected organoleptically between bananas irradiated at 0.15 kGy and the control. Results of the physico-chemical attributes of the bananas were reported for fruits at colour stage 5 and after 10 and 15 days of storage. The combination treatment of hot water immersion and irradiation at the above settings further extended the shelf life of the banana fruits

  14. Oncologists' strategies and barriers to effective communication about the end of life.

    Science.gov (United States)

    Granek, Leeat; Krzyzanowska, Monika K; Tozer, Richard; Mazzotta, Paolo

    2013-07-01

    Communicating about the end of life with patients has been reported as one of the most difficult and stressful part of the work of oncologists. Despite this fact, oncologists receive little training in this area, and many do not communicate effectively with patients. The purpose of this analysis, part of a larger study examining oncologists' experiences of patient loss, was to explore oncologists' communication strategies and communication barriers when discussing end-of-life issues with patients. Twenty oncologists were interviewed at three hospitals about their communication strategies on end-of-life issues with patients. The data were analyzed using the grounded theory method. The findings revealed the strategies to effective communication about the end of life included: being open and honest; having ongoing, early conversations; communicating about modifying treatment goals; and balancing hope and reality. Barriers to implementing these strategies fell broadly into three domains, including physician factors, patient factors, and institutional factors. Physician factors included difficulty with treatment and palliation, personal discomfort with death and dying, diffusion of responsibility among colleagues, using the "death-defying mode," lack of experience, and lack of mentorship. Patient factors included, patients and/or families being reluctant to talk about the end of life, language barriers, and younger age. Institutional factors included stigma around palliative care, lack of protocol about end-of-life issues; and lack of training for oncologists on how to talk with patients about end-of-life issues. We conclude by drawing implications from our study and suggest that further research and intervention are necessary to aid oncologists in achieving effective communication about end-of-life issues.

  15. Current debates on end-of-life sedation: an international expert elicitation study.

    Science.gov (United States)

    Papavasiliou, Evangelia Evie; Payne, Sheila; Brearley, Sarah

    2014-08-01

    End-of-life sedation, though increasingly prevalent and widespread internationally, remains one of the most highly debated medical practices in the context of palliative medicine. This qualitative study aims to elicit and record the perspectives of leading international palliative care experts on current debates. Twenty-one professionals from diverse backgrounds, sharing field-specific knowledge/expertise defined by significant scholarly contribution on end-of-life sedation, were recruited. Open-ended, semi-structured interviews, following a topic-oriented structure reflecting on current debates, were conducted. Results were analysed using thematic content analysis. Three main aspects of sedation were identified and discussed as potentially problematic: (a) continuous deep sedation as an extreme facet of end-of-life sedation, (b) psycho-existential suffering as an ambivalent indication for sedation and (c) withdrawal or withholding of artificial nutrition and hydration as potentially life-shortening. On these grounds, concerns were reported over end-of-life sedation being morally equivalent to euthanasia. Considerable emphasis was placed on intentions as the distinguishing factor between end-of-life acts, and protective safeguards were introduced to distance sedation from euthanasia. This study shows that, despite the safeguards introduced, certain aspects of sedation, including the intentions associated with the practice, are still under question, parallels being drawn between end-of-life sedation and euthanasia. This reaffirms the existence of a grey area surrounding the two practices, already evidenced in countries where euthanasia is legalized. More clarity over the issues that generate this grey area, with their causes being uncovered and eliminated, is imperative to resolve current debates and effectively inform research, policy and practice of end-of-life sedation.

  16. Looking at the end-of-life directive and challenges in recycling

    DEFF Research Database (Denmark)

    Smink, Carla

    2004-01-01

    The article deals with end-of-life vechile regulations. Focus is on the European end-of-life vechile directive (2000/53/EC) and how Denmark and the Netherlands have dealt with the regulations in the past 30 years....

  17. Doctors' learning experiences in end-of-life care

    DEFF Research Database (Denmark)

    Fosse, Anette; Ruths, Sabine; Malterud, Kirsti

    2017-01-01

    death could even be welcomed. Through challenging dialogues dealing with family members’ hope and trust, they learnt how to adjust words and decisions according to family and patient’s life story. Interdisciplinary role models helped them balance uncertainty and competence in the intermediate position......Background: Doctors often find dialogues about death difficult. In Norway, 45% of deaths take place in nursing homes. Newly qualified medical doctors serve as house officers in nursing homes during internship. Little is known about how nursing homes can become useful sites for learning about end-of-life...... care. The aim of this study was to explore newly qualified doctors’ learning experiences with end-of-life care in nursing homes, especially focusing on dialogues about death. Methods: House officers in nursing homes (n = 16) participated in three focus group interviews. Interviews were audiotaped...

  18. Performance evaluation of gamma irradiated SiR-EPDM blends

    Energy Technology Data Exchange (ETDEWEB)

    Deepalaxmi, R., E-mail: deepalaxmivaithi@gmail.com; Rajini, V.

    2014-07-01

    Highlights: • The effects of gamma irradiation on SiR-EPDM blend are examined. • Cross-linking reaction is dominant in blends C, D and E, due to higher EPDM content. • The tensile strength and hardness of blend E is improved by gamma irradiation. • The blend C and EPDM rich blends (D, E) are found to have superior performance. • Among C, D and E, suitable blend can be selected for a particular NPP application. - Abstract: Cable insulation materials (CIM) should perform their safety functions throughout their installed life in nuclear power plants (NPP). The CIM will be exposed to gamma irradiation at the installed locations. In order to forecast long-term performance of CIM, the short time accelerated testing was carried out. Due to its good mechanical strength, ethylene propylene diene monomer (EPDM) is widely used as CIM. Silicone rubber (SiR) is used in high temperature environments, due to its good di-electric properties/hydrophobicity. The blending of these two polymers may result in the improvement in their specific properties. This paper analyses the effects of gamma irradiation on the five different compositions (90-10; 70-30; 50-50; 30-70; 10-90) of SiR-EPDM blends. The blends were exposed to four different doses (25 Mrad, 100 Mrad, 200 Mrad and 250 Mrad) of gamma irradiation. The electrical and mechanical parameters like volume resistivity (VRY), surface resistivity (SRY), tensile strength (TS), elongation at break (EB), hardness (H) of the virgin and gamma irradiated blends were determined as per ASTM/IEC standards. The nature of degradation was investigated using Fourier transform infrared spectroscopy (FTIR). The simultaneous occurrence of cross-linking and chain scission is found to be the mechanism for ageing in SiR-EPDM blends. The electrical parameters such as volume resistivity and surface resistivity of all the blends are found to improve for all doses of gamma irradiation. To validate the influence of cross-linking reaction of the Si

  19. Extension shelf life of batte by using hydrocolloids and gamma irradiation

    Directory of Open Access Journals (Sweden)

    Mervat M. Anwar

    2015-10-01

    Full Text Available Batte (is baked french one of the most baked coated most prevalent in the markets after the cake wrapping. Batte exposed generally two types of corruption which is occurring phenomenon of (anti-staling and corruption microbial (molds. In this study produced batte with an attempt to prolong the period of its validity by addition 1.5% hydrocolloids, (which is 0.5% sodium alginate, 0.5% k-carrageenan and 0.5% hydroxyl propyl methylcellulose (HPMC to hard wheat flour 72% (HWF to improve materials for mellowness and anti-staling, whereas batte exposed to gamma irradiation at doses 0.5, 1, 1.5, 2, 3 and 5 kGy to decrease microbial load. Hydrocolloids at 1.5% improved the rheological properties of dough farinogragh and aextensograph parameters. The hydrocolloids increase flexibility, rubber and freshness of batte to 24 days compared to 8 days in control sample. Thiobarbituric acid (T.B.A values at the end of storage at room temperature (ranged to 0.253–0.352 mg malonaldehyde/kg that were less than these mentioned by the Egyptian Standard. Also, gamma irradiation reduced the total bacterial count of batte product. Sensory evaluation of produced batte was done. The addition of 1.5% hydrocolloids and exposed to gamma irradiation had higher freshness and increase shelf-life for 20, 25, 30, 35 and 40 days against only 15 days for control sample.

  20. End-of-life costs of medical care for advanced stage cancer patients

    Directory of Open Access Journals (Sweden)

    Kovačević Aleksandra

    2015-01-01

    Full Text Available Background/Aim. Cancer, one of the leading causes of mortality in the world, imposes a substantial economic burden on each society, including Serbia. The aim of this study was to evaluate the major cancer cost drivers in Serbia. Methods. A retrospective, indepth, bottom-up analysis of two combined databases was performed in order to quantify relevant costs. End-of-life data were obtained from patients with cancer, who deceased within the first year of the established diagnose, including basic demographics, diagnosis, tumour histology, medical resource use and related costs, time and cause of death. All costs were allocated to one of the three categories of cancer health care services: primary care (included home care, hospital outpatient and hospital inpatient care. Results. Exactly 114 patients were analyzed, out of whom a high percent (48.25% had distant metastases at the moment of establishing the diagnosis. Malignant neoplasms of respiratory and intrathoracic organs were leading causes of morbidity. The average costs per patient were significantly different according to the diagnosis, with the highest (13,114.10 EUR and the lowest (4.00 EUR ones observed in the breast cancer and melanoma, respectively. The greatest impact on total costs was observed concerning pharmaceuticals, with 42% of share (monoclonal antibodies amounted to 34% of all medicines and 14% of total costs, followed by oncology medical care (21%, radiation therapy and interventional radiology (11%, surgery (9%, imaging diagnostics (9% and laboratory costs (8%. Conclusion. Cancer treatment incurs high costs, especially for end-of-life pharmaceutical expenses, ensued from medical personnel tendency to improve such patients’ quality of life in spite of nearing the end of life. Reimbursement policy on monoclonal antibodies, in particular at end-stage disease, should rely on cost-effectiveness evidence as well as documented clinical efficiency. [Projekat Ministarstva nauke

  1. [Precarity, vulnerability, anticipating end-of-life care at home].

    Science.gov (United States)

    Bonneval, Camille

    2016-02-01

    Many patients want to end their life at home. Care teams adapt to these wishes and organise a form of treatment which blends safety of care and the respect of the expectations of the patients and family members. When factors of precarity increase the vulnerability inherent to the end of life, caregivers anticipate and support as best as they can the difficulties encountered as testified by a hospital at home team in Dax. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  2. Pain and symptom management in palliative care and at end of life.

    Science.gov (United States)

    Wilkie, Diana J; Ezenwa, Miriam O

    2012-01-01

    The purpose of this review is to provide a literature update of the research published since 2004 on pain and symptom management in palliative care and at end of life. Findings suggest that pain and symptoms are inadequately assessed and managed, even at the end of life. Although not pervasive, there is evidence of racial/ethnic disparities in symptom management in palliative care and at end of life. There is a need for a broader conceptualization and measurement of pain and symptom management as multidimensional experiences. There is insufficient evidence about mechanisms underlying pain at end of life. Although there are advances in the knowledge of pain as a multidimensional experience and the many symptoms that occur sometimes with pain, gaps remain. One approach to addressing the gaps will involve assessment and management of pain and symptoms as multidimensional experiences in people receiving palliative care and at end of life. Copyright © 2012 Elsevier Inc. All rights reserved.

  3. Nurse involvement in end-of-life decision making: the ETHICUS Study

    DEFF Research Database (Denmark)

    Benbenishty, Julie; Ganz, Freda DeKeyser; Lippert, Anne

    2006-01-01

    The purpose was to investigate physicians' perceptions of the role of European intensive care nurses in end-of-life decision making.......The purpose was to investigate physicians' perceptions of the role of European intensive care nurses in end-of-life decision making....

  4. Microbiological and sensory evaluation of the shelf-life of irradiated chicken breast meat

    International Nuclear Information System (INIS)

    Miyagusku, L.; Chen, F.; Leitao, M.F. de F.; Baffa, O.

    2003-01-01

    Kraft paper boxes containing 10 expanded polystyrene trays with 200g skinless deboned chicken breast each were irradiated with 60 Co source of a Nordion JS7500 irradiator. The trays were previously wrapped with polyethylene film. The samples were exposed to 1.5; 3.0 and 7.0 kGy doses in the static mode at 0º and 180º in relation to the irradiation beam. Set of 18 alanine+paraffin dosimeters per treatment were distributed inside the boxes for evaluation of irradiation dose homogeneity. A separeted dose calibration curve was obtained by irradiating in the range of 1 to 10kGy. After the irradiation, the chicken breasts were stored at 5±1ºC for 39 days and were analysed microbiologically in total psychrotrophic aerobic bacteria, total mesophilic aerobic bacteria, molds and yeasts, Pseudomonas spp, Enterobacteriaceae, lactic bacteria counts and E.coli during the storage period. The results revealed a linear behaviour of the alanine+paraffin dosimeters in the range of 1 to 10kGy irradiation. In regard to the microbiological aspect, compared to the shelf-life of 5 days for the controls, there were a increasing of 1.75; 4.40 e 7.0 times shelf-life for chicken breasts irradiated with 1.5; 3.0 and 7.0kGy, respectively. There was an increasing change of the smell of burnt as the irradiation doses increased. Thus, 3kGy dose was considered as the ideal dose to assure a longer shelf-life to the product, without perceptible changes in the aspect [pt

  5. Irradiation test and performance evaluation of DUPIC fuel

    International Nuclear Information System (INIS)

    Yang, Myung Seung; Song, K. C.; Moon, J. S.

    2002-05-01

    The objective of the project is to establish the performance evaluation system of DUPIC fuel during the Phase II R and D. In order to fulfil this objectives, irradiation test of DUPIC fuel was carried out in HANARO using the non-instrumented and SPND-instrumented rig. Also, the analysis on the in-reactor behavior analysis of DUPIC fuel, out-pile test using simulated DUPIC fuel as well as performance and integrity assessment in a commercial reactor were performed during this Phase. The R and D results of the Phase II are summarized as follows : - Performance evaluation of DUPIC fuel via irradiation test in HANARO - Post irradiation examination of irradiated fuel and performance analysis - Development of DUPIC fuel performance code (modified ELESTRES) considering material properties of DUPIC fuel - Irradiation behavior and integrity assessment under the design power envelope of DUPIC fuel - Foundamental technology development of thermal/mechanical performance evaluation using ANSYS (FEM package)

  6. End-of-life medical decisions in France: a death certificate follow-up survey 5 years after the 2005 act of parliament on patients' rights and end of life.

    Science.gov (United States)

    Pennec, Sophie; Monnier, Alain; Pontone, Silvia; Aubry, Régis

    2012-12-03

    The "Patients' Rights and End of Life Care" Act came into force in France in 2005. It allows withholding/withdrawal of life-support treatment, and intensified use of medications that may hasten death through a double effect, as long as hastening death is not the purpose of the decision. It also specifies the requirements of the decision-making process. This study assesses the situation by examining the frequency of end-of-life decisions by patients' and physicians' characteristics, and describes the decision-making processes. We conducted a nationwide retrospective study of a random sample of adult patients who died in December 2009. Questionnaires were mailed to the physicians who certified/attended these deaths. Cases were weighted to adjust for response rate bias. Bivariate analyses and logistic regressions were performed for each decision. Of all deaths, 16.9% were sudden deaths with no information about end of life, 12.2% followed a decision to do everything possible to prolong life, and 47.7% followed at least one medical decision that may certainly or probably hasten death: withholding (14.6%) or withdrawal (4.2%) of treatments, intensified use of opioids and/or benzodiazepines (28.1%), use of medications to deliberately hasten death (i.e. not legally authorized) (0.8%), at the patient's request (0.2%) or not (0.6%). All other variables held constant, cause of death, patient's age, doctor's age and specialty, and place of death, influenced the frequencies of decisions. When a decision was made, 20% of the persons concerned were considered to be competent. The decision was discussed with the patient if competent in 40% (everything done) to 86% (intensification of alleviation of symptoms) of cases. Legal requirements regarding decision-making for incompetent patients were frequently not complied with. This study shows that end-of-life medical decisions are common in France. Most are in compliance with the 2005 law (similar to some other European countries

  7. [End-of-life in specialized medical pediatrics department: A French national survey].

    Science.gov (United States)

    Ravanello, Alice; Desguerre, Isabelle; Frache, Sandra; Hubert, Philippe; Orbach, Daniel; Aubry, Régis

    2017-03-01

    In France, most of children die in the hospital. This national survey aimed to achieve better understanding of end-of life care in specialized medical pediatrics departments for children facing the end-of-life, identify the available resources, put forward the difficulties encountered by professionals and describe end-of-life paths of children who died in these departments. This study is based on a nationwide survey conducted among all existing specialized medical pediatrics departments (onco-haematology, neurology, reanimation) in France in 2015. Among 94 specialized medical pediatrics departments in France, 53 participated in our survey (response rate=56%). At the time of the survey, 13% of inpatients were facing the end-of-life. Regarding training, 13% of departments did not have personnel trained in palliative care and 21% did not set up any professional support. However, when taking care of a child's end of life in 2014, 77% of these departments solicited a regional resource team of pediatric palliative care. This survey helps describe 225 end-of-life paths of children decease of a terminal illness in the specialized pediatrics departments. Seventy-two percent suffered from refractory symptoms before their death, 64% were concerned by a terminal sedation and 75% by a limitation of life-sustaining treatment decision. End-of-life care is a reality for specialized pediatrics departments. The frequency of major and refractory symptoms often requires the completion of sedation. The resources of service are acceptable but some deficiencies have been noted especially concerning training and support for caregivers, adaptation of premises or family support. Copyright © 2017. Published by Elsevier SAS.

  8. Labelling of end-of-life decisions by physicians.

    Science.gov (United States)

    Deyaert, Jef; Chambaere, Kenneth; Cohen, Joachim; Roelands, Marc; Deliens, Luc

    2014-07-01

    Potentially life-shortening medical end-of-life practices (end-of-life decisions (ELDs)) remain subject to conceptual vagueness. This study evaluates how physicians label these practices by examining which of their own practices (described according to the precise act, the intention, the presence of an explicit patient request and the self-estimated degree of life shortening)they label as euthanasia or sedation. We conducted a large stratified random sample of death certificates from 2007 (N=6927).The physicians named on the death certificate were approached by means of a postal questionnaire asking about ELDs made in each case and asked to choose the most appropriate label to describe the ELD. Response rate was 58.4%. In the vast majority of practices labelled as euthanasia, the self-reported actions of the physicians corresponded with the definition in the Belgian euthanasia legislation; practices labelled as palliative or terminal sedation lack clear correspondence with definitions of sedation as presented in existing guidelines. In these cases, an explicit life-shortening intention by means of drug administration was present in 21.6%, life shortening was estimated at more than 24 h in 51% and an explicit patient request was absentin 79.7%. Our results suggest that, unlike euthanasia,the concept of palliative or terminal sedation covers abroad range of practices in the minds of physicians. This ambiguity can be a barrier to appropriate sedation practice and indicates a need for better knowledge of the practice of palliative sedation by physicians.

  9. Determination of end-of-life-failure fractions of HTGR-fuel particles by postirradiation annealing and beta autoradiography

    International Nuclear Information System (INIS)

    Thiele, B.A.; Herren, M.

    1978-11-01

    Fission-product contamination of the helium coolant of High-Temperature Gas-Cooled Reactors (HTGR) is strongly influenced by the end-of-life (EOL) failed-particle fraction. Knowledge of the EOL-failure fraction is the basis for model calculations to predict the total fission product release from the reactor core. After disintegration of irradiation fuel rods, fuel particles are placed in individual holes of a graphite tray. During a 5-h heat treatment at 1000 0 C in a helium atmosphere failed particles leak fission products, especially the volatile cesium, into the graphite. After unloading a β-autoradiograph of the tray is made. Holes that housed defective particles are identified from black spots on the β-sensitive film. The EOL-failure fraction is the ratio of defective particles to the total number of particles tested. The technique is called PIAA, PostIrradiation Annealing and Autoradiography. The PIAA technique was applied to particles of a Trisocoated highly-enriched UO 2 fissile batch irradiated to a burnup of 35% FIMA at an irradiation temperature of 1250 0 C. Visual examination showed all particles to be intact. From 11 to 47% of the particles had failed, as determined by PIAA. Further, postirradiation examination showed that localized corrosion of the silicon carbide coating by fission-product rare-earth chlorides had occurred

  10. Improving end-of-life care: Recommendations from the IOM.

    Science.gov (United States)

    Dobbins, Elizabeth H

    2016-09-22

    A 2014 consensus report by the Institute of Medicine offers recommendations for healthcare providers to decrease unwanted care and improve the quality of life at the end of life. This article discusses the recommendations of interest to advanced practice registered nurses.

  11. Communication Matters: Exploring the Intersection of Family and Practitioner End of Life Communication

    Directory of Open Access Journals (Sweden)

    Leah M. Omilion-Hodges

    2017-03-01

    Full Text Available After establishing a baseline understanding of some of the factors that influence and shape family end of life communication, empirical research centered on the communication tendencies of nationally-recognized palliative care clinicians is presented. Because death is no longer confined to the bedroom and individuals are increasingly turning to hospitals and health care institutes to assist with end of life, the role of palliative care practitioners is vital. To that end, common communication-rooted issues that may transpire among various medical personnel are explored. Focus on a shared underlying tension—care vs. cure—links the findings between family and palliative care clinician communication regarding end of life. Practical communication solutions and suggestions are offered to facilitate productive and mindful end of life communication between and among family members and health care practitioners.

  12. Irradiated fuel performance evaluation technology development

    International Nuclear Information System (INIS)

    Koo, Yang Hyun; Bang, J. G.; Kim, D. H.

    2012-01-01

    Alpha version performance code for dual-cooled annular fuel under steady state operation, so called 'DUOS', has been developed applying performance models and proposed methodology. Furthermore, nonlinear finite element module which could be integrated into transient/accident fuel performance code was also developed and evaluated using commercial FE code. The first/second irradiation and PIE test of annular pellet for dual-cooled annular fuel in the world have been completed. In-pile irradiation test DB of annular pellet up to burnup of 10,000 MWd/MTU through the 1st test was established and cracking behavior of annular pellet and swelling rate at low temperature were studied. To do irradiation test of dual-cooled annular fuel under PWR's simulating steady-state conditions, irradiation test rig/rod design/manufacture of mock-up/performance test have been completed through international collaboration program with Halden reactor project. The irradiation test of large grain pellets has been continued from 2002 to 2011 and completed successfully. Burnup of 70,000 MWd/MTU which is the highest burnup among irradiation test pellets in domestic was achieved

  13. Team-Based Models for End-of-Life Care: An Evidence-Based Analysis

    Science.gov (United States)

    2014-01-01

    Background End of life refers to the period when people are living with advanced illness that will not stabilize and from which they will not recover and will eventually die. It is not limited to the period immediately before death. Multiple services are required to support people and their families during this time period. The model of care used to deliver these services can affect the quality of the care they receive. Objectives Our objective was to determine whether an optimal team-based model of care exists for service delivery at end of life. In systematically reviewing such models, we considered their core components: team membership, services offered, modes of patient contact, and setting. Data Sources A literature search was performed on October 14, 2013, using Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid Embase, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), and EBM Reviews, for studies published from January 1, 2000, to October 14, 2013. Review Methods Abstracts were reviewed by a single reviewer and full-text articles were obtained that met the inclusion criteria. Studies were included if they evaluated a team model of care compared with usual care in an end-of-life adult population. A team was defined as having at least 2 health care disciplines represented. Studies were limited to English publications. A meta-analysis was completed to obtain pooled effect estimates where data permitted. The GRADE quality of the evidence was evaluated. Results Our literature search located 10 randomized controlled trials which, among them, evaluated the following 6 team-based models of care: hospital, direct contact home, direct contact home, indirect contact comprehensive, indirect contact comprehensive, direct contact comprehensive, direct, and early contact Direct contact is when team members see the patient; indirect contact is when they advise another health care practitioner (e.g., a family doctor) who sees

  14. Enabling occupation at the end of life: A literature review.

    Science.gov (United States)

    Mills, Katherine; Payne, Angela

    2015-12-01

    Occupation, or meaningful activity, can contribute to the well-being and quality of life of all individuals. It is thus a logical tautology that occupation should be enabled for those at the end of life. Our present review examines current provision of these processes by Occupational Therapist, who can be much-valued members of multidisciplinary palliative care teams. Following a literature search and critical selection, 10 global papers were identified examining occupation and occupational therapy at the end of life in the acute, hospice, and community environments. Universally, there appeared to be a dearth of therapists working in end-of-life care. Provision of palliative care in hospitals was found to be compensatory or rehabilitative. Hospice therapy emerged as pleasingly occupational, though the number of hospice places was disappointingly few. Community literature was sparse, so it proved challenging to draw definitive conclusions. Promising research refracted light on occupation at home; however, it also revealed stretched domiciliary services, where clients are not well informed about the potential scope of occupational therapy. A "good death" involving a quality end-of-life experience is the foundational goal overarching all therapy and medicine in the provision of palliative care. Arguably, an occupation-focused approach provided by therapists meets client needs to enable meaningful experiences in the limited time left to them. Current occupational therapy practice environments are not necessarily achieving these goals in commensurate fashion. There is a need to promote the role of occupational therapy and circumscribe what therapists can offer. Further research is necessitated across all environments and future funding for therapist positions in palliative teams. End-of-life care can be complex and challenging; however, therapists can facilitate fulfillment of client-centered occupational goals. In engaging with personally constructed nuances of meaning

  15. Shared decision-making in end-stage renal disease: a protocol for a multi-center study of a communication intervention to improve end-of-life care for dialysis patients.

    Science.gov (United States)

    Eneanya, Nwamaka D; Goff, Sarah L; Martinez, Talaya; Gutierrez, Natalie; Klingensmith, Jamie; Griffith, John L; Garvey, Casey; Kitsen, Jenny; Germain, Michael J; Marr, Lisa; Berzoff, Joan; Unruh, Mark; Cohen, Lewis M

    2015-06-12

    End-stage renal disease carries a prognosis similar to cancer yet only 20 % of end-stage renal disease patients are referred to hospice. Furthermore, conversations between dialysis team members and patients about end-of-life planning are uncommon. Lack of provider training about how to communicate prognostic data may contribute to the limited number of end-of-life care discussions that take place with this chronically ill population. In this study, we will test the Shared Decision-Making Renal Supportive Care communication intervention to systematically elicit patient and caretaker preferences for end-of-life care so that care concordant with patients' goals can be provided. This multi-center study will deploy an intervention to improve end-of-life communication for hemodialysis patients who are at high risk of death in the ensuing six months. The intervention will be carried out as a prospective cohort with a retrospective cohort serving as the comparison group. Patients will be recruited from 16 dialysis units associated with two large academic centers in Springfield, Massachusetts and Albuquerque, New Mexico. Critical input from patient advisory boards, a stakeholder panel, and initial qualitative analysis of patient and caretaker experiences with advance care planning have informed the communication intervention. Rigorous communication training for hemodialysis social workers and providers will ensure that standardized study procedures are performed at each dialysis unit. Nephrologists and social workers will communicate prognosis and provide advance care planning in face-to-face encounters with patients and families using a social work-centered algorithm. Study outcomes including frequency and timing of hospice referrals, patient and caretaker satisfaction, quality of end-of-life discussions, and quality of death will be assessed over an 18 month period. The Shared Decision-Making Renal Supportive Care Communication intervention intends to improve discussions

  16. Effect of irradiation on nutritional quality of chicken feet with pickled peppers in shelf life

    International Nuclear Information System (INIS)

    Li Shurong; Zhou Linyan; Yi Jianyong; Feng Min; Li Li; Yang Ping; Wang Dening; Gu Guiqiang; Zhu Jiating

    2013-01-01

    The effect of irradiation on nutritional quality of soft packaged chicken feet with pickled peppers within shelf life were investigated. Chicken feet were irradiated by E-beam which max dose was 10 kGy, and all the samples were stored at 0 ∼ 10℃ and analyzed one month after irradiation treatment. Significant sterilizing effect was got for soft packaged chicken feet with pickled peppers by irradiation; The contents of protein and fat were changed after irradiation treatment; the contents of V_A, V_E and V_B_3 in irradiated chicken feet were increased; The total contents of amino acids increased when irradiation dose were more than 4 kGy; The contents of total acids decreased after irradiation treatment, but the contents of cholesterol and nitrite increased. Above all, irradiation treatment can be used to improve nutritional quality of chicken feet with pickled peppers in shelf life. (authors)

  17. Family-centered end-of-life care in the ICU.

    Science.gov (United States)

    Wiegand, Debra L; Grant, Marian S; Cheon, Jooyoung; Gergis, Mary A

    2013-08-01

    Families of older adults are intricately involved in the end-of-life decision-making process for a family member with a serious illness in the intensive care unit (ICU) setting. However, families are not always as involved and as informed as they would like to be. Creating a culture that assesses family needs and supports families is an important component of family-centered care. There are several strategies that nurses and other members of the interdisciplinary team can use to promote family-centered end-of-life care in the ICU. Nurses can get to know the family by spending time talking with them, assessing them, seeking to understand their perspectives on their family member's condition, and discussing previously verbalized patient wishes for care. This article offers strategies nurses can use to help guide the family through the end-of-life decision-making process, support families as difficult and complex decisions are made in collaboration with the health care team, and prepare families for the dying process. Copyright 2013, SLACK Incorporated.

  18. Positive emotion communication: Fostering well-being at end of life.

    Science.gov (United States)

    Terrill, Alexandra L; Ellington, Lee; John, Kevin K; Latimer, Seth; Xu, Jiayun; Reblin, Maija; Clayton, Margaret F

    2018-04-01

    Little is known about positive emotion communication (PEC) in end-of-life care. This study aims to identify types and patterns of PEC among hospice nurses, caregivers, and patients. A coding system based on positive psychology theory was applied as a secondary analysis to audio recordings of hospice nurse home visits with cancer patients and family caregivers, collected as part of a prospective longitudinal study. Eighty recordings (4 visits from 20 triads) were coded for humor, connection, praise, positive focus, gratitude, taking joy/savoring, and perfunctory statements. Descriptive statistics revealed the greatest proportion of PEC was made by nurses. Humor was most frequently used across all speakers. Cluster analysis revealed four PEC visit types: Savor/Take Joy; Humor; Perfunctory; and Other-focused Expressions of Positive Emotions. Linear mixed effect regression was used to estimate the trajectory of PEC over time, but no significant change was found. We found that positive emotions are common in nurse, caregiver and patient communication at end-of-life and do not decline closer to death. This study is among the first to explore PEC at end-of-life, and offers a way to bring strengths-based approaches into end of life communication research. Copyright © 2017 Elsevier B.V. All rights reserved.

  19. Evaluating a Clinical Decision Support Interface for End-of-Life Nurse Care.

    Science.gov (United States)

    Febretti, Alessandro; Stifter, Janet; Keenan, Gail M; Lopez, Karen D; Johnson, Andrew; Wilkie, Diana J

    2014-01-01

    Clinical Decision Support Systems (CDSS) are tools that assist healthcare personnel in the decision-making process for patient care. Although CDSSs have been successfully deployed in the clinical setting to assist physicians, few CDSS have been targeted at professional nurses, the largest group of health providers. We present our experience in designing and testing a CDSS interface embedded within a nurse care planning and documentation tool. We developed four prototypes based on different CDSS feature designs, and tested them in simulated end-of-life patient handoff sessions with a group of 40 nurse clinicians. We show how our prototypes directed nurses towards an optimal care decision that was rarely performed in unassisted practice. We also discuss the effect of CDSS layout and interface navigation in a nurse's acceptance of suggested actions. These findings provide insights into effective nursing CDSS design that are generalizable to care scenarios different than end-of-life.

  20. END-OF-LIFE DECISIONS IN DUTCH NEONATOLOGY

    NARCIS (Netherlands)

    Moratti, Sofia

    2010-01-01

    This contribution describes the regulation of end-of-life decisions in neonatology in the Netherlands. An account is given of the process of formulating rules, which includes a report by the Dutch Association for Paediatrics, two Court rulings, a report by a Consultation Group appointed by the

  1. Palliative and end-of-life care in South Dakota.

    Science.gov (United States)

    Minton, Mary E; Kerkvliet, Jennifer L; Mitchell, Amanda; Fahrenwald, Nancy L

    2014-05-01

    Geographical disparities play a significant role in palliative and end-of-life care access. This study assessed availability of palliative and end of life (hospice) care in South Dakota. Grounded in a conceptual model of advance care planning, this assessment explored whether South Dakota health care facilities had contact persons for palliative care, hospice services, and advance directives; health care providers with specialized training in palliative and hospice care; and a process for advance directives and advance care planning. Trained research assistants conducted a brief telephone survey. Of 668 health care eligible facilities, 455 completed the survey for a response rate of 68 percent (455 out of 668). Over one-half of facilities had no specific contact person for palliative care, hospice services and advance directives. Nursing homes reported the highest percentage of contacts for palliative care, hospice services and advance directives. Despite a lack of a specific contact person, nearly 75 percent of facilities reported having a process in place for addressing advance directives with patients; slightly over one-half (53 percent) reported having a process in place for advance care planning. Of participating facilities, 80 percent had no staff members with palliative care training, and 73 percent identified lack of staff members with end-of-life care training. Palliative care training was most commonly reported among hospice/home health facilities (45 percent). The results of this study demonstrate a clear need for a health care and allied health care workforce with specialized training in palliative and end-of-life care.

  2. Benchmark Analyses on the Natural Circulation Test Performed During the PHENIX End-of-Life Experiments. Final Report of a Co-ordinated Research Project 2008-2011

    International Nuclear Information System (INIS)

    2013-07-01

    The International Atomic Energy Agency (IAEA) supports Member State activities in the area of advanced fast reactor technology development by providing a forum for information exchange and collaborative research programmes. The Agency's activities in this field are mainly carried out within the framework of the Technical Working Group on Fast Reactors (TWG-FR), which assists in the implementation of corresponding IAEA activities and ensures that all technical activities are in line with the expressed needs of Member States. Among its broad range of activities, the IAEA proposes and establishes coordinated research projects (CRPs) aimed at the improvement of Member State capabilities in the area of fast reactor design and analysis. An important opportunity to undertake collaborative research was provided by the experimental campaign of the French Alternative Energies and Atomic Energy Commission (CEA) in the prototype sodium fast reactor PHENIX before it was shut down in 2009. The overall purpose of the end of life tests was to gather additional experience on the operation of sodium cooled reactors. As the CEA opened the experiments to international cooperation, in 2007 the IAEA launched a CRP on ''Control Rod Withdrawal and Sodium Natural Circulation Tests Performed during the PHENIX End-of-Life Experiments''. The CRP, with the participation of institutes from eight countries, contributed to improving capabilities in sodium cooled reactor simulation through code verification and validation, with particular emphasis on temperature and power distribution calculations and the analysis of sodium natural circulation phenomena. The objective of this report is to document the results and main achievements of the benchmark analyses on the natural circulation test performed in the framework of the PHENIX end of life experimental campaign

  3. Economic impact analysis of an end-of-life programme for nursing home residents.

    Science.gov (United States)

    Teo, W-S Kelvin; Raj, Anusha Govinda; Tan, Woan Shin; Ng, Charis Wei Ling; Heng, Bee Hoon; Leong, Ian Yi-Onn

    2014-05-01

    Due to limited end-of-life discussions and the absence of palliative care, hospitalisations are frequent at the end of life among nursing home residents in Singapore, resulting in high health-care costs. Our objective was to evaluate the economic impact of Project Care at the End-of-Life for Residents in homes for the Elderly (CARE) programme on nursing home residents compared to usual end-of-life care. DESIGN AND SETTINGS/PARTICIPANTS: Project CARE was introduced in seven nursing homes to provide advance care planning and palliative care for residents identified to be at risk of dying within 1 year. The cases consisted of nursing home residents enrolled in the Project CARE programme for at least 3 months. A historical group of nursing home residents not in any end-of-life care programme was chosen as the matched controls. Cost differences between the two groups were analysed over the last 3 months and final month of life. The final sample comprised 48 Project CARE cases and 197 controls. Compared to the controls, the cases were older with more comorbidities and higher nursing needs. After risk adjustment, Project CARE cases demonstrated per-resident cost savings of SGD$7129 (confidence interval: SGD$4544-SGD$9714) over the last 3 months of life and SGD$3703 (confidence interval: SGD$1848-SGD$5557) over the last month of life (US$1 = SGD$1.3). This study demonstrated substantial savings associated with an end-of-life programme. With a significant proportion of the population in Singapore requiring nursing home care in the near future, these results could assist policymakers and health-care providers in decision-making on allocation of health-care resources.

  4. The influence of gamma irradiation on shelf-life extension of banana

    International Nuclear Information System (INIS)

    Tiravat, K.

    1971-01-01

    Effect of various doses of gamma radiation on shelf-life extension of Hom Tong banana stored at 17 0 C, 20 0 C, and 23 0 C was described. Irradiated banana stored at 20 0 C and 23 0 C did not show any retardation in ripening. Doses from 20-40 Krad appeared to delay ripening of the banana stored at 17 0 C for 3-5 days. No significant difference in weight losses between irradiated and non-irradiated banana was detected during storage

  5. Reflections on Hope and Its Implications for End-of-Life Care.

    Science.gov (United States)

    Mattes, Malcolm D; Sloane, Michelle A

    2015-05-01

    Physicians caring for individuals with life-altering, incurable illnesses often have a desire to convey a sense of hope while also helping their patients prepare for the end of life to minimize unnecessary suffering and grief. Unfortunately, in the United States, most people receive more-aggressive treatments toward the end of life than studies would suggest that they desire. This reflects the challenging task of balancing optimism and realism, and how providing a false sense of hope for a cure for too long a time while avoiding advance care planning may contribute significantly to the problem. This article explores the interplay of hope and advance care planning, and suggests a need for excellent individualized communication in the setting of advanced cancer to improve end-of-life care. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

  6. Effect of a home-based end-of-life nursing service on hospital use at the end of life and place of death: a study using administrative data and matched controls.

    Science.gov (United States)

    Chitnis, X A; Georghiou, T; Steventon, A; Bardsley, M J

    2013-12-01

    To assess the effect of routinely delivered home-based end-of-life care on hospital use at the end of life and place of death. Retrospective analysis using matched controls and administrative data. Community-based care in England. 29,538 people aged over 18 who received Marie Curie nursing support compared with 29,538 controls individually matched on variables including: age, socioeconomic deprivation, prior hospital use, number of chronic conditions and prior diagnostic history. Home-based end-of-life nursing care delivered by the Marie Curie Nursing Service (MCNS), compared with end-of-life care available to those who did not receive MCNS care. Proportion of people who died at home; numbers of emergency and elective inpatient admissions, outpatient attendances and attendances at emergency departments in the period until death; and notional costs of hospital care. Intervention patients were significantly more likely to die at home and less likely to die in hospital than matched controls (unadjusted OR 6.16, 95% CI 5.94 to 6.38, pnursing for longer. Home-based end-of-life care offers the potential to reduce demand for acute hospital care and increase the number of people able to die at home.

  7. Graduate Students' Reflections on Elder and End-of-Life Care for Prisoners.

    Science.gov (United States)

    Baumann, Steven L; Todaro-Franceschi, Vidette

    2017-07-01

    The focus of this report was graduate nursing students' reflections on elder and end-of-life care for prisoners. The personal reflections of 21 graduate nursing students who attended a presentation by Susan J. Loeb on October 26, 2016 were included in this report. The title of the presentation was "Enhancing End-of-Life Care for Prisoners Through Partnering With the Prison Community." The student essays were synthesized to construct a summary essay, from which four themes were identified: aging in prison, dying in prison, ethical and professional issues in the elder and end-of-life care of prisoners, and ethical and professional issues in research involving elderly and end-of-life care of prisoners. These findings were interpreted from a global perspective in light of two different nursing perspectives: the humanbecoming tradition and the science of unitary human beings.

  8. Good end-of-life care according to patients and their GPs

    NARCIS (Netherlands)

    Borgsteede, Sander D.; Graafland-Riedstra, Corrie; Deliens, Luc; Francke, Anneke L.; van Eijk, Jacques ThM; Willems, Dick L.

    2006-01-01

    BACKGROUND: Most patients prefer to die at home, where a GP provides end-of-life care. A few previous studies have been directed at the GPs' values on good end-of-life care, yet no study combined values of patients and their own GP. AIM: To explore the aspects valued by both patients and GPs in

  9. Good end-of-life care according to patients and their GPs.

    NARCIS (Netherlands)

    Borgsteede, S.D.; Graafland-Riedstra, C.; Deliens, L.; Francke, A.L.; Eijk, J.T.M. van; Willems, D.L.

    2006-01-01

    Background: Most patients prefer to die at home, where a GP provides end-of-life care. A few previous studies have been directed at the GPs' values on good end-of-life care, yet no study combined values of patients and their own GP. Aim: To explore the aspects valued by both patients and GPs in

  10. Recent Analyses of Phenix End of Life Tests and Perspectives

    International Nuclear Information System (INIS)

    Fontaine, B.; Martin, L.; Prulhière, G.; Eschbach, R.; Portier, J.-L.; Masoni, P.; Tauveron, N.; Bavière, R.; Verwaerde, D.; Hamy, J.-M.

    2013-01-01

    Conclusion: • End of Life tests performed at PHENIX in 2009 gathered a lot of information concerning thermalhydraulics, core physics and fuel behavior in SFR cores. • The analysis of these tests is still undergoing for some of them, involving international collaborations. • To better understand the measurements, complex models are developed thanks to recent computer science progress: • thermalhydraulics: coupling CFD and system codes neutronics: - perturbation theory applied to Bateman equations - model of distorted core; • mechanics: fluid-structure interaction. The test results allow to validate these developments, which could be applied in the future for new SFR design

  11. Combined effect of antimicrobial coating and gamma irradiation on shelf-life extension of pre-cooked shrimp (Penaeus spp.)

    International Nuclear Information System (INIS)

    Ouattara, B.; Sabato, S.F.; Lacroix, M.

    2001-01-01

    The present study was conducted to evaluate the combined effect of low-dose gamma irradiation and antimicrobial coating on the shelf life of pre-cooked shrimp (Penaeus spp.). Antimicrobial coatings were obtained by incorporating various concentrations of thyme oil and trans-cinnamaldehyde in coating formulations prepared from soy or whey protein isolates. Coated shrimps were stored at 4±1°C under aerobic conditions and were periodically evaluated for aerobic plate counts (APCs) and Pseudomonas putida. Sensory evaluations were performed for appearance, odor, and taste using a hedonic test. Results showed that gamma irradiation and coating treatments had synergistic effects (p < = 0.05) in reducing the APCs and P. putida with at least a 12-day extension of shelf life. Without irradiation, the inhibitory effects of the coating solutions were closely related to the concentration of thyme oil and trans-cinnamaldehyde. No detrimental effects of gamma irradiation on organoleptic parameters (appearance, odor, and taste) were observed. However, incorporation of thyme oil and trans-cinnamaldehyde reduced the acceptability scores for taste and odor

  12. Refrigerated poultry breast fillets packed in modified atmosphere and irradiated: bacteriological evaluation, shelf life and sensory acceptance

    Directory of Open Access Journals (Sweden)

    Samira Pirola Santos Mantilla

    2012-12-01

    Full Text Available In the present study the effects on shelf life and sensory acceptance of gamma-irradiated refrigerated poultry breast fillets subjected to modified atmosphere packaging (80% CO2/20% N2 or vacuum were investigated. After irradiation with 2 kGy, sensory acceptance tests and monitoring of bacterial growth were performed in order to determine the sanitary quality of the samples. It has been found that irradiation, used in combination with modified atmosphere packaging, can double the shelf life of refrigerated poultry breast fillets by reducing the populations of aerobic mesophilic and psychrotrophic bacteria, enterobacteria, coliforms, Listeria spp. and Aeromonas spp., without significantly modifying its color or its overall appearance, the lactic acid bacteria being the most resistant to exposure to radiation and carbon dioxide.

  13. A Multinational perspective to managing end-of-life electronics

    Energy Technology Data Exchange (ETDEWEB)

    Herold, M.

    2007-07-01

    This thesis focuses on how multinational electronics manufacturers manage used products in the EU, USA, Japan and China. Managing used or end-of-life products has interesting environmental and commercial implications. Recovering end-of-life products can reduce the environmental effects of disposal, raw material extraction, transport, and production. Whereas the commercial effects include image benefits and savings on raw material costs. Manufacturer involvement in end-of-life management is especially topical in the electronics industry, which is the focus of this thesis. Electronics products, such as TVs and computers, have been targeted with extended producer responsibility (EPR) legislation in different countries across the world. EPR is an environmental policy approach that forces manufacturers to take physical and/or financial responsibility for end-of-life products. The main objective of this dissertation was to increase understanding of how multinational manufacturers manage end-of-life products in the EU, in the USA, and in China and Japan, and the regional and company-specific factors explain their levels of involvement. This study consisted of an inductive 16-case multiple case study. The products and companies included in the study were as follows: Refrigerators (Bosch und Siemens Hausgeraete, Electrolux, Whirlpool); TVs (Samsung, Philips, Hitachi); PCs (Hewlett Packard, NEC, Fujitsu Limited and Fujitsu-Siemens Computers and an anonymous company, Alpha Computers); Mobile phones (Nokia, Motorola, Samsung); Telecommunication network equipment (Nokia, Motorola, Huawei). A manufacturer's level of involvement in end-of-life management can be characterized in terms of the level of organizational capabilities. These capabilities range from none to running a treatment facility and recovering value from own branded products. Levels in between can be characterized by outsourcing end-of-life management to industry-wide schemes, managing contracts for treating

  14. Euthanasia and other end-of-life decisions: a mortality follow-back study in Belgium

    Directory of Open Access Journals (Sweden)

    Bossuyt Nathalie

    2009-03-01

    Full Text Available Abstract Background This study compares prevalence and types of medical end-of-life decisions between the Dutch-speaking and French-speaking communities of Belgium. This is the first nationwide study that can make these comparisons and the first measurement after implementation of the euthanasia law (2002. Methods We performed a mortality follow-back study in 2005–2006. Data were collected via the nationwide Sentinel Network of General Practitioners, an epidemiological surveillance system representative of all Belgian GPs. Weekly, all GPs reported the medical end-of-life decisions among all non-sudden deaths of patients in their practice. We compared the northern Dutch-speaking (60% and southern French-speaking communities (40% controlling for population differences. Results We analysed 1690 non-sudden deaths. An end-of-life decision with possible life-shortening effect was made in 50% of patients in the Dutch-speaking community and 41% of patients in the French-speaking community (OR 1.4; 95%CI, 1.2 to 1.8. Continuous deep sedation until death occurred in 8% and 15% respectively (OR 0.5; 95%CI, 0.4 to 0.7. Community differences regarding the prevalence of euthanasia or physician-assisted suicide were not significant. Community differences were more present among home/care home than among hospital deaths: non-treatment decisions with explicit life-shortening intention were made more often in the Dutch-speaking than in the French-speaking community settings (OR 2.2; 95%CI, 1.2 to 3.9; while continuous deep sedation occurred less often in the Dutch-speaking community settings (OR 0.5; 95%CI, 0.3 to 0.9. Conclusion Even though legal and general healthcare systems are the same for the whole country, there are considerable variations between the communities in type and prevalence of certain end-of-life decisions, even after controlling for population differences.

  15. Preferences for autonomy in end-of-life decision making in modern Korean society.

    Science.gov (United States)

    Kim, Su Hyun

    2015-03-01

    The demand for autonomy in medical decision making is increasing among Korean people, but it is not well known why some people prefer autonomy in decision making but others do not. The aim of this study was to determine the extent to which Korean adults wished to exercise autonomy in the process of decision making regarding end-of-life treatment and to determine whether economic issues and family functioning, in particular, were associated with preferences for participation in decision making in Korean people. This study was a cross-sectional correlational study using a survey. Data were collected using structured questionnaires from 354 patients or their families who visited ambulatory departments at two general hospitals in South Korea, recruited by the proportionate quota sampling method. Data analysis was performed using multinomial logistic regression analyses. The study was approved by the hospitals' directors and the ethics committee of Kyungpook National University Hospital. Written informed consent was given by all participants. A majority of Korean people wanted to make autonomous decisions regarding treatment at the end of life. Preferences for autonomous decision making regarding end-of-life treatment, rather than relying on family, showed a significant increase in association with poor family functioning and low income. Results of this study suggested the necessity for development of alternatives to a dominant traditional "family-centered" approach in Korean people, in order to enhance end-of-life decision making for people who wish to take an active role in the decision-making process. Healthcare providers need to examine not only patients' preferred decision-making style but also any reasons for their choice, in particular, family conflict and financial burden. © The Author(s) 2014.

  16. The significance of end-of-life dreams and visions.

    Science.gov (United States)

    Grant, Pei; Wright, Scott; Depner, Rachel; Luczkiewicz, Debra

    End-of-life dreams and visions (ELDVs) have been well documented through history and across cultures. They appear to affect both dying people and their families deeply, and may be a source of profound meaning and comfort. The aims of the study were to; document hospice patients' ELDV experiences over time using a daily survey, examine the content and subjective significance of ELDVs, and relate the prevalence, content and significance of end-of-life experiences over time until death. Patients (n = 66) in a hospice inpatient unit, between January 2011 and July 2012, were interviewed daily. The interview contained closed questions about the content, frequency and level of comfort or distress of dreams and visions. Most participants reported at least one dream or vision and almost half of the dreams and visions occurred during sleep. Nearly all patients reported that their experience felt real. The most common content featured deceased friends and relatives, followed by living friends and relatives. As participants approached death, comforting dreams and visions of the deceased became more prevalent. End-of-life dreams and visions are commonly experienced during dying. These dreams and visions may be a profound source of potential meaning and comfort to the dying.

  17. Attitudes of Dutch nurses towards their involvement in end-of-life decisions with a possible life-shortening effect.

    NARCIS (Netherlands)

    Albers, G.; Francke, A.L.; Veer, A.J. de; Onwuteaka-Philipsen, B.D.

    2012-01-01

    Background: Nurses are often involved in end-of-life decision making as they play an important role in caring for terminally ill patients. Aim: To investigate nurses’ attitudes towards their involvement in end-of-life decisions with a possible lifeshortening effect, and a possible relationship with

  18. End-of-life care in the general wards of a Singaporean hospital: an Asian perspective.

    Science.gov (United States)

    Phua, Jason; Kee, Adrian Chin-Leong; Tan, Adeline; Mukhopadhyay, Amartya; See, Kay Choong; Aung, Ngu Wah; Seah, Angeline S T; Lim, Tow Keang

    2011-12-01

    Despite international differences in cultural perspectives on end-of-life issues, little is known of the care for the dying in the general wards of acute hospitals in Asia. We performed a retrospective medical chart review of all 683 adult patients who died without intensive care unit (ICU) admission in our Singaporean hospital in 2007. We first evaluated the prevalence of do-not-resuscitate (DNR) orders and orders for or against life-sustaining therapies; second, if such orders were discussed with the patients and/or family members; and third, the actual treatments provided before death. There were DNR orders for 66.2% of patients and neither commitment for DNR nor cardiopulmonary resuscitation (CPR) for 28.1%. Orders to limit life-sustaining therapies, including ICU admission, intubation, and vasopressors/inotropes were infrequent. Only 6.2% of the alert and conversant patients with DNR orders were involved in discussions on these orders. In contrast, such discussions with their family members occurred 82.9% of the time. Interventions in the last 24 hours of life included CPR (9.4%), intubation (6.4%), vasopressors/inotropes (14.8%), tube feeding (24.7%), and antibiotics (44.9%). Analgesia was provided in 29.1% of patients. There was a lack of commitment by doctors on orders for DNR/CPR and to limit life-sustaining therapies, infrequent discussions with patients on end-of-life decisions, and excessive burdensome interventions with inadequate palliative care for the dying. These findings may reflect certain Asian cultural biases. More work is required to improve our quality of end-of-life care.

  19. Life table of grape phylloxera on some irradiated in vitro cultured rootstocks

    International Nuclear Information System (INIS)

    Makee, H.; Charbaji, T.; Ayyoubi, Z.; Idris, I.

    2007-08-01

    The life table of local strain of grape phylloxera on the most commonly used rootstocks; Ru140, R99 and 3309 C and one local variety Helwani, which were in vitro cultured and treated with low doses of gamma irradiation was determined. Additionally, the effect of different concentrations of IAA on reproduction and development of phylloxera, which infested the roots of our local grape variety Helwani, was evaluated. Our results showed that the life table of grape phylloxera was different between irradiated and unirradiated in vitro plants. The survival, fecundity and developmental time were reduced by applying irradiation. Thus, low doses of gamma irradiation increased grape resistance to phylloxera. The was a positive effect of of IAA on the resistance of Helwani to phylloxera when it was infested at old age (80-d-old). However, the susceptible of Helwani to phlloxera was increased when it was infested at young age (40-d-old). The present study provides good information on the possibility of using irradiation and hormone to increase the resistance of grape to phylloxera.(author)

  20. Culturally Diverse Communities and End-of-Life Care

    Science.gov (United States)

    ... Azen, S.P. (1995). Ethnicity and attitudes toward patient autonomy. JAMA, 274, 820-5 . Phipps, E., True, G., & ... briefly about end-of-life options and neglect culture or values (Tulsky, Fischer, Rose, & Arnold, 1998). Speaking ...

  1. Haemodialysis patients and end-of-life decisions: a theory of personal preservation.

    Science.gov (United States)

    Calvin, Amy Olivier

    2004-06-01

    Lack of knowledge about the end-of-life treatment preferences of patients undergoing haemodialysis is problematic in the acute care setting as, often, patients are unable to communicate their treatment wishes effectively and have not previously documented their desires in the form of advance directives. Existing theoretical models offer an incomplete explanation of end-of-life treatment decisions in haemodialysis patients. This paper reports a study exploring decisions about end-of-life treatment (e.g. cardiopulmonary resuscitation, mechanical ventilation) in people with kidney failure undergoing haemodialysis. Grounded theory was used. Theoretical sampling led to selection of 20 haemodialysis patients (11 men and nine women with a mean age of 56) who attended three dialysis outpatient centres in central Texas. They were interviewed about end-of-life treatment plans and the use of advance directives (i.e. living wills and durable powers of attorney for health care). Interviews, transcripts and field notes from the first 12 patients were analysed by making constant comparisons. The remaining eight interviews were used for validation purposes. Data collection and analysis spanned the years 1997-2000. When prompted to think about and discuss end-of-life treatments, haemodialysis patients chose to focus on living rather than dying. A substantive theory of 'personal preservation' was developed. This consists of three phases: knowing the odds for survival, defining individuality (beating the odds, discovering meaning, being optimistic and having faith in a higher force) and personal preservation (being responsible and taking chances). The theory of personal preservation furthers understanding of illness behaviour and the process by which patients make decisions about end-of-life treatments. It can be used to sensitize health care professionals to patients' desires and to enhance patient-professional communication.

  2. Can Playing an End-of-Life Conversation Game Motivate People to Engage in Advance Care Planning?

    Science.gov (United States)

    Van Scoy, Lauren J; Green, Michael J; Reading, Jean M; Scott, Allison M; Chuang, Cynthia H; Levi, Benjamin H

    2017-09-01

    Advance care planning (ACP) involves several behaviors that individuals undertake to prepare for future medical care should they lose decision-making capacity. The goal of this study was to assess whether playing a conversation game could motivate participants to engage in ACP. Sixty-eight English-speaking, adult volunteers (n = 17 games) from communities around Hershey, Pennsylvania, and Lexington, Kentucky, played a conversation card game about end-of-life issues. Readiness to engage in 4 ACP behaviors was measured by a validated questionnaire (based on the transtheoretical model) immediately before and 3 months postgame and a semistructured phone interview. These behaviors were (1) completing a living will; (2) completing a health-care proxy; (3) discussing end-of-life wishes with loved ones; and (4) discussing quality versus quantity of life with loved ones. Participants' (n = 68) mean age was 51.3 years (standard deviation = 0.7, range: 22-88); 94% of the participants were caucasian and 67% were female. Seventy-eight percent of the participants engaged in ACP behaviors within 3 months of playing the game (eg, updating documents, discussing end-of-life issues). Furthermore, 73% of the participants progressed in stage of change (ie, readiness) to perform at least 1 of the 4 behaviors. Scores on measures of decisional balance and processes of change increased significantly by 3 months postintervention. This pilot study found that individuals who played a conversation game had high rates of performing ACP behaviors within 3 months. These findings suggest that using a game format may be a useful way to motivate people to perform important ACP behaviors.

  3. End-of-life training for paid carers working with people with learning disabilities.

    Science.gov (United States)

    Codling, Mary; Knowles, Jane; Vevers, Ann

    2014-04-01

    People with learning disabilities are living longer lives. Over the past few years, research has explored the needs of people with learning disabilities, their families and learning disability professionals in relation to end-of-life care and death. However, little is known about the needs of paid carers and their experience of end-of-life care. This article discusses the development, implementation and evaluation of a study day about end-of-life care that was delivered to paid carers on two separate occasions in Berkshire Healthcare NHS Foundation Trust. A total of 43 paid carers attended and the days were well evaluated. The need for further training for paid carers who work with people with learning disabilities at the end of life was highlighted.

  4. Simulation-based end-of-life care training during surgical clerkship: assessment of skills and perceptions.

    Science.gov (United States)

    Parikh, Priti P; Brown, Ronald; White, Mary; Markert, Ronald J; Eustace, Rosemary; Tchorz, Kathryn

    2015-06-15

    Assessment of interpersonal and psychosocial competencies during end-of-life care training is essential. This study reports the relationship between simulation-based end-of-life care Objective Structured Clinical Examination ratings and communication skills, trust, and self-assessed empathy along with the perceptions of students regarding their training experiences. Medical students underwent simulation-based end-of-life care OSCE training that involved standardized patients who evaluated students' communication skills and physician trust with the Kalamazoo Essential Elements Communication Checklist and the Wake Forest Physician Trust Scale. Students also completed the Jefferson Scale of Physician Empathy. Pearson correlation was used to examine the relationship between OSCE performance grades and communication, trust, and empathy scores. Student comments were analyzed using the constant comparative method of analysis to identify dominant themes. The 389 students (mean age 26.6 ± 2.8 y; 54.5% female) had OSCE grades that were positively correlated with physician trust scores (r = 0.325, P training to be a valuable learning experience and appreciated its placement early in clinical training. We found that simulation-based OSCE training in palliative and end-of-life care can be effectively conducted during a surgery clerkship. Moreover, the standardized patient encounters combined with the formal assessment of communication skills, physician trust, and empathy provide feedback to students at an early phase of their professional life. The positive and appreciative comments of students regarding the opportunity to practice difficult patient conversations suggest that attention to these professional characteristics and skills is a valued element of clinical training and conceivably a step toward better patient outcomes and satisfaction. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Assessment and Treatment Considerations for Post Traumatic Stress Disorder at End of Life.

    Science.gov (United States)

    Glick, Debra M; Cook, Joan M; Moye, Jennifer; Kaiser, Anica Pless

    2018-01-01

    Post traumatic stress disorder (PTSD) may first emerge, reemerge, or worsen as individuals approach end of life and may complicate the dying process. Unfortunately, lack of awareness of the occurrence and/or manifestation of PTSD at end of life can lead to PTSD going unaddressed. Even if PTSD is properly diagnosed, traditional evidence-based trauma-focused treatments may not be feasible or advisable with this group as many patients at end of life often lack the physical and mental stamina to participate in traditional psychotherapy. This article reviews the clinical and empirical literature on PTSD at end of life, as well as discusses assessment and psychotherapy treatment issues with this neglected population. In addition, it expands on the current reviews of this literature 1-3 by extrapolating results from nontraditional treatment approaches with other patient populations. Elements of these approaches with patients sharing similar characteristics and/or comorbidities with patients with PTSD at end of life may provide additional benefits for the latter population. Clinical implications and suggestions for interdisciplinary care providers are provided.

  6. Study on shelf life extension of papayas irradiated by /sup 60/Co gamma-rays

    Energy Technology Data Exchange (ETDEWEB)

    Chang, M.S.; Chen, M.D.; Lin, C.T.; Fu, Y.K.

    1984-11-01

    Papayas are one of the main fresh fruits in Taiwan area. Papaya fruits were treated with hot water to pasteurize peels followed by /sup 60/Co gamma-ray irradiation to extend the ripening time. The purpose of synergetic methods is to extend the shelf life of papaya fruits. This experiment was carried out by seven treatments, which were: (1) control group, (2) hot water treatment only, (3) hot water treatment with a 25 krad ..gamma..-irradiation, (4) hot water treatment with a 50 krad ..gamma..-irradiation, (5) hot water treatment with a 75 krad ..gamma..-irradiation, (6) 75 krad ..gamma..-irradiation only, and (7) hot water treatment with a 100 krad ..gamma..-irradiation. The items of observation were: surface yellowing, surface decaying, quality of texture, and length of period lasted after irradiation for 50% marketable papayas. The results of this study showed that a shelf-life extension of six days could be obtained for papayas subjected to hot water (50 to 55/sup 0/C) treatment and a 100 krad irradiation. 3 refs., 2 figs., 2 tabs.

  7. Life table of grape phylloxera on some irradiated in vitro cultured rootstocks

    International Nuclear Information System (INIS)

    Makee, H.; Charbaji, T.; Ayyoubi, Z.; Idris, I.

    2008-01-01

    The life table of local strain of grape phylloxera on the most commonly used rootstocks: Ru140, R99 and 3309C and one local variety ''Helwani'' which were in vitro cultured and treated with low doses of gamma irradiation was determined. Additionally, the effect of different concentrations of IAA on reproduction and development of phylloxera, which infested the roots of our local grape variety H elwani , was evaluated. Our results showed that the life table of grape phylloxera was different between irradiated and unirradiated in vitro plants. The survival, fecundity and developmental time were reduced by applying irradiation. Thus, low doses of gamma irradiation increased grape resistance to phylloxera. There was a positive effect of IAA on the resistance of ''Helwani'' to phylloxera when it was infested at old age (80-d-old). However, the susceptible of ''Helwani'' to phylloxera was increased when it was infested at young age (40-d-old). (author)

  8. How Islam Influences End-of-Life Care: Education for Palliative Care Clinicians.

    Science.gov (United States)

    Leong, Madeline; Olnick, Sage; Akmal, Tahara; Copenhaver, Amanda; Razzak, Rab

    2016-12-01

    According to the Joint Commission, cultural competency is a core skill required for end-of-life care. Religious and cultural beliefs predominantly influence patients' lives, especially during the dying process. Therefore, palliative care clinicians should have at least a basic understanding of major world religions. Islam is a major world religion with 1.7 billion followers. At our institution, a needs assessment showed a lack of knowledge with Islamic teachings regarding end-of-life care. To improve knowledge of clinically relevant Islamic teachings regarding end-of-life care. After consultation with a Muslim chaplain, we identified key topics and created a 10-question pretest. The pretest was administered, followed by a one-hour educational intervention with a Muslim chaplain. Next, a post-test (identical to the pretest) was administered. Eleven palliative care clinicians participated in this study. The average score on the pretest was 6.0 ± 1.2 (mean + SD) (maximum 10). After the educational intervention, the average score improved to 9.6 ± 0.7 (95% CI 2.7-4.4; P Islam influences patients' end-of-life decisions. In this pilot study, a one-hour educational intervention improved knowledge of Islamic teachings regarding end-of-life care. We present a framework for this intervention, which can be easily replicated. We also provide key teaching points on Islam and end-of-life care. Additional research is necessary to determine the clinical effects of this intervention over time and in practice. In the future, we plan to expand the educational material to include other world religions. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  9. Typology of end-of-life priorities in Saudi females: averaging analysis and Q-methodology

    Directory of Open Access Journals (Sweden)

    Hammami MM

    2016-05-01

    Full Text Available Muhammad M Hammami,1,2 Safa Hammami,1 Hala A Amer,1 Nesrine A Khodr1 1Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Centre, 2College of Medicine, Alfaisal University, Riyadh, Saudi Arabia Background: Understanding culture-and sex-related end-of-life preferences is essential to provide quality end-of-life care. We have previously explored end-of-life choices in Saudi males and found important culture-related differences and that Q-methodology is useful in identifying intraculture, opinion-based groups. Here, we explore Saudi females’ end-of-life choices.Methods: A volunteer sample of 68 females rank-ordered 47 opinion statements on end-of-life issues into a nine-category symmetrical distribution. The ranking scores of the statements were analyzed by averaging analysis and Q-methodology.Results: The mean age of the females in the sample was 30.3 years (range, 19–55 years. Among them, 51% reported average religiosity, 78% reported very good health, 79% reported very good life quality, and 100% reported high-school education or more. The extreme five overall priorities were to be able to say the statement of faith, be at peace with God, die without having the body exposed, maintain dignity, and resolve all conflicts. The extreme five overall dis-priorities were to die in the hospital, die well dressed, be informed about impending death by family/friends rather than doctor, die at peak of life, and not know if one has a fatal illness. Q-methodology identified five opinion-based groups with qualitatively different characteristics: “physical and emotional privacy concerned, family caring” (younger, lower religiosity, “whole person” (higher religiosity, “pain and informational privacy concerned” (lower life quality, “decisional privacy concerned” (older, higher life quality, and “life quantity concerned, family dependent” (high life quality, low life satisfaction. Out of the

  10. Age-based disparities in end-of-life decisions in Belgium: a population-based death certificate survey.

    Science.gov (United States)

    Chambaere, Kenneth; Rietjens, Judith A C; Smets, Tinne; Bilsen, Johan; Deschepper, Reginald; Pasman, H Roeline W; Deliens, Luc

    2012-06-18

    A growing body of scientific research is suggesting that end-of-life care and decision making may differ between age groups and that elderly patients may be the most vulnerable to exclusion of due care at the end of life. This study investigates age-related disparities in the rate of end-of-life decisions with a possible or certain life shortening effect (ELDs) and in the preceding decision making process in Flanders, Belgium in 2007, where euthanasia was legalised in 2002. Comparing with data from an identical survey in 1998 we also study the plausibility of the 'slippery slope' hypothesis which predicts a rise in the rate of administration of life ending drugs without patient request, especially among elderly patients, in countries where euthanasia is legal. We performed a post-mortem survey among physicians certifying a large representative sample (n = 6927) of death certificates in 2007, identical to a 1998 survey. Response rate was 58.4%. While the rates of non-treatment decisions (NTD) and administration of life ending drugs without explicit request (LAWER) did not differ between age groups, the use of intensified alleviation of pain and symptoms (APS) and euthanasia/assisted suicide (EAS), as well as the proportion of euthanasia requests granted, was bivariately and negatively associated with patient age. Multivariate analysis showed no significant effects of age on ELD rates. Older patients were less often included in decision making for APS and more often deemed lacking in capacity than were younger patients. Comparison with 1998 showed a decrease in the rate of LAWER in all age groups except in the 80+ age group where the rate was stagnant. Age is not a determining factor in the rate of end-of-life decisions, but is in decision making as patient inclusion rates decrease with old age. Our results suggest there is a need to focus advance care planning initiatives on elderly patients. The slippery slope hypothesis cannot be confirmed either in general or

  11. QUALITY OF LIFE OF PATIENTS WITH END-STOMA IN MEDAN: A PHENOMENOLOGICAL STUDY

    Directory of Open Access Journals (Sweden)

    Fahrizal Alwi

    2018-02-01

    Full Text Available Background: Colorectal cancer continues to be a serious problem in Indonesia. A common colorectal treatment is surgical removal of the diseased colon, followed by the creation of a colostomy through the abdominal wall to bypass the colorectal function of emptying waste products. Those who require permanent colostomy are likely to have quality of life issues impacting their physical, psychological, social, and spiritual needs. There issues impact persons’ life satisfaction, happiness, and overall quality of life. Objective: The aim of study was to describe the experiences of patients with end-stoma regarding their quality of life. Methods: The study design used descriptive phenomenology following the approach of Collaizzi. There were 12 participants who qualified using purposive sampling based on the inclusion criteria. The data were gathered in-depth interviews. Analysis and interpretation used verbatim descriptions in Bahasa Indonesia and subsequently translated into English language. Results: The research emerged seven themes, namely: (i becoming limited in doing daily activity, (ii having limitation during sexual and social intercourse, (iii having various negative feelings after the existence of end-stoma, (iv having financial difficulties, (v attempting to survive with end-stoma, (vi experiencing changes in fulfilling rest and sleep, physic, and complication, and (vii having expectation which has to be achieved after having end-stoma. Conclusion: The results show that patients with end-stoma run into spiritual, social, psychological and physical disorder that affect the quality of their life. This study provides an understanding of the quality of life of patients with end-stoma and nurses are able to provide appropriate nursing care.

  12. Ethics of End of Life Decisions in Pediatrics: A Narrative Review of the Roles of Caregivers, Shared Decision-Making, and Patient Centered Values

    Directory of Open Access Journals (Sweden)

    Jonathan D. Santoro

    2018-04-01

    Full Text Available Background: This manuscript reviews unique aspects of end of life decision-making in pediatrics. Methods: A narrative literature review of pediatric end of life issues was performed in the English language. Results: While a paternalistic approach is typically applied to children with life-limiting medical prognoses, the cognitive, language, and physical variability in this patient population is wide and worthy of review. In end of life discussions in pediatrics, the consideration of a child’s input is often not reviewed in depth, although a shared decision-making model is ideal for use, even for children with presumed limitations due to age. This narrative review of end of life decision-making in pediatric care explores nomenclature, the introduction of the concept of death, relevant historical studies, limitations to the shared decision-making model, the current state of end of life autonomy in pediatrics, and future directions and needs. Although progress is being made toward a more uniform and standardized approach to care, few non-institutional protocols exist. Complicating factors in the lack of guidelines include the unique facets of pediatric end of life care, including physical age, paternalism, the cognitive and language capacity of patients, subconscious influencers of parents, and normative values of death in pediatrics. Conclusions: Although there have been strides in end of life decision-making in pediatrics, further investigation and research is needed in this field.

  13. Ethics of End of Life Decisions in Pediatrics: A Narrative Review of the Roles of Caregivers, Shared Decision-Making, and Patient Centered Values.

    Science.gov (United States)

    Santoro, Jonathan D; Bennett, Mariko

    2018-04-26

    Background: This manuscript reviews unique aspects of end of life decision-making in pediatrics. Methods: A narrative literature review of pediatric end of life issues was performed in the English language. Results: While a paternalistic approach is typically applied to children with life-limiting medical prognoses, the cognitive, language, and physical variability in this patient population is wide and worthy of review. In end of life discussions in pediatrics, the consideration of a child’s input is often not reviewed in depth, although a shared decision-making model is ideal for use, even for children with presumed limitations due to age. This narrative review of end of life decision-making in pediatric care explores nomenclature, the introduction of the concept of death, relevant historical studies, limitations to the shared decision-making model, the current state of end of life autonomy in pediatrics, and future directions and needs. Although progress is being made toward a more uniform and standardized approach to care, few non-institutional protocols exist. Complicating factors in the lack of guidelines include the unique facets of pediatric end of life care, including physical age, paternalism, the cognitive and language capacity of patients, subconscious influencers of parents, and normative values of death in pediatrics. Conclusions: Although there have been strides in end of life decision-making in pediatrics, further investigation and research is needed in this field.

  14. Nurses' autonomy in end-of-life situations in intensive care units.

    Science.gov (United States)

    Paganini, Maria Cristina; Bousso, Regina Szylit

    2015-11-01

    The intensive care unit environment focuses on interventions and support therapies that prolong life. The exercise by nurses of their autonomy impacts on perception of the role they assume in the multidisciplinary team and on their function in the intensive care unit context. There is much international research relating to nurses' involvement in end-of-life situations; however, there is a paucity of research in this area in Brazil. In the Brazilian medical scenario, life support limitation generated a certain reluctance of a legal nature, which has now become unjustifiable with the publication of a resolution by the Federal Medical Council. In Brazil, the lack of medical commitments to end-of-life care is evident. To understand the process by which nurses exercise autonomy in making end-of-life decisions in intensive care units. Symbolic Interactionism and Corbin and Strauss theory methodology were used for this study. Data were collected through single audio-recorded qualitative interviews with 14 critical care nurses. The comparative analysis of the data has permitted the understanding of the meaning of nurse's experience in exercising autonomy relating to end-of-life decision-making. Institutional ethics approval was obtained for data collection. Participants gave informed consent. All data were anonymized. The results revealed that nurses experience the need to exercise autonomy in intensive care units on a daily basis. Their experience expressed by the process of increase opportunities to exercise autonomy is conditioned by the pressure of the intensive care unit environment, in which nurses can grow, feel empowered, and exercise their autonomy or else can continuously depend on the decisions made by other professionals. Nurses exercise their autonomy through care. They work to create new spaces at the same time that they acquire new knowledge and make decisions. Because of the complexity of the end-of-life situation, nurses must adopt a proactive attitude

  15. A relational ethical approach to end-of-life delirium.

    Science.gov (United States)

    Wright, David Kenneth; Brajtman, Susan; Macdonald, Mary Ellen

    2014-08-01

    Delirium is a condition of acute onset and fluctuating course in which a person's level of consciousness and cognition become disturbed. Delirium is a common and distressing phenomenon in end-of-life care, yet it is underrecognized and undertreated. In this article, we review qualitative descriptions of the delirium experience in end-of-life care, found through a systematic search of academic databases, to generate insight into the intersubjective nature of the delirium experience. Our analysis of retrieved studies advances an understanding of the relational ethical dimensions of this phenomenon, that is, how delirium is lived by patients, families, and health care providers and how it affects the relationships and values at stake. We propose three themes that explain the distressing nature of delirium in palliative care: 1) experiences of relational tension; 2) challenges in recognizing the delirious person; and 3) struggles to interpret the meaning of delirious behaviors. By approaching end-of-life delirium from a perspective of relational ethics, attention is focused on the implications for the therapeutic relationship with patients and families when delirium becomes part of the dying trajectory. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  16. Team Leadership and Cancer End-of-Life Decision Making.

    Science.gov (United States)

    Waldfogel, Julie M; Battle, Dena J; Rosen, Michael; Knight, Louise; Saiki, Catherine B; Nesbit, Suzanne A; Cooper, Rhonda S; Browner, Ilene S; Hoofring, Laura H; Billing, Lynn S; Dy, Sydney M

    2016-11-01

    End-of-life decision making in cancer can be a complicated process. Patients and families encounter multiple providers throughout their cancer care. When the efforts of these providers are not well coordinated in teams, opportunities for high-quality, longitudinal goals of care discussions can be missed. This article reviews the case of a 55-year-old man with lung cancer, illustrating the barriers and missed opportunities for end-of-life decision making in his care through the lens of team leadership, a key principle in the science of teams. The challenges demonstrated in this case reflect the importance of the four functions of team leadership: information search and structuring, information use in problem solving, managing personnel resources, and managing material resources. Engaging in shared leadership of these four functions can help care providers improve their interactions with patients and families concerning end-of-life care decision making. This shared leadership can also produce a cohesive care plan that benefits from the expertise of the range of available providers while reflecting patient needs and preferences. Clinicians and researchers should consider the roles of team leadership functions and shared leadership in improving patient care when developing and studying models of cancer care delivery.

  17. Training Providers and Patients to Talk about End-of-Life Care

    Science.gov (United States)

    Failing to discuss the transition from active cancer treatment to end-of-life care can leave doctors unsure of what a patient truly wants. Failing to receive end-of-life care in line with their values and wishes can cause patients and their families great distress. Researchers have developed innovative, evidence-based programs to help doctors and patients improve their communication skills and grow comfortable with these discussions.

  18. End-of-Life Inventory Decisions of Service Parts

    NARCIS (Netherlands)

    M. Pourakbar (Morteza)

    2011-01-01

    textabstractWith the spurt of technology and innovation the life cycles of parts and products have become shorter and service parts enter their final phases earlier. Final phase of a typical service part starts once the part production is ceased and ends when the last service or warranty contract

  19. Use of opioids and sedatives at End-of-Life

    Directory of Open Access Journals (Sweden)

    Shin Wei Sim

    2014-01-01

    Full Text Available Despite their proven efficacy and safety, opioid and sedative use for palliation in patients afflicted with cancer in Singapore have been shown to be a fraction of that in other countries. This paper explores the various psychosocial and system-related factors that appear to propagate this conservative approach to care in what is largely a western-influenced care practice. A search for publications relating to sedative and opioid usage in Asia was performed on PubMed, Google, Google Scholar, World Health Organization, and Singapore′s government agency websites using search terms such as "opioids," "sedatives," "palliation," "end-of-life-care," "pain management," "palliative care," "cancer pain," "Asia," "Singapore," and "morphine." Findings were classified into three broad groups - system-related, physician-related, and patient-related factors. A cautious medico-legal climate, shortage of physicians trained in palliative care, and lack of instruments for symptom assessment of patients at the end of life contribute to system-related barriers. Physician-related barriers include delayed access to palliative care due to late referrals, knowledge deficits in non-palliative medicine physicians, and sub-optimal care provided by palliative physicians. Patients′ under-reporting of symptoms and fear of addiction, tolerance, and side effects of opioids and sedatives may lead to conservative opioid use in palliative care as well. System-related, physician-related, and patient-related factors play crucial roles in steering the management of palliative patients. Addressing and increasing the awareness of these factors may help ensure patients receive adequate relief and control of distressing symptoms.

  20. Shelf-life extension of preservative-free hydrated feed using gamma pasteurization and its effect on growth performance of eel

    International Nuclear Information System (INIS)

    Kim, Dongho; Song, Hyunpa; Lim, Sangyong; Jo, Minho; Song, Duseop; Jo, Cheorun

    2012-01-01

    Hydrated feed (HF) promotes the growth performance and shortens the feeding time of fish by increasing the efficiency of digestion. However, the shelf-life of HF is a concern due to its relatively higher water content. In this study, radiation pasteurization was applied to improve the shelf-life and microbiological quality of HF for fish farming. Preservative-free HF containing 25% moisture was gamma-irradiated and its microbiological and nutritional properties evaluated in addition to a practical feeding trial carried out using eel. The viable counts of bacteria and fungi in HF were 10 6 and 10 4 CFU/g, respectively. All coliform bacteria and yeast in HF were eliminated by irradiation at a dose of 5 kGy, and total aerobic bacteria were eliminated at 10 kGy. The shelf-life of the preservative-free and irradiated (10 kGy) HF was estimated as 6 months under ambient conditions. The nutritional composition of HF was stable up to 10 kGy of irradiation. Based on a feeding trial, it was proven that eel fed HF had about 20% higher growth rate than that fed dried feed. - Highlights: ► Hydrated feed (HF) promotes the growth performance and shortens the feeding time of fish but shelf-life is a concern. ► Radiation pasteurization was applied to improve the shelf-life and microbiological quality of HF for fish farming. ► The shelf-life of the preservative-free and irradiated (10 kGy) HF was estimated as 6 months under ambient conditions. ► Eel fed HF had about 20% higher growth rate than that fed dried feed in feeding trial.

  1. Technical limits on performance reserves and life expectancy in nuclear power stations with light water reactors

    International Nuclear Information System (INIS)

    Wanner, R.; Brosi, S.; Duijvestijn, G.

    1990-01-01

    The safety margin (i.e. the difference between the loads equipment can take and those actually imposed on components) in a reactor pressure vessel is a major factor in the life expectancy of a nuclear power station. This safety margin is reduced considerably by reductions in the toughness of equipment caused by neutron irradiation and growth of cracks. Once the minimum safety margin is infringed, the nuclear power station is at the end of its working life. 13 figs., 11 refs

  2. Staying Out of the Closet: LGBT Older Adults' Hopes and Fears in Considering End-of-Life.

    Science.gov (United States)

    Wilson, Kimberley; Kortes-Miller, Katherine; Stinchcombe, Arne

    2018-03-01

    Canada is experiencing population aging, and given the heterogeneity of older adults, there is increasing diversity in late life. The purpose of this study was to help fill the research gaps on LGBT aging and end-of-life. Through focus groups, we sought to better understand the lived experience of older LGBT individuals and to examine their concerns associated with end-of-life. Our analysis highlights the idea that identifying as LGBT matters when it comes to aging and end-of-life care. In particular, gender identity and sexual orientation matter when it comes to social connections, in the expectations individuals have for their own care, and in the unique fear related to staying out of the closet and maintaining identity throughout aging and end-of-life. This study underscores the need to consider gender identity and sexual orientation at end-of-life. In particular, recognition of intersectionality and social locations is crucial to facilitating positive aging experiences and end-of-life care.

  3. Fighting for Dear Life: Christians and Aggressive End-of-Life Care.

    Science.gov (United States)

    Shinall, Myrick C

    2014-01-01

    Patients or their family members sometimes give religious reasons for requesting life-sustaining technologies that have little hope of restoring health. This poses an ethical challenge for clinicians and a potential strain on limited health-care resources. Among Christians, one explanation for a preference for aggressive, life-prolonging care is the influence of the idea of martyrdom, which became the normative form of dying in early Christianity. The ancient discourse of martyrdom and the modern discourse of aggressive medical care both share a martial orientation and commend an ethos of combat. This paper examines ancient Christian martyrdom discourse to illuminate its affinity with the discourse of aggressive medical care. The ethos of martyrdom has shaped Christian attitudes toward death such that preference for aggressive medical care at the end of life is understandable.

  4. End-of-life care and mental illness: a model for community psychiatry and beyond.

    Science.gov (United States)

    Candilis, Philip J; Foti, Mary Ellen G; Holzer, Jacob C

    2004-02-01

    End-of-life care is often influenced by the stereotyping of patients by age, diagnosis, or cultural identity. Two common stereotypes arise from the presumed incompetence of many patients to contribute to end-of-life decisions, and the fear that the discussions themselves will be de-stabilizing. We present a model for end-of-life discussions that combines competence assessment with healthcare preferences in a psychiatric population that faces identical stereotypes. The model, which draws on clinical research in competence and suicide risk assessment, has important implications for all patients in the community who are marginalized or stereotyped during discussions of end-of-life treatment.

  5. End-of-life-vignettes. A Chaplain's story.

    Science.gov (United States)

    Bodemann, Christina

    2014-03-01

    Julia, a 31-year-old woman, is brain dead after having suffered a cardiac arrest. This article describes a hospital chaplain's journey with her family through the tragedy of letting her die. It addresses the power of pastoral presence and prayer in a situation of loss and grief and the importance of storytelling for everyone involved in Julia's end-of-life care.

  6. Health-related quality of life of patients with endometrial cancer who are disease-free following external irradiation

    International Nuclear Information System (INIS)

    Klee, Marianne; Machin, David

    2001-01-01

    Health-related quality of life (HQoL) is assessed through the patients' own evaluation of the impact that a disease and its treatment may have on some of the physical, psychological and social aspects of their lives. The purpose of this study is to describe the HQoL of patients with endometrial cancer who are free of disease after undergoing external irradiation. An HQoL questionnaire was designed and validated, and consisted of the EORTC QLQ-C30 and 80 additional questions. The patients provided self-reported assessments at the end of radiotherapy, and 1, 3, 6, 12, 18 and 24 months later. Forty-nine out of 66 potential subjects participated in the study, which was confined to the period during which the women were disease free. Most patients experience physical side effects at the end of treatment and up to 6 months thereafter; 10% of the patients have chronic local symptoms and a large number of the patients think about their treatment even two years later. The patients' overall evaluation of their quality of life is lower than that of a matched population of healthy women

  7. Mental competence and surrogate decision-making towards the end of life.

    Science.gov (United States)

    Strätling, M; Scharf, V E; Schmucker, P

    2004-01-01

    German legislation demands that decisions about the treatment of mentally incompetent patients require an 'informed consent'. If this was not given by the patient him-/herself before he/she became incompetent, it has to be sought by the physician from a guardian, who has to be formally legitimized before. Additionally this surrogate has to seek the permission of a Court of Guardianship (Vormundschaftsgericht), if he/she intends to consent to interventions, which pose significant risks to the health or the life of the person under his/her care. This includes 'end-of-life decisions'. Deviations from this procedure are only allowed in acute emergencies or cases of 'medical futility'. On the basis of epidemiological and demographical data it can be shown that the vast majority of surrogate decisions on incompetent patients in Germany is not covered by legally valid consent. Moreover, the data suggests that if consent were to be requested according to the legal regulations, both the legal and medical system could realistically never cope with the practical consequences of this. Additionally, empiric research has revealed serious deficits concerning medical 'end of life-decisions' and practical performance in palliative care. As a consequence a multidisciplinary discussion has developed in Germany about the reform of present legislation with respect to key-issues like the assessment of mental competence, the options for exercising patient self-determination via advance directives and durable powers of attorney, the improvement of palliative care facilities, the clarification of formal procedures for surrogate decision-making in health care and towards the end of life and the possibilities and their limitations of controlling these decision-making processes 'externally' (e.g., by Guardianship Courts or committees). The authors discuss those proposals, which clearly dominate the present debate: They all aim to comply with the scientific basis of German law, jurisdiction

  8. A management system for end-of-life tyres: a Portuguese case study.

    Science.gov (United States)

    Ferrão, Paulo; Ribeiro, Paulo; Silva, Paulo

    2008-01-01

    The European Union introduced several policy instruments based in the extended producer responsibility (EPR) in order to improve the environmental performance of products and services through their life cycles. In this context, the Portuguese government decided to apply the EPR concept to tyres, and producers were obliged to constitute an end-of-life management system to promote the collection, recycling and reuse of end-of-life (EOL) tyres. This required producers, distributors, recyclers and retreaders to be identified and characterized, and local processing infrastructures to be analyzed. The information was used to design an economically optimised EOL tyre management system while promoting the activity of all EOL operators in order for the imposed collecting and recovery targets to be fulfilled. This paper discusses the interaction between the different governmental, private and academic institutions for the creation of the integrated management system for EOL tyres, the approach taken, the technical, political and legal aspects underneath them, as well as the environmental consequences induced by the creation of the management system. The results obtained during the first years of operation are reported and show an increase in the collection and recycling of EOL tyres and the consolidation of the collection and processing infrastructures.

  9. Communication and Decision-Making About End-of-Life Care in the Intensive Care Unit.

    Science.gov (United States)

    Brooks, Laura Anne; Manias, Elizabeth; Nicholson, Patricia

    2017-07-01

    Clinicians in the intensive care unit commonly face decisions involving withholding or withdrawing life-sustaining therapy, which present many clinical and ethical challenges. Communication and shared decision-making are key aspects relating to the transition from active treatment to end-of-life care. To explore the experiences and perspectives of nurses and physicians when initiating end-of-life care in the intensive care unit. The study was conducted in a 24-bed intensive care unit in Melbourne, Australia. An interpretative, qualitative inquiry was used, with focus groups as the data collection method. Intensive care nurses and physicians were recruited to participate in a discipline-specific focus group. Focus group discussions were audio-recorded, transcribed, and subjected to thematic data analysis. Five focus groups were conducted; 17 nurses and 11 physicians participated. The key aspects discussed included communication and shared decision-making. Themes related to communication included the timing of end-of-life care discussions and conducting difficult conversations. Implementation and multidisciplinary acceptance of end-of-life care plans and collaborative decisions involving patients and families were themes related to shared decision-making. Effective communication and decision-making practices regarding initiating end-of-life care in the intensive care unit are important. Multidisciplinary implementation and acceptance of end-of-life care plans in the intensive care unit need improvement. Clear organizational processes that support the introduction of nurse and physician end-of-life care leaders are essential to optimize outcomes for patients, family members, and clinicians. ©2017 American Association of Critical-Care Nurses.

  10. Intensity of treatment in Swiss cancer patients at the end-of-life

    Directory of Open Access Journals (Sweden)

    Bähler C

    2018-03-01

    Full Text Available Caroline Bähler,1 Andri Signorell,1 Eva Blozik,1,2 Oliver Reich1 1Department of Health Sciences, Helsana Insurance Group, Zürich, Switzerland; 2Department of Medicine, University Medical Centre Freiburg, Freiburg im Breisgau, Germany Purpose: Current evidence on the care-delivering process and the intensity of treatment at the end-of-life of cancer patients is limited and remains unclear. Our objective was to examine the care-delivering processes in health care during the last months of life with real-life data of Swiss cancer patients. Patients and methods: The study population consisted of adult decedents in 2014 who were insured at Helsana Group. Data on the final cause of death were provided additionally by the Swiss Federal Statistical Office. Of the 10,275 decedents, 2,710 (26.4% died of cancer. Intensity of treatment and health care utilization (including transitions at their end-of-life were examined. Intensity measures included the following: last dose of chemotherapy within 14 days of death, a new chemotherapy regimen starting <30 days before death, more than one hospital admission or spending >14 days in hospital in the last month, death in an acute care hospital, more than one emergency visit and ≥1 intensive care unit admission in the last month of life. Results: In the last 6 months of life, 89.5% of cancer patients had ≥1 transition, with 87.2% being hospitalized. Within 30 days before death, 64.2% of the decedents had ≥1 intensive treatment, whereby 8.9% started a new chemotherapy. In the multinomial logistic regression model, older age, higher density of nursing home beds and home care nurses were associated with a decrease, while living in the Italian- or French-speaking part of Switzerland was associated with an increase in intensive care. Conclusion: Swiss cancer patients insured by Helsana Group experience a considerable number of transitions and intensive treatments at the end-of-life, whereby treatment intensity

  11. Parent Perspectives of Neonatal Intensive Care at the End-of-Life.

    Science.gov (United States)

    Currie, Erin R; Christian, Becky J; Hinds, Pamela S; Perna, Samuel J; Robinson, Cheryl; Day, Sara; Meneses, Karen

    2016-01-01

    This descriptive qualitative study explored parent experiences related to their infant's neonatal intensive care unit (NICU) hospitalization, end-of-life care, and palliative care consultation. "Life and death in the NICU environment" emerged as the primary theme with the following categories: ups and downs of parenting in the NICU, decision-making challenges in the NICU, and parent support. Parents encountered challenges with areas for improvement for end-of-life and palliative care in the NICU. Further research is necessary to understand barriers with integrating palliative care and curative care in the NICU, and how NICU care affects bereavement and coping outcomes after infant death. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Development of high performance lubricant through the compatibilization of polyalphaolefin, polyurea and irradiated polytetrafluoroethylene

    International Nuclear Information System (INIS)

    Ratao, Natalia T.; Zen, Heloisa A.; Lugao, Ademar B.

    2013-01-01

    High performance lubricants are essential for shipping and oil exploration industries for working under severe conditions of temperature, pressure and contamination. Polytetrafluoroethylene (PTFE) is widely used as a lubricating additive in greases for presenting the lowest known coefficient of friction, is commercially found irradiated in air, by this way can be grinded and oxygenated terminal groups can be formed. PTFE processed by ionizing radiation with 4μ average particle size was supplied by Uniflon and compared with the ultraviolet-irradiated PTFE with the same average particle size, from Dupont. The characterization of functional proprieties by drop point, oil separation and four ball test was conducted with a polyurea base grease additive with both types of PTFE. The chemical characterization was done with Differential Scanning Calorimetry (DSC). The drop point and oil separation tests showed that the Uniflon irradiated PTFE improved the thermal resistance and stability of polyurea grease due to the greater presence of the end groups increase the compatibility of the additive with the fluid. Four ball tests showed that the grease with Uniflon irradiated PTFE also has a better antiwear and extreme pressure performance because of the greater polarity of the molecules improving the dispersion and anchoring of the PTFE in metal surface voids, reducing wear. The PTFE processed by ionizing radiation showed greater compatibility with polyurea grease and polyalphaolefin fluid and the grease functional characteristics met the requirements for a high performance lubricant. (author)

  13. Life Course Stage and Social Support Mobilization for End-of-Life Caregivers.

    Science.gov (United States)

    LaValley, Susan A; Gage-Bouchard, Elizabeth A

    2018-04-01

    Caregivers of terminally ill patients are at risk for anxiety, depression, and social isolation. Social support from friends, family members, neighbors, and health care professionals can potentially prevent or mitigate caregiver strain. While previous research documents the importance of social support in helping end-of-life caregivers cope with caregiving demands, little is known about differences in social support experiences among caregivers at different life course stages. Using life course theory, this study analyzes data from in-depth interviews with 50 caregivers of patients enrolled in hospice services to compare barriers to mobilizing social support among caregivers at two life course stages: midlife caregivers caring for parents and older adult caregivers caring for spouses/partners. Older adult caregivers reported different barriers to mobilizing social support compared with midlife caregivers. Findings enhance the understanding of how caregivers' life course stage affects their barriers to mobilization of social support resources.

  14. End-of-life care beliefs among Hindu physicians in the United States.

    Science.gov (United States)

    Ramalingam, Vijaya Sivalingam; Saeed, Fahad; Sinnakirouchenan, Ramapriya; Holley, Jean L; Srinivasan, Sinnakirouchenan

    2015-02-01

    Several studies from the United States and Europe showed that physicians' religiosity is associated with their approach to end-of-life care beliefs. No such studies have focused exclusively on Hindu physicians practicing in the United States. A 34-item questionnaire was sent to 293 Hindu physicians in the United States. Most participants believed that their religious beliefs do not influence their practice of medicine and do not interfere with withdrawal of life support. The US practice of discussing end-of-life issues with the patient, rather than primarily with the family, seems to have been adopted by Hindu physicians practicing in the United States. It is likely that the ethical, cultural, and patient-centered environment of US health care has influenced the practice of end-of-life care by Hindu physicians in this country. © The Author(s) 2013.

  15. Medical futility in children's nursing: making end-of-life decisions.

    Science.gov (United States)

    Brien, Irene O; Duffy, Anita; Shea, Ellen O

    Caring for infants at end of life is challenging and distressing for parents and healthcare professionals, especially in relation to making decisions regarding withholding or withdrawal of treatment. The concept of medical futility must be considered under these circumstances. Parents and healthcare professionals should be involved together in making these difficult decisions. However, for some parents, emotions and guilt often are unbearable and, understandably, parents can be reluctant to make a decision. Despite the recognition of parental autonomy, if parents disagree with a decision made by medical staff, the case will be referred to and solved by the courts. The courts' decisions are often based on the best interest of the child. In this article, the authors discuss the concepts of 'parental autonomy' and 'the child's best interests' when determining medical futility for infants or neonates. The role of the nurse when caring for the dying child and their family is multifaceted. While nurses do not have a legitimate role in decision making at the end of life, it is often nurses who, through their advocacy role, inform doctors about parents' wishes and it is often nurses who support parents during this difficult time. Furthermore, nurses caring for dying children should be familiar to the family, experienced in end-of-life care and comfortable talking to parents about death and dying and treatment choices. Children's nurses therefore require advanced communication skills and an essential understanding of the ethical and legal knowledge relating to medical futility in end-of-life children's nursing.

  16. Medical futility in children's nursing: making end-of-life decisions.

    LENUS (Irish Health Repository)

    Brien, Irene O

    2012-02-01

    Caring for infants at end of life is challenging and distressing for parents and healthcare professionals, especially in relation to making decisions regarding withholding or withdrawal of treatment. The concept of medical futility must be considered under these circumstances. Parents and healthcare professionals should be involved together in making these difficult decisions. However, for some parents, emotions and guilt often are unbearable and, understandably, parents can be reluctant to make a decision. Despite the recognition of parental autonomy, if parents disagree with a decision made by medical staff, the case will be referred to and solved by the courts. The courts\\' decisions are often based on the best interest of the child. In this article, the authors discuss the concepts of \\'parental autonomy\\' and \\'the child\\'s best interests\\' when determining medical futility for infants or neonates. The role of the nurse when caring for the dying child and their family is multifaceted. While nurses do not have a legitimate role in decision making at the end of life, it is often nurses who, through their advocacy role, inform doctors about parents\\' wishes and it is often nurses who support parents during this difficult time. Furthermore, nurses caring for dying children should be familiar to the family, experienced in end-of-life care and comfortable talking to parents about death and dying and treatment choices. Children\\'s nurses therefore require advanced communication skills and an essential understanding of the ethical and legal knowledge relating to medical futility in end-of-life children\\'s nursing.

  17. Eliciting regret improves decision making at the end of life.

    Science.gov (United States)

    Djulbegovic, Benjamin; Tsalatsanis, Athanasios; Mhaskar, Rahul; Hozo, Iztok; Miladinovic, Branko; Tuch, Howard

    2016-11-01

    Management choices at the end of life are high-stake decisions fraught with emotions, chief among is regret. Our objective in this paper is to test the utility of a regret-based model to facilitate referral to hospice care while helping patients clarify their preferences on how they wish to spend the remaining days of their lives. A prospective cohort study that enrolled consecutive adult patients (n = 178) aware of the terminal nature of their disease. The patients were at the point in care where they had to decide between continuing potentially 'curative/life-prolonging' treatment (Rx) versus hospice care. Preferences were elicited using a Dual Visual Analog Scale regarding the level of regret of omission versus commission (RgO/RgC) towards hospice care and Rx. Each patient's RgO/RgC was contrasted against the predictive probability of death to suggest a management plan, which was then compared with the patient's actual choice. The probability of death was estimated using validated Palliative Performance Scale predictive model. Eighty-five percent (151/178) of patients agreed with the model's recommendations (p < 0.000001). Model predicted the actual choices for 72% (128/178) of patients (p < 0.00001). Logistic regression analysis showed that people who were initially inclined to be referred to hospice and were predicted to choose hospice over disease-directed treatment by the regret model have close to 98% probability of choosing hospice care at the end of their lives. No other factors (age, gender, race, educational status and pain level) affected their choice. Using regret to elicit choices in the end-of-life setting is both descriptively and prescriptively valid. People with terminal disease who are initially inclined to choose hospice and do not regret such a choice will select hospice care with high level of certainty. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  18. End-of-life issues as perceived by Lebanese judges.

    Science.gov (United States)

    Adib, Salim M; Kawas, Sami H; Hajjar, Theresa A

    2003-05-01

    to assess the attitudes of judges in Beirut, Lebanon, regarding end-of-life issues such as assisted suicide and withholding or withdrawing life-sustaining treatment. 85% of all currently acting and in-training judges and public prosecutors in Beirut (N=135) were surveyed using a mailed questionnaire that assessed attitudes toward intervention in five hypothetical cases. The associations of attitudes, on a scale from least to most 'sympathetic' toward assisting those who desire to end their lives, were measured by a variety of personal, social and professional variables. younger individuals, and those who have not yet been formally appointed as judges, were significantly more sympathetic to withdrawal or withholding of life-sustaining devices when patients or their proxies requested it, and more in support of assisted suicide. Gender, religious denomination, religious practice, and personal experience with prolonged illness leading to death among close friends or family, were generally not significant predictors of respondents' attitudes. Years of experience as a judge correlated strongly with age and may have contributed to its predictive effect. a relatively more sympathetic attitude among younger judges, many of them women, and among trainees, may reflect a historical evolution in younger age-groups in Lebanon today. A survey of opinions in the public may help reach a more conclusive understanding in this regard. In any case, judges in Lebanon will remain important partners in the debate, as they will continue to be the final interpreters of the letter of the law in end-of-life issues.

  19. Effect of gamma-irradiation for shelf life extension of chicken meat

    International Nuclear Information System (INIS)

    Prachasitthisak, Y.; Ito, Hitoshi.

    1996-01-01

    On the study of microbiological quality of 12 samples of chicken meat produced in several different area in Japan, total aerobic bacteria were determined as 8x10 4 to 5x10 7 per g. Coliforms were 8x10 1 to 3x10 4 per g with Escherichia, Proteus and Klebsiella. Dominant putrefactive bacteria were determined as lactic acid bacteria, Pseudomonas and Flavobacterium. The shelf life of irradiated chicken meat at 1 kGy extended more than 6 days at 10degC storage. Irradiation of chicken meat at 3 kGy extended 12 days. Coliforms were disappeared at 1 kGy irradiation. (author)

  20. Benchmark Analyses on the Control Rod Withdrawal Tests Performed During the PHÉNIX End-of-Life Experiments. Report of a Coordinated Research Project 2008–2011

    International Nuclear Information System (INIS)

    2014-06-01

    The IAEA supports Member State activities in advanced fast reactor technology development by providing a major fulcrum for information exchange and collaborative research programmes. The IAEA’s activities in this field are mainly carried out within the framework of the Technical Working Group on Fast Reactors (TWG-FR), which assists in the implementation of corresponding IAEA activities and ensures that all technical activities are in line with the expressed needs of Member States. In the broad range of activities, the IAEA proposes and establishes coordinated research projects (CRPs) aimed at improving Member States’ capabilities in fast reactor design and analysis. An important opportunity to conduct collaborative research activities was provided by the experimental campaign run by the French Alternative Energies and Atomic Energy Commission (CEA, Commissariat à l’énergie atomique et aux énergies alternatives) at the PHÉNIX, a prototype sodium cooled fast reactor. Before the definitive shutdown in 2009, end-of-life tests were conducted to gather additional experience on the operation of sodium cooled reactors. Thanks to the CEA opening the experiments to international cooperation, the IAEA decided in 2007 to launch the CRP entitled Control Rod Withdrawal and Sodium Natural Circulation Tests Performed during the PHÉNIX End-of-Life Experiments. The CRP, together with institutes from seven States, contributed to improving capabilities in sodium cooled fast reactor simulation through code verification and validation, with particular emphasis on temperature and power distribution calculations and the analysis of sodium natural circulation phenomena. The objective of this publication is to document the results and main achievements of the benchmark analyses on the control rod withdrawal test performed within the framework of the PHÉNIX end-of-life experimental campaign

  1. Benchmark Analyses on the Control Rod Withdrawal Tests Performed During the PHÉNIX End-of-Life Experiments. Report of a Coordinated Research Project 2008–2011

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2014-06-15

    The IAEA supports Member State activities in advanced fast reactor technology development by providing a major fulcrum for information exchange and collaborative research programmes. The IAEA’s activities in this field are mainly carried out within the framework of the Technical Working Group on Fast Reactors (TWG-FR), which assists in the implementation of corresponding IAEA activities and ensures that all technical activities are in line with the expressed needs of Member States. In the broad range of activities, the IAEA proposes and establishes coordinated research projects (CRPs) aimed at improving Member States’ capabilities in fast reactor design and analysis. An important opportunity to conduct collaborative research activities was provided by the experimental campaign run by the French Alternative Energies and Atomic Energy Commission (CEA, Commissariat à l’énergie atomique et aux énergies alternatives) at the PHÉNIX, a prototype sodium cooled fast reactor. Before the definitive shutdown in 2009, end-of-life tests were conducted to gather additional experience on the operation of sodium cooled reactors. Thanks to the CEA opening the experiments to international cooperation, the IAEA decided in 2007 to launch the CRP entitled Control Rod Withdrawal and Sodium Natural Circulation Tests Performed during the PHÉNIX End-of-Life Experiments. The CRP, together with institutes from seven States, contributed to improving capabilities in sodium cooled fast reactor simulation through code verification and validation, with particular emphasis on temperature and power distribution calculations and the analysis of sodium natural circulation phenomena. The objective of this publication is to document the results and main achievements of the benchmark analyses on the control rod withdrawal test performed within the framework of the PHÉNIX end-of-life experimental campaign.

  2. Typology of end-of-life priorities in Saudi females: averaging analysis and Q-methodology

    Science.gov (United States)

    Hammami, Muhammad M; Hammami, Safa; Amer, Hala A; Khodr, Nesrine A

    2016-01-01

    Background Understanding culture-and sex-related end-of-life preferences is essential to provide quality end-of-life care. We have previously explored end-of-life choices in Saudi males and found important culture-related differences and that Q-methodology is useful in identifying intraculture, opinion-based groups. Here, we explore Saudi females’ end-of-life choices. Methods A volunteer sample of 68 females rank-ordered 47 opinion statements on end-of-life issues into a nine-category symmetrical distribution. The ranking scores of the statements were analyzed by averaging analysis and Q-methodology. Results The mean age of the females in the sample was 30.3 years (range, 19–55 years). Among them, 51% reported average religiosity, 78% reported very good health, 79% reported very good life quality, and 100% reported high-school education or more. The extreme five overall priorities were to be able to say the statement of faith, be at peace with God, die without having the body exposed, maintain dignity, and resolve all conflicts. The extreme five overall dis-priorities were to die in the hospital, die well dressed, be informed about impending death by family/friends rather than doctor, die at peak of life, and not know if one has a fatal illness. Q-methodology identified five opinion-based groups with qualitatively different characteristics: “physical and emotional privacy concerned, family caring” (younger, lower religiosity), “whole person” (higher religiosity), “pain and informational privacy concerned” (lower life quality), “decisional privacy concerned” (older, higher life quality), and “life quantity concerned, family dependent” (high life quality, low life satisfaction). Out of the extreme 14 priorities/dis-priorities for each group, 21%–50% were not represented among the extreme 20 priorities/dis-priorities for the entire sample. Conclusion Consistent with the previously reported findings in Saudi males, transcendence and dying in

  3. Typology of end-of-life priorities in Saudi females: averaging analysis and Q-methodology.

    Science.gov (United States)

    Hammami, Muhammad M; Hammami, Safa; Amer, Hala A; Khodr, Nesrine A

    2016-01-01

    Understanding culture-and sex-related end-of-life preferences is essential to provide quality end-of-life care. We have previously explored end-of-life choices in Saudi males and found important culture-related differences and that Q-methodology is useful in identifying intraculture, opinion-based groups. Here, we explore Saudi females' end-of-life choices. A volunteer sample of 68 females rank-ordered 47 opinion statements on end-of-life issues into a nine-category symmetrical distribution. The ranking scores of the statements were analyzed by averaging analysis and Q-methodology. The mean age of the females in the sample was 30.3 years (range, 19-55 years). Among them, 51% reported average religiosity, 78% reported very good health, 79% reported very good life quality, and 100% reported high-school education or more. The extreme five overall priorities were to be able to say the statement of faith, be at peace with God, die without having the body exposed, maintain dignity, and resolve all conflicts. The extreme five overall dis-priorities were to die in the hospital, die well dressed, be informed about impending death by family/friends rather than doctor, die at peak of life, and not know if one has a fatal illness. Q-methodology identified five opinion-based groups with qualitatively different characteristics: "physical and emotional privacy concerned, family caring" (younger, lower religiosity), "whole person" (higher religiosity), "pain and informational privacy concerned" (lower life quality), "decisional privacy concerned" (older, higher life quality), and "life quantity concerned, family dependent" (high life quality, low life satisfaction). Out of the extreme 14 priorities/dis-priorities for each group, 21%-50% were not represented among the extreme 20 priorities/dis-priorities for the entire sample. Consistent with the previously reported findings in Saudi males, transcendence and dying in the hospital were the extreme end-of-life priority and dis

  4. Balancing dual roles in end-of-life research.

    Science.gov (United States)

    Martin, Wanda; Grey, Meredith; Webber, Terry; Robinson, Linnea; Hartt, Nancy; Cairns, Moira; Stajduhar, Kelli

    2007-01-01

    Ethical and practical issues are sure to arise from the majority of research studies done with palliative populations. Whether it is feeling opportunistic, being emotionally available, or struggling with witnessing a gap in service and needs of the participants receiving care, nurses involved in research find a way to balance both roles to meet the needs of the participants as well as the study (McIlfatrick, Sullivan, & McKenna, 2006). This paper highlights some of the practical and ethical issues that arise when frontline nurses also take on the role of research assistant for studies with palliative populations. Specifically, the authors highlight their personal experiences based on their research assistant work on a study examining family caregiver coping in end-of-life cancer care. The authors discuss the "balancing act" of taking on these dual roles and offer recommendations on how to be with and approach people when doing research at the end of life using a framework based on Swanson's Theory of Caring (1991).

  5. Factors associated with end-of-life by home-visit nursing-care providers in Japan.

    Science.gov (United States)

    Nakanishi, Miharu; Niimura, Junko; Nishida, Atsushi

    2017-06-01

    Home-visit nursing-care services in Japan are expected to provide home hospice services for older patients with non-cancer diseases. The aim of the present study was to examine factors that contribute to the provision of end-of-life care by home-visit nursing-care providers in Japan. The present retrospective study was carried out using nationally representative cross-sectional data from the 2007, 2010, and 2013 Survey of Institutions and Establishments for Long-Term Care. A total of 138 008 randomly sampled home-visit nursing-care service users were included in this analysis. End-of-life care (study outcome) was defined as the provision of nursing-care within the last month of life. Of the 138 008 patients at home, 2280 (1.7%) received home-based nursing care within the last month of life, and end-of-life care was offered primarily to cancer patients (n = 1651; 72.4%). After accounting for patient characteristics, patients were more likely to receive end-of-life care when they used home-visit nursing-care providers that had a greater number of nursing staff or were located in a region with fewer hospital beds. Among home-visit nursing-care providers, the nursing staff ratio and the availability of hospital beds were related to the provision of end-of-life care. Home-visit nursing-care providers should establish specialist hospice care teams with enhanced staffing ratios to allow for the adequate provision of home-based end-of-life care. A community-based network between home-visit nursing-care providers and hospitals should also be established to attain an integrated end-of-life care system for elderly populations in regions with more hospital beds. Geriatr Gerontol Int 2017; 17: 991-998. © 2016 Japan Geriatrics Society.

  6. Quality of Living and Dying: Pediatric Palliative Care and End-of-Life Decisions in the Netherlands.

    Science.gov (United States)

    Brouwer, Marije; Maeckelberghe, Els; DE Weerd, Willemien; Verhagen, Eduard

    2018-07-01

    In 2002, The Netherlands continued its leadership in developing rules and jurisdiction regarding euthanasia and end-of-life decisions by implementing the Euthanasia Act, which allows euthanasia for patients 12 years of age and older. Subsequently, in 2005, the regulation on active ending of life for newborns was issued. However, more and more physicians and parents have stated that the age gap between these two regulations-children between 1 and 12 years old-is undesirable. These children should have the same right to end their suffering as adults and newborn infants. An extended debate on pediatric euthanasia ensued, and currently the debate is ongoing as to whether legislation should be altered in order to allow pediatric euthanasia. An emerging major question regards the active ending of life in the context of palliative care: How does a request for active ending of life relate to the care that is given to children in the palliative phase? Until now, the distinction between palliative care and end-of-life decisions continues to remain unclear, making any discussion about their mutual in- and exclusiveness hazardous at best. In this report, therefore, we aim to provide insight into the relationship between pediatric palliative care and end-of-life decisions, as understood in the Netherlands. We do so by first providing an overview of the (legal) rules and regulations regarding euthanasia and active ending of life, followed by an analysis of the relationship between these two, using the Dutch National Guidelines for Palliative Care for Children. The results of this analysis revealed two major and related features of palliative care and end-of-life decisions for children: (1) palliative care and end-of-life decisions are part of the same process, one that focuses both on quality of living and quality of dying, and (2) although physicians are seen as ultimately responsible for making end-of-life decisions, the involvement of parents and children in this decision is

  7. A Study on the Dimension Analysis of the End-of-Life Grid

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jaejun; Lee, Joungyeul; Kim, Hyeongkoo; Kim, Yonghwan [KEPCO Nuclear Fuel, Daejeon (Korea, Republic of)

    2014-05-15

    In this research, statistical analyses are performed for the components of cell dimension using the end-of-life (EOL) grids. The analyzed grids are the mid grids and the materials of the grids are the zirconium (Zr) based alloys. The analyses of grid dimensions are performed using the statistical method. The new factors are proposed and evaluated from hot cell data and nominal design values. It is worthy to note that the correlation between the relaxation factor and the cell size has the statistical significance and the cell relaxation and the cell pitch are analogized from the cell size. It is necessary in future that the analyses are performed between the grid width and these factors to obtain the effects for the grid width growth.

  8. A survey of views and practice patterns of dialysis medical directors toward end-of-life decision making for patients with end-stage renal disease.

    Science.gov (United States)

    Fung, Enrica; Slesnick, Nate; Kurella Tamura, Manjula; Schiller, Brigitte

    2016-07-01

    Patients with end-stage renal disease report infrequent end-of-life discussions, and nephrology trainees report feeling unprepared for end-of-life decision making, but the views of dialysis medical directors have not been studied. Our objective is to understand dialysis medical directors' views and practice patterns on end-of-life decision making for patients with ESRD. We administered questionnaires to dialysis medical directors during medical director meetings of three different dialysis organizations in 2013. Survey questions corresponded to recommendations from the Renal Physicians Association clinical practice guidelines on initiation and withdrawal of dialysis. There were 121 medical director respondents from 28 states. The majority of respondents felt "very prepared" (66%) or "somewhat prepared" (29%) to participate in end-of-life decisions and most (80%) endorsed a model of shared decision making. If asked to do so, 70% of the respondents provided prognostic information "often" or "nearly always." For patients with a poor prognosis, 36% of respondents would offer a time-limited trial of dialysis "often" or "nearly always", while 56% of respondents would suggest withdrawal from dialysis "often" or "nearly always" for those with a poor prognosis currently receiving dialysis therapy. Patient resistance and fear of taking away hope were the most commonly cited barriers to end-of-life discussions. Views and reported practice patterns of medical directors are consistent with clinical practice guidelines for end-of-life decision making for patients with end-stage renal disease but inconsistent with patient perceptions. © The Author(s) 2016.

  9. Shelf-life enhancement of lamb meat under refrigeration by gamma irradiation

    International Nuclear Information System (INIS)

    Paul, P.; Venugopal, V.; Nair, P.M.

    1990-01-01

    Influence of low dose gamma irradiation on the storage stability of fresh lamb meat (prepacked chunks and mince) at 0-3 degrees C was examined by sensory, microbiological and chemcial criteria. The meat chuncks irradiated at 1.0 kGy and 2.5 kGy remained in acceptable condition for 3 and 5 weeks respectively, whereas the corresponding shelf life for irradiated (1.0 kGy and 2.5 kGy) mince were 2 and 4 weeks respectively. In contrast, unirradiated meat chuncks and mince spoiled within one week of storage at 0-3 degrees C

  10. Extending shelf-life and economic evaluation of strawberry irradiated in Egypt

    International Nuclear Information System (INIS)

    Mahmoud, A.A.

    1988-01-01

    This study was made on ''Egypt's mega gamma I'' irradiator the radiation which is cobalt-60. The following dose was studied in detail 3.5 KGy, was compared with unirradiated sample was studied at the same time. The storage conditions for refrigeration were 4+-1 0 C. During storage periodic fruits were carried out as certain organoleptic properties. The refrigerated irradiated fruits have a shelf life of more than 30 days, whereas the unirradiated ones last only up to 14 days. On the other side the study of economic evaluation of irradiated strawberry showed that the activity of cobalt-60 source needed to satisfy requirement of gamma-irradiation processing of the annual strawberry production in Egypt has been figured a 0.563 Mci for a total activity

  11. Microbiology, sensory evaluation and shelf life of irradiated chicken breast fillets stored in air or vacuum

    Directory of Open Access Journals (Sweden)

    Samira Pirola Santos Mantilla

    2011-06-01

    Full Text Available This work investigated the effects of different packaging methods (air and vacuum combined with irradiation (0.0, 2.0 and 3.0 kGy on the preservation of chicken breast fillets stored at 1ºC for up to 18 days by sensorial test, determination of pH and bacterial growth. The findings indicated that the post-irradiation lag phase increased with the dose, leading to an extension in shelf-life. Vacuum-packed samples irradiated at 3.0 kGy exhibited the longest shelf life. Among the analyzed bacteria, coliforms and Listeria spp. were most sensitive to gamma radiation. All the fillets acquired more attractive coloration and better overall impression with irradiation. The combined use of vacuum packaging and irradiation (3.0 kGy reduced the microbial populations without causing change in pH and yielded a significant shelf-life extension of refrigerated fillets, besides improving its appearance.

  12. Embracing a broad spirituality in end of life discussions and advance care planning.

    Science.gov (United States)

    Churchill, Larry R

    2015-04-01

    Advance care planning for end of life typically focuses on the mechanics of completing living wills and durable power of attorney documents. Even when spiritual aspects of end of life care are discussed, the dominant assumptions are those of traditional religious systems. A broad view of spirituality is needed, one that may involve traditional religious beliefs but also includes personal understandings of what is holy or sacred. Embracing this broad practice of spirituality will help both familial and professional caregivers honor an essential aspect of end of life discussions and promote greater discernment of the deep meaning in advance care documents.

  13. [The pediatric patient at the end-of-life. A challenge for its identification and treatment. A survey in pediatricians and medical residents].

    Science.gov (United States)

    Rendón-Macías, Mario Enrique; Olvera-González, Héctor; Villasís-Keever, Miguel Angel

    2011-01-01

    Identification of pediatric patients at the end-of-life is not easy because criteria used are based on adults' criteria. In this survey we explore the children end-of-life definition pediatricians have, as well as to determine which interventions they use when caring a patient at end-of-life. Tertiary referral pediatric hospital. Staff pediatricians (SP) and medical residents (MR). A self-administrated questionnaire was built and validated. It contains five vignettes of pediatric patients: Two with WHO criteria for an end-of-life condition (EC) and three without an end-of-life condition (NEC). PARTICIPANTS identified each patient with or without an end-of-life condition, and which palliative actions they would perform accordingly Their responses were recorded in a 4-option Likert scale. Ordinal regression was used to assess if some of the participants' characteristics were related to the identification of an end-of-life condition. Response rate was 84.2% (128/152); of whom 63 were SP and 65 MR. EC cases were well identified in 90 and 93%, while NEC in 30 and 40%, respectively Palliative actions were more according in EC patients, but around 20% would not provide them. Among NEC patients, there were more disparities of palliative actions to be delivered, and it was statistically significantly. Ordinal regression showed that some participants' characteristics are associated to the appropriate identification of end-of-life patients; however, these factors were not consistent across the five scenarios. Among pediatricians, criteria of end-of-life conditions are not well established, neither the palliative actions. Educational interventions are needed to improve the quality of life of these children.

  14. Patient-reported assessment of quality care at end of life: development and validation of Quality Care Questionnaire-End of Life (QCQ-EOL).

    Science.gov (United States)

    Yun, Young Ho; Kim, Soo-Hyun; Lee, Kyoung-Min; Park, Sang Min; Lee, Chang Geol; Choi, Youn Seon; Lee, Won Sup; Kim, Si-Young; Heo, Dae Seog

    2006-09-01

    Our goal was to validate an instrument with which terminally ill patients could evaluate the quality of care they receive at the end of life (EOL). Questionnaire development followed a four-phase process: item generation and reduction, construction, pilot testing, and field-testing. Using relevance and priority criteria and pilot testing, we developed a 16-item questionnaire. Factor analyses of data from 235 patients resulted in the Quality Care Questionnaire-End of Life (QCQ-EOL) covering dignity-conserving care, care by health care professionals, individualised care, and family relationships. All subscales and total scores showed high internal consistency (Cronbach alpha range, 0.73-0.89). The ability of total score and selective subscale scores clearly differentiated patients on the basis of clinical situation, sense of dignity, and general rating of care quality. Correlations of scores between patients and caregivers were substantial. The QCQ-EOL can be adopted to assess the quality of care received by terminally ill patients.

  15. Alloy development for irradiation performance. Semiannual progress report for period ending September 30, 1985

    International Nuclear Information System (INIS)

    1986-02-01

    This report is the twenty-second in a series of Technical Progress Reports on ''Alloy Development for Irradiation Performance'' (ADIP), which is one element of the Fusion Reactor Materials Program, conducted in support of the magnetic Fusion Energy Program of the US Department of energy. This report is organized along topical lines with Chapters 3 through 8 devoted to the various alloy classes that are currently under investigation. Thus the work of a given laboratory may appear at several different places in the report. The materials compatibility and environmental effects work on all alloy classes is collected together in Chapter 9. The Table of Contents is annotated for the convenience of the reader

  16. End-of-life practices: The opinions of undergraduate medical ...

    African Journals Online (AJOL)

    2017-12-01

    Dec 1, 2017 ... illness, injury or other physical or mental condition that, in medical judgment, will .... was all the registered first- to fifth-year medical students at the School ..... patient should have sole responsibility in end-of-life decisions. The.

  17. Age-based disparities in end-of-life decisions in Belgium: a population-based death certificate survey

    Directory of Open Access Journals (Sweden)

    Chambaere Kenneth

    2012-06-01

    Full Text Available Abstract Background A growing body of scientific research is suggesting that end-of-life care and decision making may differ between age groups and that elderly patients may be the most vulnerable to exclusion of due care at the end of life. This study investigates age-related disparities in the rate of end-of-life decisions with a possible or certain life shortening effect (ELDs and in the preceding decision making process in Flanders, Belgium in 2007, where euthanasia was legalised in 2002. Comparing with data from an identical survey in 1998 we also study the plausibility of the ‘slippery slope’ hypothesis which predicts a rise in the rate of administration of life ending drugs without patient request, especially among elderly patients, in countries where euthanasia is legal. Method We performed a post-mortem survey among physicians certifying a large representative sample (n = 6927 of death certificates in 2007, identical to a 1998 survey. Response rate was 58.4%. Results While the rates of non-treatment decisions (NTD and administration of life ending drugs without explicit request (LAWER did not differ between age groups, the use of intensified alleviation of pain and symptoms (APS and euthanasia/assisted suicide (EAS, as well as the proportion of euthanasia requests granted, was bivariately and negatively associated with patient age. Multivariate analysis showed no significant effects of age on ELD rates. Older patients were less often included in decision making for APS and more often deemed lacking in capacity than were younger patients. Comparison with 1998 showed a decrease in the rate of LAWER in all age groups except in the 80+ age group where the rate was stagnant. Conclusion Age is not a determining factor in the rate of end-of-life decisions, but is in decision making as patient inclusion rates decrease with old age. Our results suggest there is a need to focus advance care planning initiatives on elderly patients. The

  18. End-of-Life Preferences: A Theory-Driven Inventory

    Science.gov (United States)

    Bonin-Scaon, Sylvie; Munoz Sastre, Maria Teresa; Chasseigne, Gerard; Sorum, Paul C.; Mullet, Etienne

    2009-01-01

    The study aimed at making a theory-driven inventory of end-of-life preferences. Participants were asked about a variety of preferences representing all eight motivational states described in Apter's Metamotivational Theory (AMT; Apter, 2001). Data from a convenience sample of 965 community participants and a convenience sample of 81 persons…

  19. Shelf life extension of minimally processed ready-to-cook (RTC) cabbage by gamma irradiation

    International Nuclear Information System (INIS)

    Banerjee, Aparajita; Chatterjee, Suchandra; Variyar, Prasad S.; Sharma, Arun

    2016-01-01

    Gamma irradiation (0.5-2.5 kGy) in combination with low temperature (4-15 °C) storage was attempted to increase shelf life of ready-to-cook shredded cabbage wrapped in cling films. A maximum extension in shelf life of 8 days, while retaining the microbial and sensory quality, was obtained with an irradiation dose of 2 kGy and storage at 10 °C. Gamma irradiation also inhibited browning of shredded cabbage at their cut edges resulting in enhanced visual appeal. An increase in total antioxidant activity was observed with respect to DPPH and hydroxyl radical scavenging ability while the nitric oxide radical scavenging activity and ferric reducing property remained unaffected with irradiation. Total phenolic, flavonoid and vitamin C content remained unchanged due to irradiation. No significant migration of additives from cling films into stimulant water was observed up to a radiation dose of 2 kGy thus demonstrating the feasibility of such films for above applications. (author)

  20. Shelf life extension of minimally processed ready-to-cook (RTC) cabbage by gamma irradiation.

    Science.gov (United States)

    Banerjee, Aparajita; Chatterjee, Suchandra; Variyar, Prasad S; Sharma, Arun

    2016-01-01

    Gamma irradiation (0.5-2.5 kGy) in combination with low temperature (4-15 °C) storage was attempted to increase shelf life of ready-to-cook shredded cabbage wrapped in cling films. A maximum extension in shelf life of 8 days, while retaining the microbial and sensory quality, was obtained with an irradiation dose of 2 kGy and storage at 10 °C. Gamma irradiation also inhibited browning of shredded cabbage at their cut edges resulting in enhanced visual appeal. An increase in total antioxidant activity was observed with respect to DPPH and hydroxyl radical scavenging ability while the nitric oxide radical scavenging activity and ferric reducing property remained unaffected with irradiation. Total phenolic, flavonoid and vitamin C content remained unchanged due to irradiation. No significant migration of additives from cling films into stimulant water was observed up to a radiation dose of 2 kGy thus demonstrating the feasibility of such films for above applications.

  1. Low doze γ-irradiation influence on drosophila life span in different genetics background

    International Nuclear Information System (INIS)

    Moskalev, A.

    2007-01-01

    Complete text of publication follows. The main goal of this work was to study in Drosophila melanogaster the contribution of DNA damage sensing and repair, apoptosis and heat shock defence into life span and physical activity alteration after gamma-irradiation at low doze rate. In our experiments, the strains were exposed to chronic gamma-irradiation from a 226Ra source (50 R/h) at doze rate 0.17 cGy/h at pre-imago development stages only. The absorbed radiation dose per generation (from embryo to imago, 12 days) was 60 cGy. Life span estimation was prepared in adult males and females separately. We compared the life span of apoptotic (p53, DIAP-1, dApaf-1, Dcp-1, reaper, grim and hid), heat shock defence (HSP70, HSP23, HSF), DNA damage sensing (ATR) and repair (XPF, XPC, PCNA, DSB repair helicase homologs) mutants after chronic irradiation with the control. On the basis of our investigation we have concluded: 1) Low doze irradiation alter the life span depending on genetic background (mutant alleles, heterozygosity level and sex); 2) Age dynamics of physical activity positively correlates with the life span; 3) Longevity potential forms at early development stages; 4) DNA damage sensing, DNA repair, heat shock defence and apoptosis as aging preventing mechanisms play crucial role in radiation-induced life span hormesis.

  2. Shelf-life extension of pear (Pyrus communis L.) by gamma-irradiation

    International Nuclear Information System (INIS)

    Wani, A.M.; Hussain, P.R.; Dar, M.A.; Mir, M.A.

    2007-01-01

    Hard and unripe pear fruit was precooled and subjected to γ-irradiation in the range of 0.1-2.5 kGy. After irradiation fruit was stored under ambient conditions (25±2 degC, RH 70%) and evaluated periodically for firmness, total soluble solids, titratable acidity, chlorophyll, physiological loss in weight, visual colour score, overall acceptability and microbial load. γ-irradiation at 0.1-0.9 kGy did not show any significant effect with respect to shelf-life extension and microbial load. However, irradiation doses of 1.0-1.5 kGy significantly (p≤0.05) delayed ripening and did not spoil for 14 days of storage under ambient conditions. The microbial load was reduced without affecting the physico-chemical and sensory attributes. The irradiation doses of 2.0-2.5 kGy resulted in reduced microbial load and delayed ripening but adversely affected the fruit colour. (author)

  3. Irradiation test of FPGA for BES III

    International Nuclear Information System (INIS)

    Chen Yixin; Liang Hao; Xue Jundong; Liu Baoying; Liu Qiang; Yu Xiaoqi; Zhou Yongzhao; Hou Long

    2005-01-01

    The irradiation effect of FPGA, applied in Front-end Electronics for experiments of High-Energy Physics, is a serious problem. The performance of FPGA, used in the front-end card of Muon Counters of BES III project, needs to be evaluated under irradiation. SEUs on Altera ACEX 1K FPGA, observed in the experiment under the irradiation of γ ray, 14 and 2.5 MeV neutrons, was investigated. The authors calculated involved cross-section and provided reasonable analysis and evaluation for the result of the experiment. The conclusion about feasibility of applying ACEX 1K FPGA in the front-end card of the readout system of Muon Counters for BES III was given. (authors)

  4. Improving quality of some types of cheese by gamma irradiation

    International Nuclear Information System (INIS)

    Sallam, E.M.E.A

    2010-01-01

    The use of ionizing radiation as a food preservation technique has been recognized for many years as a means to reduce food losses, improve food safety, and extend shelf life. Furthermore, irradiation can be an effective way of reducing the incidence of food borne disease and treating a variety of potential problems in food supplies. The treatment of food with ionizing radiation is one of the most thoroughly researched techniques available to the food processing industry. In view of the afore mentioned the objective of this study were to study the effect of irradiation time and dose on Ras cheese quality, investigate the effect of irradiation after ripening on cheese quality and possibility of prolonging the shelf-life of Ras cheese, study the effect of irradiation dose on Kareish cheese quality and its shelf- life and to monitor the chemical, microbiological and sensory changes during ripening and storage of Ras and Kareish cheeses .The results of this study will be presented in three parts: Part I: Effect of irradiation dose and time on some properties of Ras cheese:Part II: Effect of irradiation on some properties during storage of ripened Ras cheese.Part III: Effect of irradiation on the quality and shelf-life of Kareish cheese: It could be concluded that irradiation caused a significant reduction of cheese ripening indices, and count of total viable,proteolytic, lipolytic bacteria and mould and yeast. Using irradiation doses of 3 and 4 kGy were able to stop the ripening factors and these safety dose were used to prevent the ripened Ras cheese irradiation of ripened Ras cheese has been prolonged the shelf-life of Ras cheese to about 32 months compared with control cheese, which showed only 18 months. The obtained results revealed that the best irradiation treatment was at the end of ripening period. Also safety irradiation of Kareish cheese has been prolonged the shelf-life of Kareish cheese to about 54 days compared with 12 days only control cheese.

  5. 76 FR 35221 - Proposed Collection; Comment Request; NINR End-of-Life and Palliative Care Science Needs...

    Science.gov (United States)

    2011-06-16

    ... Request; NINR End-of-Life and Palliative Care Science Needs Assessment: Funding Source Questionnaire... Collection: Title: NINR End-of-Life and Palliative Care Science Needs Assessment: Funding Source... Collection: The NINR End-of-Life Science Palliative Care (EOL PC) Needs Assessment: Funding Source...

  6. End of life care and decision making: Opinions and experiences of the general public, bereaved relatives, and professionals

    NARCIS (Netherlands)

    N.J.H. Raijmakers (Natasja)

    2013-01-01

    textabstractEnd-of-life care aims to improve quality of life of patients and their relatives facing problems associated with life-threatening illness in the last days of life. End-of-life decision-making is an important aspect of end-of-life care that can have a significant impact on the process of

  7. REUSE OF AUTOMOTIVE COMPONENTS FROM DISMANTLED END OF LIFE VEHICLES

    Directory of Open Access Journals (Sweden)

    Piotr NOWAKOWSKI

    2013-12-01

    Full Text Available The problem of recycling end of life automotive vehicles is serious worldwide. It is one of the most important streams of waste in developed countries. It has big importance as recycling potential of raw materials content in automotive vehicles is valuable. Different parts and assemblies after dismantling can also be reused in vehicles where replacement of specific component is necessary. Reuse of the components should be taken into consideration in selecting the vehicles dismantling strategy. It also complies with European Union policy concerning end of life vehicles (ELV. In the paper it is presented systematic approach to dismantling strategies including disassembly oriented on further reuse of components. It is focused on decision making and possible benefits calculation from economic and environmental point of view.

  8. Application of low-dose gamma irradiation to extend the shelf life of minimally processed Red Beet (Beta vulgaris sp. vulgaris L.), cv. Early Wonder

    International Nuclear Information System (INIS)

    Hernandez, Nilber Kenup

    2006-01-01

    This study was aimed at investigating the effects of low-dose gamma irradiation on shelf-life extension and phyto sanitary safety of minimally processed red beet with basis on physicochemical; microbiological; chemical and sensory analyses. The samples (Beta vulgaris ssp. vulgaris L.), Early Wonder cultivar, were cultivated in the experimental area of the Horticulture Sector of the Departamento de Fitotecnia of the Instituto de Agronomia, Universidade Federal Rural do Rio de Janeiro, Seropedica, RJ, as part of two experiments performed during the second semester of 2005. In each experiment, 1200 plants (40 per linear meter of terrain) were sowed. Physicochemical analyses (fresh mass; length; average diameter and total soluble solids) of the edible part of the red beets (their tuberous roots) were periodically carried out in order to assess the most appropriate time for harvest by monitoring the development of the plants. Those times were found to be 104 and 73 days after transplanting, respectively. The harvested edible part of the roots were minimally processed and separated in two groups: (1) gamma irradiated (with doses of 0.5; 1.0 and 1.5 kGy) and (2) non-irradiated (control). All samples were stored at 8 degree C. Microbiological analyses were performed during the storage period (22 and 21 days, for experiments 1 and 2, respectively) in order to evaluate the phyto sanitary quality of the samples (Salmonella sp.; coliforms and total count of mesophilic aerobic and lactic acid bacteria). The samples irradiated with 1.0 and 1.5 kGy were found to remain appropriate for consumption for 21 days, as compared to only 7 days for the control. Monitoring of chemical composition was also performed and included the determination of saccharose; glucose; fructose and vitamins B1 and B2. No difference was found between the concentrations of those vitamins in irradiated and control samples at the end of the storage period, whereas significant changes in sugar contents were

  9. Pre-analysis of Phenix End-of-Life Thermal-hydraulic tests with the MARS-LMR Code

    International Nuclear Information System (INIS)

    Jeong, Hae Yong; Ha, Kwi Seok; Kwon, Young Min; Chang, Won Pyo; Suk, Su Dong; Lee, Yong Bum

    2009-01-01

    A prototype SFR, PHENIX has been operated by the French Commissariat a l'energie atomique (CEA) and the Electricite de France (EdF) since 1973. Through the successful operation for 35 years, PHENIX has achieved its original objective to demonstrate a fast breeder reactor technology and also played an important role as an irradiation facility for innovative fuels and materials. Since its first operation, PHENIX has accumulated about 4,300 equivalent full power days (EFPDs) of operational experience and it reached its final shutdown in 2009. Before the decommissioning of PHENIX, the CEA started a PHENIX end-of-life (EOL) test program and opened it for international collaboration to share the valuable information from the test. The KAERI joined this program to utilize the unique opportunity to validate its SFR system analysis code, MARS-LMR which will be a basic tool in future SFR development

  10. Hospital executive leadership: a critical component for improving care at the end of life.

    Science.gov (United States)

    Cooney, James P; Landers, Glenn M; Williams, Julianna M

    2002-01-01

    End-of-life care and its planning by individuals, in concert with their families and professional healthcare givers, pose important social, legal, and ethical issues. The authors evaluate the results of a multi-year (1997-2001) collaborative effort among representatives of Georgia healthcare providers, healthcare payers, and the general public that was designed to (a) improve end-of-life care through a community-focused field effort to increase public awareness, execution, and institutional management of advance directives and (b) impact institutional and state government systems and policies around end-of-life care. The authors conclude that a proactive presence of senior management is integral in implementing systematic change in hospital-based end-of-life care and offer practical recommendations to hospital leaders to affect real change in their institutions.

  11. Studies on the effect of gamma irradiation on shelf life of Kagzi lime (Citrus aurantifolia swingle)

    International Nuclear Information System (INIS)

    Pandey, S.K.; Bisen, A.

    2006-01-01

    Influence of irradiation on shelf life of Kagzi lime fruits were studied. The results revealed that most of the physical and chemical parameters of fruits were significantly influenced by 100 Gy gamma radiation up to 22 days without affecting fruit quality. Higher doses of gamma irradiation (> 200 Gy) deteriorated the fruit quality and organoleptic parameters of the fruit. Thus, irradiation of lime fruits with 100 Gy gamma radiation extended shelf life of lime fruits and also helps in maintaining the chemical constituents viz., T.S.S. Acidity, Vitamin C, pH and juice content. (author)

  12. Life cycle assessment of EPS and CPB inserts: design considerations and end of life scenarios.

    Science.gov (United States)

    Tan, Reginald B H; Khoo, Hsien H

    2005-02-01

    Expanded polystyrene (EPS) and corrugated paperboard (CPB) are used in many industrial applications, such as containers, shock absorbers or simply as inserts. Both materials pose two different types of environmental problems. The first is the pollution and resource consumption that occur during the production of these materials; the second is the growing landfills that arise out of the excessive disposal of these packaging materials. Life cycle assessment or LCA will be introduced in this paper as a useful tool to compare the environmental performance of both EPS and CPB throughout their life cycle stages. This paper is divided into two main parts. The first part investigates the environmental impacts of the production of EPS and CPB from 'cradle-to-gate', comparing two inserts--both the original and proposed new designs. In the second part, LCA is applied to investigate various end-of-life cases for the same materials. The study will evaluate the environmental impacts of the present waste management practices in Singapore. Several 'what-if' cases are also discussed, including various percentages of landfilling and incineration. The SimaPro LCA Version 5.0 software's Eco-indicator 99 method is used to investigate the following five environmental impact categories: climate change, acidification/eutrophication, ecotoxicity, fossil fuels and respiratory inorganics.

  13. Improving the Hygienic Quality and Shelf-Life of Minced Common Carp Fish by Gamma Irradiation

    International Nuclear Information System (INIS)

    El-Khawas, Kh.H.; Fawzia, M.; El-Nashaby; Abd El-daim, M.H.

    1999-01-01

    This investigation aimed to improve the hygienic quality and extend cold storage life of minced carp fish by gamma irradiation. The frozen samples were gamma irradiation at 0, 2, 4 and 6 kGy doses and the effects of these treatments on the chemical properties, microbiological aspects and sensory properties were studied post treatments and during cold storage. Irradiation of samples at doses of 2, 4 and 6 kGy greatly reduced its microbial counts and prolonged its shelf-life for 2, 4, and 6 weeks at 4 ±degree, respectively against only 3 days for control samples. Moreover, 4 kGy dose completely destroyed Staph aureus. The chemical composition of samples did not alter neither by γirradiation treatments nor by cold storage. Furthermore, irradiation treatments had no effects on pH-value, TVBN and TMA contents, while a gradual increase in these chemical quality indexes was observed during cold storage. However, both irradiation treatments and cold storage increased the TBA value

  14. United States Acculturation and Cancer Patients’ End-of-Life Care

    Science.gov (United States)

    Wright, Alexi A.; Stieglitz, Heather; Kupersztoch, Yankel M.; Paulk, M. Elizabeth; Kim, Yookyung; Katz, Ingrid T.; Munoz, Francisco; Jimenez, Rachel B.; Mutchler, Jan; Rivera, Lorna; Back, Anthony L.; Prigerson, Holly G.

    2013-01-01

    Background Culture shapes how people understand illness and death, but few studies examine whether acculturation influences patients’ end-of-life treatment preferences and medical care. Methods and Findings In this multi-site, prospective, longitudinal cohort study of terminally-ill cancer patients and their caregivers (n = 171 dyads), trained interviewers administered the United States Acculturation Scale (USAS). The USAS is a 19-item scale developed to assess the degree of “Americanization” in first generation or non-US born caregivers of terminally-ill cancer patients. We evaluated the internal consistency, concurrent, criterion, and content validity of the USAS. We also examined whether caregivers’ USAS scores predicted patients’ communication, treatment preferences, and end-of-life medical care in multivariable models that corrected for significant confounding influences (e.g. education, country of origin, English proficiency). The USAS measure was internally consistent (Cronbach α = 0.98); and significantly associated with US birthplace (r = 0.66, Punit (AOR = 1.36, 95% CI:1.05–1.76). Scores indicating greater acculturation were also associated with increased odds of patient participation in clinical trials (AOR = 2.20, 95% CI:1.28–3.78), compared with lower USAS scores, and greater odds of patients receiving chemotherapy (AOR = 1.59, 95% CI:1.20–2.12). Conclusion The USAS is a reliable and valid measure of “Americanization” associated with advanced cancer patients’ end-of-life preferences and care. USAS scores indicating greater caregiver acculturation were associated with increased odds of patient participation in cancer treatment (chemotherapy, clinical trials) compared with lower scores. Future studies should examine the effects of acculturation on end-of-life care to identify patient and provider factors that explain these effects and targets for future interventions to improve care (e.g., by designing more

  15. TU-D-201-01: Definition and Purpose of End-Of-Life for Brachytherapy Devices and Software

    International Nuclear Information System (INIS)

    Melhus, C.

    2015-01-01

    Brachytherapy devices and software are designed to last for a certain period of time. Due to a number of considerations, such as material factors, wear-and-tear, backwards compatibility, and others, they all reach a date when they are no longer supported by the manufacturer. Most of these products have a limited duration for their use, and the information is provided to the user at time of purchase. Because of issues or concerns determined by the manufacturer, certain products are retired sooner than the anticipated date, and the user is immediately notified. In these situations, the institution is facing some difficult choices: remove these products from the clinic or perform tests and continue their usage. Both of these choices come with a financial burden: replacing the product or assuming a potential medicolegal liability. This session will provide attendees with the knowledge and tools to make better decisions when facing these issues. Learning Objectives: Understand the meaning ofend-of-life or “life expectancy” for brachytherapy devices and software Review items (devices and software) affected by “end-of-life” restrictions Learn how to effectively formulate “end-of-life” policies at your institution Learn about possible implications ofend-of-life” policy Review other possible approaches to “end-of-life” issue

  16. Raising end of life care issues for patients with learning disabilities.

    Science.gov (United States)

    Sander, Ruth

    2012-11-30

    This qualitative study explored the views of three learning disability nurses, and three district nurses, caring for people with learning disabilities at the end of their lives. Although they saw some good practice, the nurses identified several difficulties associated with end of life care.

  17. Alkyne End Group Production in Polymeric Materials Induced by Swift Heavy Ion Irradiations

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Swift heavy ions in matter lose energy mainly through electronic processes.Since the energy deposition is centered in a very small region with a very high energy density,new effects such as production of alkyne end group can be induced.In this work,PET,PS,PC and PI films are irradiated with Ar,Kr,Xe and U ions and the relationship of the alkyne end group production with electronic energy loss is studied by Fourier transformed infrared infrared(FTLR)spectra measurements.

  18. Life-shortening and carcinogenesis in mice irradiated neonatally with x rays

    International Nuclear Information System (INIS)

    Sasaki, S.; Kasuga, T.

    1981-01-01

    The characteristics of life-shortening and carcinogenesis were investigated in x-irradiated neonatal B6WFr mice. Animals were irradiated with 24 hr after birth and allowed to complete their normal life span. Mean life span was shortened linearly with doses at a rate of 9.1% per 100 R for females and 9.8% for males. The spectrum of neoplastic diseases was apparently modulated by x irradiation, showing neonatal B6WFr mice to be highly susceptible to the induction of thymic lymphoma, liver tumor, and pituitary tumor. The dose-response relationship for thymice lymphoma could be described by a linear-quadratic model, and linearity could be rejected. Thymic lymphoma developed after a short latent period, resulting in death between 100 and 450 days of age. Liver and pituitary tumors increased with increasing dose up to 400 R and decreased thereafter. The latent period for liver tumor development was apparently shortened with increasing doses. Pituitary tumor developed in excess only in females after a long latent period

  19. Aging Prisoners' Treatment Selection: Does Prospect Theory Enhance Understanding of End-of-Life Medical Decisions?

    Science.gov (United States)

    Phillips, Laura L.; Allen, Rebecca S.; Harris, Grant M.; Presnell, Andrew H.; DeCoster, Jamie; Cavanaugh, Ronald

    2011-01-01

    Purpose: With the rapid growth in the older inmate population and the economic impact of end-of-life treatments within the cash-strapped prison system, consideration should be given to inmate treatment preferences. We examined end-of-life treatment preferences and days of desired life for several health scenarios among male inmates incarcerated…

  20. [End-of-Life Care in Intensive Care Units: Nursing strategies of family involvement at the end of life].

    Science.gov (United States)

    Cyrol, Katharina; Fröhlich, Martin R; Piatti, Francesca; Imhof, Lorenz

    2018-06-01

    Background: Family members of people dying in the intensive care unit (ICU) are exposed to many stress factors and they often do not experience involvement in End-of-Life (EoL) situations. For example, they criticize a low degree of participation in patients care, delayed or incomplete information and lack of privacy. Even nursing staff is facing various obstacles in EoL situations in ICUs. Aim: This study investigates strategies used by ICU nursing staff in German-speaking Switzerland to increase family members participation in situations at the end of life. Method: Data was collected by conducting 12 semi-structured interviews using an approach based on Grounded Theory. A model was developed to explain nursing strategies for family involvement in EoL situations in the ICU. Conclusions: Nurses provide personal space and tranquillity for family members and allow them to be present at any time. Against this background, they support family members and enable them to say goodbye consciously to a loved one. Subsequent work should examine the effectiveness of the strategies described, particularly in terms of stress reactions displayed by family members in the aftermath of EoL situations. In practice, family members should be provided space for privacy. The entire healthcare team is recommended to identify and pursue common values and objectives. Moreover, intradisciplinary exchange and mentoring need to be encouraged. In order to prepare future nursing staff for EoL situations in the ICU, recognizing and promoting their educational skills is mandatory.

  1. Ketamine PCA for treatment of end-of-life neuropathic pain in pediatrics.

    Science.gov (United States)

    Taylor, Matthew; Jakacki, Regina; May, Carol; Howrie, Denise; Maurer, Scott

    2015-12-01

    Control of neuropathic pain (NP) for children at end of life is challenging. Ketamine improves control of NP, but its use in children is not well described. We describe a retrospective case review of 14 children with terminal prognoses treated with ketamine patient-controlled analgesia (PCA) for management of opioid-refractory NP at the end of life. Median ketamine dose was 0.06 mg/kg/h (range 0.014-0.308 mg/kg/h) with a 0.05 mg/kg (range 0.03-0.5mg/kg) demand dose available every 15 minutes (range 10-60 minutes). All patients noted subjective pain relief with ketamine, and 79% had no adverse effects. Benzodiazepines limited neuropsychiatric side effects. Ketamine treatment arrested dose escalation of opioids in 64% of patients, and 79% were discharged to home hospice. Ketamine PCA is an effective, well-tolerated therapy for opioid-refractory NP in pediatric end-of-life care. © The Author(s) 2014.

  2. Quality of life and utility in irradiated laryngeal cancer patients

    International Nuclear Information System (INIS)

    Ringash, Jolie; Redelmeier, Donald A.; O'Sullivan, Brian; Bezjak, Andrea

    2000-01-01

    Purpose: To determine quality of life (QOL) and health utility in irradiated laryngeal cancer survivors. Materials and Methods: Over 6 months, consecutive follow-up patients at a comprehensive cancer centre completed the QOL questionnaire FACT-H and N and the time trade-off (TTO) utility instrument. Results: Inclusion criteria were met by 339 patients, of whom 269 were eligible, 245 were approached, and 120 agreed to participate. Most participants were men (83%) who had received radiotherapy (97%) for Stage I disease (53%) of the glottis (75%); 7% had undergone total laryngectomy. Participants differed from nonparticipants only in being younger (mean age, 65 vs. 68 years, p = 0.0049) and having higher performance status (Karnofsky 88 vs. 84, p = 0.0012). The average scores for FACT-H and N and the TTO were 124/144 (SD, 14) and 0.90/1.0 (SD, 0.16) respectively. FACT-H and N score was more highly correlated with Karnofsky score (r = 0.43, p = 0.001) than with the TTO (r = 0.29, p = 0.002). Gender predicted QOL (means: M = 125, F 118), while natural speech, no relapses, and more time since initial treatment predicted higher utility. Conclusion: The QOL of irradiated laryngeal cancer survivors was reasonably high and independent of initial disease variables. The QOL questionnaire correlated more strongly with performance status than with utility, suggesting that QOL and utility measures may be perceived differently by patients

  3. End-of-Life Care Education for Psychiatric Residents: Attitudes, Preparedness, and Conceptualizations of Dignity

    Science.gov (United States)

    Tait, Glendon R.; Hodges, Brian D.

    2009-01-01

    Objective: The authors examined psychiatric residents' attitudes, perceived preparedness, experiences, and needs in end-of-life care education. They also examined how residents conceptualized good end-of-life care and dignity. Methods: The authors conducted an electronic survey of 116 psychiatric residents at the University of Toronto. The survey…

  4. Spirituality in end-of-life care: attending the person on their journey.

    LENUS (Irish Health Repository)

    Hayden, Deborah

    2011-11-01

    Spirituality is a fundamental element to the human experience of health and healing, illness and dying. Spiritual care is an essential component of palliative and end-of-life care provision and is the responsibility of all staff and carers involved in the care of patients and families. As end-of-life care is a significant element of community nursing, this article explores the relevancy of spirituality to end-of-life practice, the challenge of defining spirituality and the attributes and skills required for the practice of spiritual care. The aim of is to encourage self reflection and open dialogue about the subject, thus enhancing community nurses\\' understanding of spiritual care practice. By reflecting and generating talk about the practice of spiritual care, it may become more normalized, recognized, and practically meaningful, thereby retaining its significance in holistic nursing.

  5. ORIGINAL ARTICLES Medical futility and end-of-life care

    African Journals Online (AJOL)

    2008-04-01

    Apr 1, 2008 ... It is based on the probability of a treatment not having the desired effect ... as empathetic participants in end-of-life decision-making is underscored. .... growing awareness of the limits of medical science's propensity to cure ...

  6. End-of-life decision-making in Canada: the report by the Royal Society of Canada expert panel on end-of-life decision-making.

    Science.gov (United States)

    Schüklenk, Udo; van Delden, Johannes J M; Downie, Jocelyn; McLean, Sheila A M; Upshur, Ross; Weinstock, Daniel

    2011-11-01

    This report on end-of-life decision-making in Canada was produced by an international expert panel and commissioned by the Royal Society of Canada. It consists of five chapters. Chapter 1 reviews what is known about end-of-life care and opinions about assisted dying in Canada. Chapter 2 reviews the legal status quo in Canada with regard to various forms of assisted death. Chapter 3 reviews ethical issues pertaining to assisted death. The analysis is grounded in core values central to Canada's constitutional order. Chapter 4 reviews the experiences had in a number of jurisdictions that have decriminalized or recently reviewed assisted dying in some shape or form. Chapter 5 provides recommendations with regard to the provision of palliative care in Canada, as well as recommendations for reform with respect to the various forms of assisted death covered in this document. © 2011 Blackwell Publishing Ltd.

  7. Hybrid disassembly system for cellular telephone end-of-life treatment

    Energy Technology Data Exchange (ETDEWEB)

    Kniebel, M.; Basdere, B.; Seliger, G. [Technical Univ. Berlin, Inst. for Machine Tools and Factory Management, Dept. of Assembly Technology and Factory Management, Berlin (Germany)

    2004-07-01

    Concern over the negative environmental impacts associated with the production, use, and end-of-life (EOL) of cellular telephones is particularly high due to large production volumes and characteristically short time scales of technological and stylistic obsolescence. Landfilled or incinerated cellular telephones create the potential for release of toxic substances. The European legislation has passed the directive on Waste of Electrical and Electronic Equipment (WEEE) to regulate their collection and appropriate end-of-life treatment. Manufacturers must conduct material recycling or remanufacturing processes to recover resources. While recovery rates can hardly be met economically by material recycling, remanufacturing and reusing cellular phones is developing into a reasonable alternative. Both end-of-life options require disassembly processes for WEEE compliant treatment. Due to the high number of different cell phone variants and their typical design that fits components into tight enclosing spaces, cellular phone disassembly becomes a challenging task. These challenges and the expected high numbers of phones to be returned in the course of the WEEE urges for automated disassembly. A hybrid disassembly system has been developed to ensure the mass-treatment of obsolete cellular phones. It has been integrated into a prototypical remanufacturing factory for cellular phones that has been planned based on market data. (orig.)

  8. Learning About End-of-Life Care in Nursing-A Global Classroom Educational Innovation.

    Science.gov (United States)

    Bailey, Cara; Hewison, Alistair; Orr, Shelly; Baernholdt, Marianne

    2017-11-01

    Teaching nursing students how to provide patient-centered end-of-life care is important and challenging. As traditional face-to-face classroom teaching is increasingly supplanted by digital technology, this provides opportunities for developing new forms of end-of-life care education. The aim of this article is to examine how a global classroom was developed using online technology to enhance nursing students' learning of end-of-life care in England and the United States. The PDSA (Plan-Do-Study-Act) quality improvement approach was used to guide the design and delivery of this curriculum innovation. The global classroom enhanced the educational experience for students. Teaching needs to be inclusive, focused, and engaging; the virtual platform must be stable and support individual learning, and learning needs to be collaborative and authentic. These findings can be used to inform the integration of similar approaches to end-of-life care education in other health care professional preparation programs. [J Nurs Educ. 2017;56(11):688-691.]. Copyright 2017, SLACK Incorporated.

  9. End of Life Strategies Among Patients with Advanced Chronic Obstructive Pulmonary Disease (COPD).

    Science.gov (United States)

    Gershon, Andrea S; Maclagan, Laura C; Luo, Jin; To, Teresa; Kendzerska, Tetyana; Stanbrook, Matthew B; Bourbeau, Jean; Etches, Jacob; Aaron, Shawn D

    2018-06-11

    The burden of advanced COPD is high globally; however, little is known about how often end of life strategies are used by this population. To describe trends in the use of end of life care strategies by people with advanced COPD in Ontario, Canada. A population-based repeated cross-sectional study examining end of life care strategies in individuals with advanced COPD was conducted. Annual proportions of individuals who received formal palliative care, long-term oxygen therapy or opioids from 2004 to 2014 were determined. Results were age- and sex- standardized as well as stratified by age, sex, socioeconomic status, urban/rural residence and immigrant status. Measurement/Main Results: There were 151,912 persons with advanced COPD in Ontario between 2004 and 2014. Use of formal palliative care services increased 1% per year from 5.3% in 2004 to 14.3% in 2014 (p value for trend COPD using end of life strategies, although increasing, remains low. Efforts should focus on increasing access to such strategies as well as educating patients and providers of their benefits.

  10. Involving healthcare professionals and family carers in setting research priorities for end-of-life care.

    Science.gov (United States)

    Diffin, Janet; Spence, Michael; Spencer, Rebecca; Mellor, Peter; Grande, Gunn

    2017-02-02

    It is important to ensure regional variances are considered when setting future end-of-life research priorities, given the differing demographics and service provision. This project sought to identify end-of-life research priorities within Greater Manchester (United Kingdom). Following an initial scoping exercise, six topics within the 10 national priorities outlined by The Palliative and end-of-life care Priority Setting Partnership were selected for exploration. A workshop involving 32 healthcare professionals and a consultation process with 26 family carers was conducted. Healthcare professionals and carers selected and discussed the topics important to them. The topics selected most frequently by both healthcare professionals and carers were 'Access to 24 hour care', 'Planning end-of-life care in advance' and 'Staff and carer education'. Healthcare professionals also developed research questions for their topics of choice which were refined to incorporate carers' views. These questions are an important starting point for future end-of-life research within Greater Manchester.

  11. Patient-Clinician Communication About End-of-Life Care in Patients With Advanced Chronic Organ Failure During One Year.

    Science.gov (United States)

    Houben, Carmen H M; Spruit, Martijn A; Schols, Jos M G A; Wouters, Emiel F M; Janssen, Daisy J A

    2015-06-01

    Patient-clinician communication is an important prerequisite to delivering high-quality end-of-life care. However, discussions about end-of-life care are uncommon in patients with advanced chronic organ failure. The aim was to examine the quality of end-of-life care communication during one year follow-up of patients with advanced chronic organ failure. In addition, we aimed to explore whether and to what extent quality of communication about end-of-life care changes toward the end of life and whether end-of-life care communication is related to patient-perceived quality of medical care. Clinically stable outpatients (n = 265) with advanced chronic obstructive pulmonary disease, chronic heart failure, or chronic renal failure were visited at home at baseline and four, eight, and 12 months after baseline to assess quality of end-of-life care communication (Quality of Communication questionnaire). Two years after baseline, survival status was assessed, and if patients died during the study period, a bereavement interview was done with the closest relative. One year follow-up was completed by 77.7% of the patients. Quality of end-of-life care communication was rated low at baseline and did not change over one year. Quality of end-of-life care communication was comparable for patients who completed two year follow-up and patients who died during the study. The correlation between quality of end-of-life care communication and satisfaction with medical treatment was weak. End-of-life care communication is poor in patients with chronic organ failure and does not change toward the end of life. Future studies should develop an intervention aiming at initiating high-quality end-of-life care communication between patients with advanced chronic organ failure and their clinicians. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  12. Effects of irradiation and refrigeration on the nutrients and shelf-life of tilapia (Oreochromis niloticus)

    International Nuclear Information System (INIS)

    Siqueira, Alessandra Aparecida Zilio Cozzo de

    2001-01-01

    The objective of this study is to enhance the shelf-life of processed fish, combining ionizing radiation and refrigeration with minimal processing. The physical, chemical, nutritional and microbiological characteristics of the specie Tilapia nilotica (Oreochromis niloticus) were studied in eviscerated samples and in commercial cuts. The fish were separated into samples irradiated with 1.0, 2.2 and 5 kGy and non-irradiated samples. They were stored at temperatures ranging from 0.5 deg C to -2 deg C for 20 and 30 days. During storage, the level of moisture in the non-irradiated samples decreased and the levels of protein and lipid increased while the irradiated samples remained stable. The levels of pH, TVB-N and NPN increased in the non-irradiated samples but tended to remain stable in the irradiated fish samples. During storage, microbiological analyses for the presence of coliforms proved the efficiency of the irradiation process. The irradiated samples had a microbiological content below the levels established by the Brazilian seafood legislation, whereas the non-irradiated samples had a higher microbiological content and were not in conformity with the officially permitted levels. Salmonella spp. and Staphylococcus aureus were not detected. The levels of amino acids in muscles and fatty acids in oil remained stable in the irradiated fish stored samples but decreased in the non-irradiated ones. Lipid-oxidation, measured by the TBARS test, showed a tendency to increase when the dose of irradiation increased. The storage products after 30 days showed good acceptability for sensorial parameters, appearance, odour, color and texture, so it is possible to increase the shelf life of a minimally processed tilapia using combined irradiation and refrigeration. (author)

  13. Stealing on insensibly: end of life politics in the United States.

    Science.gov (United States)

    Brown, Lawrence D

    2012-10-01

    Because the United States often seems (and seems eager to present itself as) the home of the technological imperative and of determination to brand all challenges to it in end-of-life care as a descent into death panels, the prospects look unpromising for progress in US public policies that would expand the range of choices of medical treatments available to individuals preparing for death. Beneath this obdurate and intermittently hysterical surface, however, the diffusion across US states and communities of living wills, advanced directives, palliative care, hospice services and debates about assisted suicide is gradually strengthening not so much 'personal autonomy' as the authority, cultural and formal, of individuals and their loved ones not merely to shape but to lead the inevitably 'social' conversations on which decisions about care at the end of life depend. In short, the nation appears to be (in terms taken from John Donne's mediations on death) 'stealing on insensibly'--making incremental progress toward the replacement of clinical and other types of dogma with end-of-life options that honor the preferences of the dying.

  14. Economic evaluation of extending shelf-life of mangoes by irradiation

    International Nuclear Information System (INIS)

    Mahmoud, A.A.

    1994-01-01

    The present study reviews the status of cultivation, annual production, local consumption and export volume of mangoes in Egypt. The data presented reflect the magnitude of annual losses due to fungal attack, insect infestation and chemical changes. Attempts have been made to ensure longer and better keeping quality of mangoes through many conventional treatments, e.g. refrigeration and chemical treatment. However, the percentage of annual loss of mangoes in Egypt is still far from being acceptable. Irradiation processing of mangoes for extending shelf-life has been considered a feasible technology in Egypt. Studies have been carried out in Egypt since 1970 to investigate the technological and nutritional status of irradiated mangoes. Nevertheless not enough comprehensive studies have been undertaken to evaluate the economic feasibility of such a technology as calculated under local environmental conditions. In this study the 'Egypt's Mega Gamma I' Irradiator (with cobalt-60 source) was used. (author)

  15. Exhaust All Measures: Ethical Issues in Pediatric End-of-Life Care.

    Science.gov (United States)

    Thieleman, Kara J; Wallace, Cara; Cimino, Andrea N; Rueda, Heidi A

    2016-01-01

    The death of a child may have a profound impact on parents, family members, and health care providers who provided care for the child. Unique challenges are faced by parents of seriously ill children as they must serve as the legal authority for health care decisions of children under age 18, although the child's wishes must also be considered. Social workers must balance core social work values, bioethical values, and psychosocial issues presented by such situations. While studies have been conducted with physicians and nurses regarding ethical issues in pediatric end-of-life care settings, little is known about how social workers experience these conflicts. This article utilizes two vignettes to illustrate potential ethical issues in this setting and applies the National Association of Social Workers Standards for Palliative and End of Life Care (NASW, 2004 ) to explore options for their resolution. These vignettes provide descriptions of possible reactions in this setting and can be used as a basis for further exploration of ethics in pediatric end-of-life care from a social work perspective.

  16. Environmental and economic analysis of end of life management options for an HDPE product using a life cycle thinking approach.

    Science.gov (United States)

    Simões, Carla L; Pinto, Lígia M Costa; Bernardo, C A

    2014-05-01

    Manufacturers have been increasingly considering the implication of materials used in commercial products and the management of such products at the end of their useful lives (as waste or as post-consumer secondary materials). The present work describes the application of the life cycle thinking approach to a plastic product, specifically an anti-glare lamellae (used for road safety applications) made with high-density polyethylene (HDPE). This study shows that optimal environmental and economic outcomes associated with this product can be realized by recovering the material at the end of its useful life (end of life, EoL) and by using the recycled HDPE as a raw material in the production of new similar products. The study confirmed the applicability of the life cycle thinking approach by industry in sustainable products development, supporting the development of robust environmental and economic guidelines.

  17. Current End-of-Life Care Needs and Care Practices in Acute Care Hospitals

    Directory of Open Access Journals (Sweden)

    Amy J. Thurston

    2011-01-01

    Full Text Available A descriptive-comparative study was undertaken to examine current end-of-life care needs and practices in hospital. A chart review for all 1,018 persons who died from August 1, 2008 through July 31, 2009 in two full-service Canadian hospitals was conducted. Most decedents were elderly (73.8% and urbanite (79.5%, and cancer was the most common diagnosis (36.2%. Only 13.8% had CPR performed at some point during this hospitalization and 8.8% had CPR immediately preceding death, with 87.5% having a DNR order and 30.8% providing an advance directive. Most (97.3% had one or more life-sustaining technologies in use at the time of death. These figures indicate, when compared to those in a similar mid-1990s Canadian study, that impending death is more often openly recognized and addressed. Technologies continue to be routinely but controversially used. The increased rate of end-stage CPR from 2.9% to 8.8% could reflect a 1994+ shift of expected deaths out of hospital.

  18. Allowing Family to be Family: End-of-Life Care in Veterans Affairs Medical Foster Homes.

    Science.gov (United States)

    Manheim, Chelsea E; Haverhals, Leah M; Jones, Jacqueline; Levy, Cari R

    2016-01-01

    The Medical Foster Home program is a unique long-term care program coordinated by the Veterans Health Administration. The program pairs Veterans with private, 24-hour a day community-based caregivers who often care for Veterans until the end of life. This qualitative study explored the experiences of care coordination for Medical Foster Home Veterans at the end of life with eight Veterans' family members, five Medical Foster Home caregivers, and seven Veterans Health Administration Home-Based Primary Care team members. A case study, qualitative content analysis identified these themes addressing care coordination and impact of the Medical Foster Home model on those involved: (a) Medical Foster Home program supports Veterans' families; (b) Medical Foster Home program supports the caregiver as family; (c) Veterans' needs are met socially and culturally at the end of life; and (d) the changing needs of Veterans, families, and caregivers at Veterans' end of life are addressed. Insights into how to best support Medical Foster Home caregivers caring for Veterans at the end of life were gained including the need for more and better respite options and how caregivers are compensated in the month of the Veteran's death, as well as suggestions to navigate end-of-life care coordination with multiple stakeholders involved.

  19. Resource recovery from end-of-life tyres in Greece: a field survey, state-of-art and trends.

    Science.gov (United States)

    Karagiannidis, A; Kasampalis, T

    2010-06-01

    Lack of consistent and available information for the entire tyre industry has often hindered adequate understanding of current and future issues that need to be addressed for improving the sustainable end-of-life tyre management. The aim of this paper is to review related best available technologies and techniques for Greece, ranging from simple mechanical processing, up to complex multistep, mechanochemical and/or thermal treatment. End-of-life tyre management guidelines in the form of a manual for supporting future entrepreneurs in this field are also discussed. Extensive data mining, classification and inventorying was performed, both in the field via questionnaires and in the literature, for the purpose of accurately determining Hellenic conditions, in order to pinpoint encountered problems, propose interventions and determine new entrepreneurship opportunities.

  20. Nitride fuels irradiation performance data base

    International Nuclear Information System (INIS)

    Brozak, D.E.; Thomas, J.K.; Peddicord, K.L.

    1987-01-01

    An irradiation performance data base for nitride fuels has been developed from an extensive literature search and review that emphasized uranium nitride, but also included performance data for mixed nitrides [(U,Pu)N] and carbonitrides [(U,Pu)C,N] to increase the quantity and depth of pin data available. This work represents a very extensive effort to systematically collect and organize irradiation data for nitride-based fuels. The data base has many potential applications. First, it can facilitate parametric studies of nitride-based fuels to be performed using a wide range of pin designs and operating conditions. This should aid in the identification of important parameters and design requirements for multimegawatt and SP-100 fuel systems. Secondly, the data base can be used to evaluate fuel performance models. For detailed studies, it can serve as a guide to selecting a small group of pin specimens for extensive characterization. Finally, the data base will serve as an easily accessible and expandable source of irradiation performance information for nitride fuels

  1. Irradiation and storage effects on sensorial and physical characteristics of Keitt mangoes (Mangifera indica L.), quality of irradiated mangoes

    International Nuclear Information System (INIS)

    Lacroix, M.; Jobin, M.; Gagnon, M.

    1992-01-01

    Mango rot caused by fungi is a major problem during storage and marketing. Gamma irradiation was used to determine its effect on the quality of U.S. mangoes irradiated in Canada with 60Co at a minimum dose of 0.60 and a maximum of 0.90 kGy. The sensory evaluation, the texture, the colour and total soluble solids content were assessed during 15 days storage period. Initially, the appearance of irradiated whole mangoes was preferred, but at the end of the storage period the reverse was observed. Although, the irradiation did not extend the shelf-life of mangoes, the pulp of irradiated mangoes was perferred for its colour, odour, taste and texture until day 9. The panelists preferred darker orange colour, fragrant, sweeter and soften mangoes

  2. Swiss doctors' attitudes towards end-of-life decisions and their determinants: a comparison of three language regions.

    Science.gov (United States)

    Fischer, Susanne; Bosshard, Georg; Faisst, Karin; Tschopp, Alois; Fischer, Johannes; Bär, Walter; Gutzwiller, Felix

    2006-06-10

    To investigate attitudes to end-of-life decisions, and the influence of cultural factors and of doctors' personal characteristics on these attitudes. As part of a European research project (EURELD), a study on attitudes towards medical end-of-life decisions was conducted among doctors in the German-, French- and Italian-speaking areas of Switzerland. A written questionnaire was sent to a random sample of nine different types of specialist; it presented 14 statements on end-of-life decisions and doctors were asked whether they agreed or disagreed with them. The response rate was 64%. 1360 questionnaires were studied. The results show general agreement with statements on the alleviation of pain and other symptoms with possible life-shortening effect, as well as on non-treatment decisions. The language region was a strong determinant of agreement on some attitudes towards end-of-life decisions. Agreement on the use of lethal drugs and alleviation of pain and other symptoms with possible life-shortening effect was higher among French-speaking than among German- and Italian-speaking doctors. For nontreatment decisions, agreement was higher in the German-speaking region than in the French- and Italian-speaking regions of the country. Italian-speaking doctors were strongly opposed to any kind of end-of-life decision. Religious believers and those who attended a larger number of terminal patients tended to disagree more often with end-of-life decisions than the other doctors. In end-of-life decision-making, Switzerland represents "Europe in miniature". The impact on end-of-life decisions of cultural factors and the number of terminal patients attended needs further consideration.

  3. Selection bias in family reports on end of life with dementia in nursing homes

    NARCIS (Netherlands)

    van der Steen, J.T.; Deliens, L.; Ribbe, M.W.; Onwuteaka-Philipsen, B.D.

    2012-01-01

    Background: Selective participation in retrospective studies of families recruited after the patient's death may threaten generalizability of reports on end-of-life experiences. Objectives: To assess possible selection bias in retrospective study of dementia at the end of life using family reports.

  4. Mechanical performance of irradiated beryllium pebbles

    Energy Technology Data Exchange (ETDEWEB)

    Scaffidi-Argentina, F.; Dalle-Donne, M.; Werle, H. [Forschungszentrum Karlsruhe GmbH Technik und Umwelt (Germany). Inst. fuer Neutronenphysik und Reaktortechnik

    1998-01-01

    For the Helium Cooled Pebble Bed (HCPB) Blanket, which is one of the two reference concepts studied within the European Fusion Technology Programme, the neutron multiplier consists of a mixed bed of about 2 and 0.1-0.2 mm diameter beryllium pebbles. Beryllium has no structural function in the blanket, however microstructural and mechanical properties are important, as they might influence the material behavior under neutron irradiation. The EXOTIC-7 as well as the `Beryllium` experiments carried out in the HFR reactor in Petten are considered as the most detailed and significant tests for investigating it. This paper reviews the present status of beryllium post-irradiation examinations performed at the Forschungszentrum Karlsruhe with samples from these irradiation experiments, emphasizing the effects of irradiation of essential material properties and trying to elucidate the processes controlling the property changes. The microstructure, the porosity distribution, the impurity content, the behavior under compression loads and the compatibility of the beryllium pebbles with lithium orthosilicate (Li{sub 4}SiO{sub 4}) during the in-pile irradiation are presented and critically discussed. Qualitative information on ductility and creep obtained by hardness-type measurements are also supplied. (author)

  5. Seeking worldwide professional consensus on the principles of end-of-life care for the critically ill. The Consensus for Worldwide End-of-Life Practice for Patients in Intensive Care Units (WELPICUS) study.

    Science.gov (United States)

    Sprung, Charles L; Truog, Robert D; Curtis, J Randall; Joynt, Gavin M; Baras, Mario; Michalsen, Andrej; Briegel, Josef; Kesecioglu, Jozef; Efferen, Linda; De Robertis, Edoardo; Bulpa, Pierre; Metnitz, Philipp; Patil, Namrata; Hawryluck, Laura; Manthous, Constantine; Moreno, Rui; Leonard, Sara; Hill, Nicholas S; Wennberg, Elisabet; McDermid, Robert C; Mikstacki, Adam; Mularski, Richard A; Hartog, Christiane S; Avidan, Alexander

    2014-10-15

    Great differences in end-of-life practices in treating the critically ill around the world warrant agreement regarding the major ethical principles. This analysis determines the extent of worldwide consensus for end-of-life practices, delineates where there is and is not consensus, and analyzes reasons for lack of consensus. Critical care societies worldwide were invited to participate. Country coordinators were identified and draft statements were developed for major end-of-life issues and translated into six languages. Multidisciplinary responses using a web-based survey assessed agreement or disagreement with definitions and statements linked to anonymous demographic information. Consensus was prospectively defined as >80% agreement. Definitions and statements not obtaining consensus were revised based on comments of respondents, and then translated and redistributed. Of the initial 1,283 responses from 32 countries, consensus was found for 66 (81%) of the 81 definitions and statements; 26 (32%) had >90% agreement. With 83 additional responses to the original questionnaire (1,366 total) and 604 responses to the revised statements, consensus could be obtained for another 11 of the 15 statements. Consensus was obtained for informed consent, withholding and withdrawing life-sustaining treatment, legal requirements, intensive care unit therapies, cardiopulmonary resuscitation, shared decision making, medical and nursing consensus, brain death, and palliative care. Consensus was obtained for 77 of 81 (95%) statements. Worldwide consensus could be developed for the majority of definitions and statements about end-of-life practices. Statements achieving consensus provide standards of practice for end-of-life care; statements without consensus identify important areas for future research.

  6. Pricing end-of-life components

    Science.gov (United States)

    Vadde, Srikanth; Kamarthi, Sagar V.; Gupta, Surendra M.

    2005-11-01

    The main objective of a product recovery facility (PRF) is to disassemble end-of-life (EOL) products and sell the reclaimed components for reuse and recovered materials in second-hand markets. Variability in the inflow of EOL products and fluctuation in demand for reusable components contribute to the volatility in inventory levels. To stay profitable the PRFs ought to manage their inventory by regulating the price appropriately to minimize holding costs. This work presents two deterministic pricing models for a PRF bounded by environmental regulations. In the first model, the demand is price dependent and in the second, the demand is both price and time dependent. The models are valid for single component with no inventory replenishment sale during the selling horizon . Numerical examples are presented to illustrate the models.

  7. Can the NICE "end-of-life premium" be given a coherent ethical justification?

    Science.gov (United States)

    Cookson, Richard

    2013-12-01

    In 2009 the UK National Institute for Health and Clinical Excellence (NICE) announced that its health technology appraisal committees would henceforth give special additional weight to health gains from life-extending end-of-life treatments. This was a response to mounting concern from NICE's stakeholders that effective new drugs for end-stage cancer often fail NICE's standard test of cost effectiveness. This change of policy may be justifiable on procedural grounds as the result of a democratic political process responding to stakeholder concerns. However, according to the "accountability for reasonableness" framework proposed by the philosopher Norman Daniels and endorsed by NICE, there also needs to be transparency about the substantive ethical grounds for public health care resource allocation decisions. In that spirit, I analyze eleven potentially relevant justifications for the NICE "end-of-life premium," drawn from the economics and philosophy literature: (1) rule of rescue, (2) fair chances, (3) ex post willingness to pay, (4) caring externality, (5) financial protection, (6) symbolic value, (7) diminishing marginal value of future life years, (8) concentration of benefits, (9) dread, (10) time to set your affairs in order, and (11) severity of illness. I conclude that none of them yields a coherent ethical justification for the NICE end-of-life premium.

  8. The Tool Life of Ball Nose end Mill Depending on the Different Types of Ramping

    Science.gov (United States)

    Vopát, Tomáš; Peterka, Jozef; Kováč, Martin

    2014-12-01

    The article deals with the cutting tool wear measurement process and tool life of ball nose end mill depending on upward ramping and downward ramping. The aim was to determine and compare the wear (tool life) of ball nose end mill for different types of copy milling operations, as well as to specify particular steps of the measurement process. In addition, we examined and observed cutter contact areas of ball nose end mill with machined material. For tool life test, DMG DMU 85 monoBLOCK 5-axis CNC milling machine was used. In the experiment, cutting speed, feed rate, axial depth of cut and radial depth of cut were not changed. The cutting tool wear was measured on Zoller Genius 3s universal measuring machine. The results show different tool life of ball nose end mills depending on the copy milling strategy.

  9. Intensity of Care at the End of Life Among Older Adults in Korea.

    Science.gov (United States)

    Kim, Su Hyun; Kang, Sangwook; Song, Mi-Kyung

    2018-01-01

    To examine the intensity of care at the end of life among older adults in Korea and to identify the individual and institutional factors associated with care intensity. This secondary data analysis included a sample of 6278 decedents aged 65 years or older who were identified from the 2009 to 2010 Korean National Health Insurance Service-National Sample Cohort Claims data. We examined the medical care received by the cohort in the last 30 days of their lives. Overall, 36.5% of the sample received at least 1 intensive care procedure in the last 30 days of their lives; 26.3% of patients experienced intensive care unit admission, with an average stay of 7.45 days, 19.5% received mechanical ventilation, 12.3% received cardiopulmonary resuscitation, and 15.5% had a feeding tube placement. A statistical analysis using a multiple logistic regression model with random effects showed that younger age, higher household income, primary diagnoses of diseases (ischemic heart disease, infectious disease, chronic lung disease, or chronic heart disease), and characteristics of care setting (large hospitals and facilities located in metropolitan areas) were significantly associated with the likelihood of receiving high-intensity care at the end of life. A substantial number of older adults in Korea experienced high-intensity end-of-life care. Both individual and institutional factors were associated with the likelihood of receiving high-intensity care. Gaining an understanding of the intensity of care at the end of life and the impact of the determinants would advance efforts to improve quality of care at the end of life for older adults in Korea.

  10. Spectroscopy and viability of Bacillus subtilis spores after ultraviolet irradiation: implications for the detection of potential bacterial life on Europa.

    Science.gov (United States)

    Noell, Aaron C; Ely, Tucker; Bolser, Diana K; Darrach, Halley; Hodyss, Robert; Johnson, Paul V; Hein, Jeffrey D; Ponce, Adrian

    2015-01-01

    One of the most habitable environments in the Solar System outside of Earth may exist underneath the ice on Europa. In the near future, our best chance to look for chemical signatures of a habitable environment (or life itself) will likely be at the inhospitable icy surface. Therefore, it is important to understand the ability of organic signatures of life and life itself to persist under simulated europan surface conditions. Toward that end, this work examined the UV photolysis of Bacillus subtilis spores and their chemical marker dipicolinic acid (DPA) at temperatures and pressures relevant to Europa. In addition, inactivation curves for the spores at 100 K, 100 K covered in one micron of ice, and 298 K were measured to determine the probability for spore survival at the surface. Fourier transform infrared spectra of irradiated DPA showed a loss of carboxyl groups to CO2 as expected but unexpectedly showed significant opening of the heterocyclic ring, even for wavelengths>200 nm. Both DPA and B. subtilis spores showed identical unknown spectral bands of photoproducts after irradiation, further highlighting the importance of DPA in the photochemistry of spores. Spore survival was enhanced at 100 K by ∼5× relative to 298 K, but 99.9% of spores were still inactivated after the equivalent of ∼25 h of exposure on the europan surface.

  11. Irradiation of Ananas comosus: shelf life improvement, nutritional quality and assessment of genotoxicity

    International Nuclear Information System (INIS)

    Susheela, K.; Damayanti, M.; Sharma, G.J.

    1997-01-01

    The effect of gamma radiation in improving the shelf life of three-quarter ripe and fully ripe pineapple fruit by reducing the incidence of fungal infection, predominantly caused by Ceratocystis paradoxa, is described. Ananas comosus irradiated at 50, 100 and 150 Gy and stored at 25-29°C with 90-97% relative humidity maintained their texture better than the controls. The maximum tolerable dose was about 250 Gy. There was, no significant loss of sugar and ascorbic acid contents in fruit irradiated at the optimum dose, i.e. 150 Gy. At the same time, the irradiated pineapple fruit (250 Gy) did not induce any harmful genotoxic effect on rats fed daily with the irradiated pineapples for 30 days

  12. Effect of some potentially synergistic treatments in combination with 100 Krad irradiation on the iced shelf life of cod fillets

    International Nuclear Information System (INIS)

    Licciardello, J.J.; Ravesi, E.M.; Tuhkunen, B.E.; Racicot, L.D.

    1984-01-01

    Irradiation of cod fillets with a maximum absorbed dose of 100 Krad extended iced storage life by about 9 days. Further extension of several days resulted when irradiation was combined concurrently with either 60% CO 2 packaging atmosphere or sorbate additive. Packaging at low oxygen tension did not provide any additional benefit for irradiated fish. No important difference in storage life of treated fish was observed due to one vs three day postmortem age. The 100 Krad treatment extended grade B quality market life as opposed to grade A (prime quality) market life. Certain physical/chemical tests were evaluated for their efficacy in estimating spoilage. Concentrations of TMA, DMA, hypoxanthine, APC and pH at spoilage were comparable in control and air-irradiated samples, but were less in sorbate-irradiated fillets. 48 references, 8 figures, 1 table

  13. Recycling end-of-life vehicles of the future. Final CRADA report.

    Energy Technology Data Exchange (ETDEWEB)

    Jody, B. J.; Pomykala, J. A.; Spangenberger, J. S.; Daniels, E.; Energy Systems

    2010-01-14

    Argonne National Laboratory (the Contractor) entered into a Cooperative Research and Development Agreement (CRADA) with the following Participants: Vehicle Recycling Partnership, LLC (VRP, which consists of General Motors [GM], Ford, and Chrysler), and the American Chemistry Council - Plastics Division (ACC-PD). The purpose of this CRADA is to provide for the effective recycling of automotive materials. The long-term goals are to (1) enable the optimum recycling of automotive materials, thereby obviating the need for legislative mandates or directives; (2) enable the recovery of automotive materials in a cost-competitive manner while meeting the performance requirements of the applications and markets for the materials; and (3) remove recycling barriers/reasons, real or perceived, to the use of advanced lightweighting materials or systems in future vehicles. The issues, technical requirements, and cost and institutional considerations in achieving that goal are complex and will require a concerted, focused, and systematic analysis, together with a technology development program. The scope and tasks of this program are derived from 'A Roadmap for Recycling End-of-Life Vehicles of the Future,' prepared in May 2001 for the DOE Office of Energy, Efficiency, and Renewable Energy (EERE)-Vehicle Technologies Program. The objective of this research program is to enable the maximum recycling of automotive materials and obsolete vehicles through the development and commercialization of technologies for the separation and recovery of materials from end-of-life vehicles (ELVs). The long-term goals are to (1) enable the optimum recycling of automotive materials, thereby obviating the need for legislative mandates or directives; (2) enable the recovery of automotive materials in a cost-competitive manner while meeting the performance requirements of the applications and markets for the materials; and (3) remove recycling barriers/reasons, real or perceived, to the use

  14. Evaluation end-of-life power generation of a satellite solar array

    International Nuclear Information System (INIS)

    Taherbaneh, Mohsen; Ghafooifard, H.; Rezaie, A.H.; Rahimi, K.

    2011-01-01

    Research highlights: → We present detailed design description and necessary considerations for solar panels utilized in a specific space mission. → All sources of losses and degradation of the solar panels are fully taken into account. → We introduce a comprehensive novel approach to investigate the electrical behavior of the solar panels. → We use a simple model to calculate the operating temperature range of the solar panels. → We also calculate Mission End-of-Life electrone fluence using SPENVIS. -- Abstract: Knowing the power generated by of solar arrays in a space missions shall satisfy mission requirements; prediction of the power generated by a solar array used in a space mission is very important and necessary. In this research, a detailed design description and necessary considerations for solar panels utilized in a specific space mission is presented. All sources of losses and degradation of solar panels are fully taken into account. This research emphasizes on investigation, analysis and verification of a manufactured solar assembly for a satellite before launch. Solar panels' generated power should be estimated at the end of the mission. For this purpose, radiation values and temperature operating range are specified for the mission. Panels' temperature operating rate is determined through considering a simple model and different spins for the satellite. Mission end-of-life 1 MeV equivalent dose is calculated by SPENVIS suite software. Finally, a comprehensive novel approach is introduced to investigate the electrical behavior of the solar panels. This approach can be implemented in MATLAB environment to obtain output power characteristics of the solar panels for each specific mission. The results are in full accordance with the mission requirements either in beginning-of-life or end-of-life. Therefore, the power prediction of the designed solar array for the mentioned satellite completely satisfies its mission requirements.

  15. Community gardens as sites of solace and end-of-life support: a literature review.

    Science.gov (United States)

    Marsh, Pauline; Spinaze, Anna

    2016-05-01

    In a pilot project, members of a community garden explored how they might provide better end-of-life support for their regional community. As part of the project, a literature review was undertaken to investigate the nexus between community gardens and end-of-life experiences (including grief and bereavement) in academic research. This article documents the findings of that review. The authors discovered there is little academic material that focuses specifically on community gardens and end-of-life experiences, but nonetheless the two subjects were seen to intersect. The authors found three points of commonality: both share a need and capacity for a) social/informal support, b) therapeutic space, and c) opportunities for solace.

  16. Investigation of control rod worth and nuclear end of life of BWR control rods

    International Nuclear Information System (INIS)

    Magnusson, Per

    2008-01-01

    This work has investigated the Control Rod Worth (CRW) and Nuclear End of Life (NEOL) values for BWR control rods. A study of how different parameters affect NEOL was performed with the transport code PHOENIX4. It was found that NEOL, expressed in terms of 10 B depletion, can be generalized beyond the conditions for which the rod is depleted, such as different power densities and void fractions, the corresponding variation in the NEOL will be about 0.2-0.4% 10 B. It was also found that NEOL results for different fuel types and different fuel enrichments have a variation of about 2-3% in 10 B depletion. A comparative study on NHOL and CRW was made between PHOENIX4 and the stochastic Monte Carlo code MCNP. It was found that there is a significant difference, both due to differences in the codes and to limitations in the geometrical modeling in PHOENIX4. Since MCNP is considered more physically correct, a methodology was developed to calculate the nuclear end of life of BWR control rods with MCNP. The advantages of the methodology are that it does not require other codes to perform the depletion of the absorber material, it can describe control rods of any design and it can deplete the control rod absorber material without burning the fuel. The disadvantage of the method is that is it time-consuming

  17. Spiritual distress of military veterans at the end of life.

    Science.gov (United States)

    Chang, Bei-Hung; Stein, Nathan R; Skarf, Lara M

    2015-06-01

    Although combat experiences can have a profound impact on individuals' spirituality, there is a dearth of research in this area. Our recent study indicates that one unique spiritual need of veterans who are at the end of life is to resolve distress caused by combat-related events that conflict with their personal beliefs. This study sought to gain an understanding of chaplains' perspectives on this type of spiritual need, as well as the spiritual care that chaplains provide to help veterans ease this distress. We individually interviewed five chaplains who have provided spiritual care to veterans at the end of life in a Veterans Administration hospital. The interviews were recorded, transcribed, and analyzed based on "grounded theory." Chaplains reported that they frequently encounter veterans at the end of life who are still suffering from thoughts or images of events that occurred during their military career. Although some veterans are hesitant to discuss their experiences, chaplains reported that they have had some success with helping the veterans to open up. Additionally, chaplains reported using both religious (e.g., confessing sins) and nonreligious approaches (e.g., recording military experience) to help veterans to heal. Our pilot study provides some insight into the spiritual distress that many military veterans may be experiencing, as well as methods that a chaplain can employ to help these veterans. Further studies are needed to confirm our findings and to examine the value of integrating the chaplain service into mental health care for veterans.

  18. Microbiology, sensory evaluation and shelf life of irradiated chicken breast fillets stored in air or vacuum

    OpenAIRE

    Mantilla, Samira Pirola Santos; Santos, Érica Barbosa; Vital, Helio de Carvalho; Mano, Sérgio Borges; Freitas, Mônica Queiroz de; Franco, Robson Maia

    2011-01-01

    This work investigated the effects of different packaging methods (air and vacuum) combined with irradiation (0.0, 2.0 and 3.0 kGy) on the preservation of chicken breast fillets stored at 1ºC for up to 18 days by sensorial test, determination of pH and bacterial growth. The findings indicated that the post-irradiation lag phase increased with the dose, leading to an extension in shelf-life. Vacuum-packed samples irradiated at 3.0 kGy exhibited the longest shelf life. Among the analyzed bacter...

  19. End-of-life expectations and experiences among nursing home patients and their relatives

    DEFF Research Database (Denmark)

    Fosse, Anette; Schaufel, Margrethe Aase; Ruths, Sabine

    2014-01-01

    . CONCLUSION: Nursing home patients and their relatives wanted doctors more involved in end-of-life care. They expected doctors to acknowledge their preferences and provide guidance and symptom relief. PRACTICE IMPLICATIONS: High-quality end-of-life care in nursing homes relies on organization, funding......OBJECTIVE: Synthesize research about patients' and relatives' expectations and experiences on how doctors can improve end-of-life care in nursing homes. METHODS: We systematically searched qualitative studies in English in seven databases (Medline, Embase, PsycINFO, CINAHL, Ageline, Cochrane...... decision-makers reported uncertainty and distress when guidance from health personnel was lacking. They worried about staff shortage and emphasized doctor availability. Relatives and health personnel seldom recognized patients' ability to consent, and patients' preferences were not always recognized...

  20. Factors influencing the end of the service life of protective gloves used in car repair shops: a preliminary report.

    Science.gov (United States)

    Emilia, Irzmańska; Agnieszka, Stefko; Katarzyna, Dyńska-Kukulska

    2015-01-01

    The paper presents the results of an end-of-service-life study on 2 kinds of protective gloves designed for workplaces in which workers are exposed to mineral oils and mechanical factors. The authors developed their own end-of-service-life study method that takes into account factors occurring during real-life use of protective gloves. The examined gloves were subjected to mechanical, chemical, and physical factors. The objective of the study was to compare the protective in new gloves subjected to a laboratory simulation test and in gloves used at workplaces in car repair shops. A further goal was to design a glove assessment procedure that would ensure comprehensive analysis of the actual level of performance provided by gloves exposed to selected chemical and mechanical factors as well as subjected to the influence of temperature and humidity, mechanical damage, and chemical degradation of material. The results lead to the conclusion that simultaneous exposure of protective gloves to mechanical, chemical, and physical factors significantly decreases their performance levels. Furthermore, similar performance levels were obtained for gloves subjected to laboratory simulation tests and for those used in the workplace.

  1. End-of-Life Medical Spending In Last Twelve Months of Life is Lower than Previously Reported

    DEFF Research Database (Denmark)

    French, Eric; Aragon, Maria; Mccauley, Jeremy

    2017-01-01

    Although end-of-life medical spending is often viewed as a major component of aggregate medical expenditure, accurate measures of this type of medical spending are scarce. We used detailed health care data for the period 2009–11 from Denmark, England, France, Germany, Japan, the Netherlands, Taiw...... but to spending on people with chronic conditions, which are associated with shorter life expectancies....

  2. Interviews on end-of-life care with older people: reflections on six european studies

    NARCIS (Netherlands)

    Pleschberger, S.; Seymour, J.E.; Payne, S.; Deschepper, R.; Onwuteaka-Philipsen, B.D.; Rurup, M.L.

    2011-01-01

    Qualitative research provides important insights into the experiences and perspectives of older people on end-of-life issues, but such research is methodologically and ethically complex. We offer a set of reflections from six end-of-life care studies conducted with older people in four European

  3. Shelf-life extension of pre-packed whole wheat flour using low dose gamma irradiation

    International Nuclear Information System (INIS)

    Rao, V.S.; Marathe, S.A.; Pednekar, M.D.; Machaiah, J.P.; Rao, B.Y.K.; Adhikari, H.R.; Thomas, Paul

    1997-01-01

    Storage studies on irradiated (0.25, 0.5 and 1.0 kGy) and non-irradiated prepacked whole wheat flour have shown that wheat flour irradiated at 0.25 kGy and stored at room temperature for 6 months did not show significant changes in the functional qualities and acceptability of the product, thereby extending the shelf-life and marketability of the product. (author). 3 refs., 4 figs

  4. The Tool Life of Ball Nose end Mill Depending on the Different Types of Ramping

    Directory of Open Access Journals (Sweden)

    Vopát Tomáš

    2014-12-01

    Full Text Available The article deals with the cutting tool wear measurement process and tool life of ball nose end mill depending on upward ramping and downward ramping. The aim was to determine and compare the wear (tool life of ball nose end mill for different types of copy milling operations, as well as to specify particular steps of the measurement process. In addition, we examined and observed cutter contact areas of ball nose end mill with machined material. For tool life test, DMG DMU 85 monoBLOCK 5-axis CNC milling machine was used. In the experiment, cutting speed, feed rate, axial depth of cut and radial depth of cut were not changed. The cutting tool wear was measured on Zoller Genius 3s universal measuring machine. The results show different tool life of ball nose end mills depending on the copy milling strategy.

  5. A practice model for rural district nursing success in end-of-life advocacy care.

    Science.gov (United States)

    Reed, Frances M; Fitzgerald, Les; Bish, Melanie R

    2017-08-24

    The development of a practice model for rural district nursing successful end-of-life advocacy care. Resources to help people live well in the end stages of life in rural areas can be limited and difficult to access. District nurse advocacy may promote end-of-life choice for people living at home in rural Australia. The lack of evidence available internationally to inform practice in this context was addressed by exploratory study. A pragmatic mixed method study approved by the University Faculty Ethics Committee and conducted from March 2014 to August 2015 was used to explore the successful end-of-life advocacy of 98 rural Australian district nurses. The findings and results were integrated then compared with theory in this article to develop concepts for a practice model. The model illustrates rural district nurse advocacy success based on respect for the rights and values of people. Advocacy action is motivated by the emotional responses of nurses to the end-of-life vulnerability people experience. The combination of willing investment in relationships, knowing the rural people and resources, and feeling supported, together enables district nurses to develop therapeutic emotional intelligence. This skill promotes moral agency in reflection and advocacy action to overcome emotional and ethical care challenges of access and choice using holistic assessment, communication, organisation of resources and empowering support for the self-determination of person-centred end-of-life goals. Recommendations are proposed from the theoretical concepts in the model. Testing the model in practice is recommended to gain the perceptions of a broader range of rural people both giving and receiving end-of-life-care. A model developed by gathering and comparing district nursing experiences and understanding using mixed methods and existing theory offers evidence for practice of a philosophy of successful person-centred advocacy care in a field of nursing that lacks specific

  6. What are the barriers to initiating end-of-life conversations with patients in the last year of life?

    Science.gov (United States)

    Travers, Alice; Taylor, Vanessa

    2016-09-02

    Improving end of life care is a national imperative. Unsatisfactory care persists particularly in acute hospitals, with shortcomings, variability in communication and advance care planning identified as fundamental issues. This review explored the literature to identify what is known about the barriers to initiating end-of-life conversations with patients from the perspective of doctors and nurses in the acute hospital setting. Six electronic databases were searched for potentially relevant records published between 2008 and 2015. Studies were included if the authors reported on barriers to discussing end of life with families or patients as described by doctors or nurses in hospital settings, excluding critical care. Of 1267 potentially relevant records, 12 were included in the review. Although there is limited high-quality evidence available, several barriers were identified. Recurrent themes within the literature related to a lack of education and training, difficulty in prognostication, cultural differences and perceived reluctance of the patient or family. This study illustrated that, in addressing barriers to communication, consideration needs to be extended to include how to embed good communication practice between patients and health professionals into the culture of this setting. Board level commitment is required to raise awareness of, and familiarity with, policies and protocols concerning communication and end-of-life care. Communication training should include practical skills and tools, opportunities to explore the personal beliefs of practitioners and managing their emotions, opportunities to analyse the local organisational (physical and social environment) and team barriers.

  7. Learning end-of-life care within a constructivist model: Undergraduate nursing students’ experiences

    Directory of Open Access Journals (Sweden)

    Anna E. van der Wath

    2015-11-01

    Full Text Available Background: Although nursing education aims to equip nursing students to provide care to dying patients and their families, nurses often feel ill-prepared to cope with the emotional labour involved in end-of-life care. Objectives: The aim of the study was to explore and describe nursing students’ experiences of end-of-life care through experiential learning within a constructivist educational model. Method: A qualitative, descriptive design was used. As part of introducing experiential learning, innovative educational practices were initiated during a second year level undergraduate nursing module on end-of-life care. Qualitative data on second-year nursing students’ experiences were collected through written reflections and analysed using open coding. Results: The themes that emerged revealed participants’ sensory and emotional experiences during the learning opportunities. Participants reflected on what they learnt and clarified their values related to death and dying. They indicated how they would apply the new meanings constructed in clinical practice. Conclusion: A constructivist educational model of experiential learning holds potential to enhance value clarification and nursing students’ sensory and emotional awareness of death and dying. Experiential learning is recommended to develop nursing students’ competency inproviding end-of-life care.

  8. Factors Affecting Patients' Preferences for and Actual Discussions About End-of-Life Care.

    Science.gov (United States)

    Fakhri, Shoaib; Engelberg, Ruth A; Downey, Lois; Nielsen, Elizabeth L; Paul, Sudiptho; Lahdya, Alexandria Z; Treece, Patsy D; Curtis, J Randall

    2016-09-01

    Discussions about end-of-life care are often difficult for patients and clinicians, and inadequate communication poses a barrier to patients receiving the care they desire. To understand factors that facilitate end-of-life care discussions that guide interventions to improve care. We examined baseline data from an ongoing randomized trial to evaluate associations between patients' self-reported desire for, and occurrence of, discussions about end-of-life care and factors influencing these discussions. Factors included emotional symptoms and barriers and facilitators to discussions. The sample included patients with serious illness (n = 473) and their primary or specialty care clinicians (n = 128). Regression analyses were adjusted for confounders and clustered patients under clinicians. Patients who endorsed each of three barriers to discussions were less likely to have had a discussion with their clinician (P-values ranging from communication about end-of-life care is associated with patient factors including communication barriers and facilitators and symptoms of depression and anxiety. Understanding these factors may facilitate design of effective communication interventions. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  9. Reducing environmental burdens of solid-state lighting through end-of-life design

    International Nuclear Information System (INIS)

    Hendrickson, C T; Matthews, D H; Ashe, M; Jaramillo, P; McMichael, F C

    2010-01-01

    With 20% of US electricity used for lighting, energy efficient solid-state lighting technology could have significant benefits. While energy efficiency in use is important, the life cycle cost, energy and environmental impacts of light-emitting diode (LED) solid-state lighting could be reduced by reusing, remanufacturing or recycling components of the end products. Design decisions at this time for the nascent technology can reduce material and manufacturing burdens by considering the ease of disassembly, potential for remanufacturing, and recovery of parts and materials for reuse and recycling. We use teardowns of three commercial solid-state lighting products designed to fit in conventional Edison light bulb sockets to analyze potential end-of-life reuse strategies for solid-state lighting and recommend strategies for the industry. Current lamp designs would benefit from standardization of part connections to facilitate disassembly and remanufacturing of components, and fewer material types in structural pieces to maximize homogeneous materials recovery. The lighting industry should also start now to develop an effective product take-back system for collecting future end-of-life products.

  10. Reducing environmental burdens of solid-state lighting through end-of-life design

    Energy Technology Data Exchange (ETDEWEB)

    Hendrickson, C T; Matthews, D H; Ashe, M; Jaramillo, P; McMichael, F C, E-mail: cth@cmu.ed [Green Design Institute, Carnegie Mellon University (United States)

    2010-01-15

    With 20% of US electricity used for lighting, energy efficient solid-state lighting technology could have significant benefits. While energy efficiency in use is important, the life cycle cost, energy and environmental impacts of light-emitting diode (LED) solid-state lighting could be reduced by reusing, remanufacturing or recycling components of the end products. Design decisions at this time for the nascent technology can reduce material and manufacturing burdens by considering the ease of disassembly, potential for remanufacturing, and recovery of parts and materials for reuse and recycling. We use teardowns of three commercial solid-state lighting products designed to fit in conventional Edison light bulb sockets to analyze potential end-of-life reuse strategies for solid-state lighting and recommend strategies for the industry. Current lamp designs would benefit from standardization of part connections to facilitate disassembly and remanufacturing of components, and fewer material types in structural pieces to maximize homogeneous materials recovery. The lighting industry should also start now to develop an effective product take-back system for collecting future end-of-life products.

  11. Palliative sedation in end-of-life care.

    Science.gov (United States)

    Maltoni, Marco; Scarpi, Emanuela; Nanni, Oriana

    2013-07-01

    The aim of this review was to present and comment on recent data published on palliative sedation in palliative and end-of-life care. Palliative sedation is a medical procedure used to deal with the refractory symptoms occurring in the advanced stages of cancer. It has clinical, nursing, relational and ethical implications, making it a highly sensitive issue. Over the last 12 months, a number of authors have published interesting new findings on different areas of palliative sedation, that is prevalence, indications, monitoring, duration and choice of drugs. In particular, a clear definition of palliative sedation and of its more pronounced form, deep continuous sedation (DCS), has emerged. It has been confirmed that, when performed in the correct way and with the right aims, palliative sedation does not have a detrimental impact on survival. Recent findings confirm that palliative sedation is an integral part of a medical palliative care approach and is needed in certain clinical situations. It is a legitimate clinical practice from any ethical point of view. While oncologists should have a basic knowledge of the procedure, its in depth study is a core competency for palliative care physicians.

  12. How do nursing home doctors involve patients and next of kin in end-of-life decisions? A qualitative study from Norway.

    Science.gov (United States)

    Romøren, Maria; Pedersen, Reidar; Førde, Reidun

    2016-01-14

    Ethically challenging critical events and decisions are common in nursing homes. This paper presents nursing home doctors' descriptions of how they include the patient and next of kin in end-of-life decisions. We performed ten focus groups with 30 nursing home doctors. Advance care planning; aspects of decisions on life-prolonging treatment, and conflict with next of kin were subject to in-depth analysis and condensation. The doctors described large variations in attitudes and practices in all aspects of end-of-life decisions. In conflict situations, many doctors were more concerned about the opinion of next of kin than ensuring the patient's best interest. Many end-of-life decisions appear arbitrary or influenced by factors independent of the individual patient's values and interests and are not based on systematic ethical reflections. To protect patient autonomy in nursing homes, stronger emphasis on legal and ethical knowledge among nursing home doctors is needed.

  13. Clinical review: Ethics and end-of-life care for critically ill patients in China

    OpenAIRE

    Li, Li Bin

    2013-01-01

    Critical care medicine in China has made great advances in recent decades. This has led to an unavoidable issue: end-of-life ethics. With advances in medical technology and therapeutics allowing the seemingly limitless maintenance of life, the exact time of death of an individual patient is often determined by the decision to limit life support. How to care for patients at the end of life is not only a medical problem but also a social, ethical, and legal issue. A lot of factors, besides cult...

  14. Improvement of life time of SCC in type 304 stainless steel by ultrasound irradiation

    International Nuclear Information System (INIS)

    Tokiwai, Moriyasu; Kimura, Hideo

    1985-01-01

    It is well known that the susceptibility to stress corrosion cracking (SCC) is controled by compressive stress such as shot-peening treatment. In this study, the effects of ultrasound irradiation to type 304 stainless upon SCC were investigated. The main findings are as follows; (1) Ultrasound irradiation produces the high level compressive stress on the surface of metals. This compressive stress was induced by the cavitation phenomenon. (2) In U-bent specimen, the initial tensile stress was mitigated and converted to compressive stress by ultrasound irradiation. (3) Type 304 stainless steel was subjected to SCC test using sodium thyosulfate solution. It was definitely demonstrated that the ultrasound irradiation was effective for the mitigation of SCC life time. (4) Ultrasound irradiation time was one of the most important factors in irradiation conditions. (author)

  15. End-of-life conversations and care: an asset-based model for community engagement.

    Science.gov (United States)

    Matthiesen, Mary; Froggatt, Katherine; Owen, Elaine; Ashton, John R

    2014-09-01

    Public awareness work regarding palliative and end-of-life care is increasingly promoted within national strategies for palliative care. Different approaches to undertaking this work are being used, often based upon broader educational principles, but little is known about how to undertake such initiatives in a way that equally engages both the health and social care sector and the local communities. An asset-based community engagement approach has been developed that facilitates community-led awareness initiatives concerning end-of-life conversations and care by identifying and connecting existing skills and expertise. (1) To describe the processes and features of an asset-based community engagement approach that facilitates community-led awareness initiatives with a focus on end-of-life conversations and care; and (2) to identify key community-identified priorities for sustainable community engagement processes. An asset-based model of community engagement specific to end-of-life issues using a four-step process is described (getting started, coming together, action planning and implementation). The use of this approach, in two regional community engagement programmes, based across rural and urban communities in the northwest of England, is described. The assets identified in the facilitated community engagement process encompassed people's talents and skills, community groups and networks, government and non-government agencies, physical and economic assets and community values and stories. Five priority areas were addressed to ensure active community engagement work: information, outreach, education, leadership and sustainability. A facilitated, asset-based approach of community engagement for end-of-life conversations and care can catalyse community-led awareness initiatives. This occurs through the involvement of community and local health and social care organisations as co-creators of this change across multiple sectors in a sustainable way. This approach

  16. Performance of irradiated silicon microstrip detectors

    International Nuclear Information System (INIS)

    Catacchini, E.; Civinini, C.; D'Alessandro, R.; Focardi, E.; Lenzi, M.; Meschini, M.; Parrini, G.; Pieri, M.

    1999-01-01

    Silicon microstrip devices to be installed in Large Hadron Collider (LHC) tracking detectors will have to operate in a high radiation environment. We report on performance studies of silicon microstrip detectors irradiated with neutrons or protons, up to fluences comparable to the first ten years of running at LHC. Obtained results show that irradiated detectors can still be operated with satisfactory signal-to-noise ratio,and in the case of inhomogeneously type inverted detector a very good position resolution is achieved regardless of the zone crossed by the particle

  17. The role of the bioethicist in family meetings about end of life care.

    Science.gov (United States)

    Watkins, Liza T; Sacajiu, Galit; Karasz, Alison

    2007-12-01

    There has been little study of the content of bioethicists' communication during family meeting consultations about end of life care. In the literature, two roles for bioethicists are usually described: the "consultant" role, in which bioethicists define and support ethical principles such as those enshrined in the "rational choice" model; and the "mediator" role, which focuses on the enhancement of communication in order to reduce conflict. In this study, we use observational data to explore how bioethicists support the practice of decision making during family meetings about end of life care. In a study conducted in the Bronx, New York, USA, researchers observed and recorded 24 decision-making meetings between hospital staff and family members of elderly patients identified as being in the last stages of illness, who were unable or unwilling to make the decision for themselves. Bioethics consultants were present during five of those meetings. Although bioethicists referred to the "rational choice" decision-making hierarchy, we did not see the systematic exploration described in the literature. Rather, our data show that bioethicists tended to employ elements of the rational model at particular turning points in the decision-making process in order to achieve pragmatic goals. As mediators, bioethicists worked to create consensus between family and staff and provided invaluable sympathy and comfort to distressed family members. We also found evidence of a context-dependent approach to mediation, with bioethicists' contributions generally supporting staff views about end of life care. Bioethicists' called to consult on family meetings about end of life care do not appear to adhere to a strict interpretation of the official guidelines. In order to negotiate the difficult terrain of end of life decision making, our data show that bioethicists often add a third role, "persuader", to official roles of "consultant" and "mediator".

  18. A co-design process developing heuristics for practitioners providing end of life care for people with dementia.

    Science.gov (United States)

    Davies, Nathan; Mathew, Rammya; Wilcock, Jane; Manthorpe, Jill; Sampson, Elizabeth L; Lamahewa, Kethakie; Iliffe, Steve

    2016-08-02

    The end of life for someone with dementia can present many challenges for practitioners; such as, providing care if there are swallowing difficulties. This study aimed to develop a toolkit of heuristics (rules-of-thumb) to aid practitioners making end-of-life care decisions for people with dementia. An iterative co-design approach was adopted using a literature review and qualitative methods, including; 1) qualitative interviews and focus groups with family carers and 2) focus groups with health and care professionals. Family carers were recruited from a national charity, purposively sampling those with experience of end-of-life care for a person with dementia. Health and care professionals were purposively sampled to include a broad range of expertise including; general practitioners, palliative care specialists, and geriatricians. A co-design group was established consisting of health and social care experts and family carers, to synthesise the findings from the qualitative work and produce a toolkit of heuristics to be tested in practice. Four broad areas were identified as requiring complex decisions at the end of life; 1) eating/swallowing difficulties, 2) agitation/restlessness, 3) ending life-sustaining treatment, and 4) providing "routine care" at the end of life. Each topic became a heuristic consisting of rules arranged into flowcharts. Eating/swallowing difficulties have three rules; ensuring eating/swallowing difficulties do not come as a surprise, considering if the situation is an emergency, and considering 'comfort feeding' only versus time-trialled artificial feeding. Agitation/restlessness encourages a holistic approach, considering the environment, physical causes, and the carer's wellbeing. Ending life-sustaining treatment supports practitioners through a process of considering the benefits of treatment versus quality-of-life and comfort. Finally, a heuristic on providing routine care such as bathing, prompts practitioners to consider adapting

  19. Extended storage of gamma-irradiated mango at tropical ambient temperature by film wrap packaging

    International Nuclear Information System (INIS)

    Janave, Machhindra T.; Sharma, A.

    2005-01-01

    Low dose gamma-irradiation of pre-climacteric mango (Mangifera indica L var.'Alphonso') fruits at 100 Gy extended the shelf-life at ambient temperature (28-32 degC) by 5-6 days. The extension of shelf-life was dose dependent, maximum being at 200 Gy by about 8-10 days. Wrapping the fruits in food grade Klin Wrap film resulted in more number of fruits remaining in semiripe condition after 21 days of storage as revealed by colour of the fruits, texture, TSS, pH, acidity and vitamin C content. The fruits retained about 40% of chlorophyll however, unwrapped fruits were complete yellow. Physiological weight loss (PWL) was reduced by 50% in Klin film wrapped fruits as compared to that in unwrapped fruits. More than 70-80% fruits remained as marketable fruits at the end of experiment when control fruits were slightly overripe. The shelf-life in Klin film wrapped irradiated mangoes was extended by about 10-15 days over irradiated unwrapped fruits resulting in total shelf-life of about 25-30 days at room temperature. In mangoes of variety 'Dasheri', gamma-irradiation extended the shelf-life by 4-5 days, which could be increased further, by another 7-10 days by Klin wrap packaging. These fruits also remained green at the end of experiment, confirming the observations with 'Alphonso' mango. These results show that low dose gamma-irradiation in combination with Klin film packaging delayed ripening as indicated by higher retention of fruit colour and reduction of PWL. (author)

  20. The end-of-life phase of high-grade glioma patients: a systematic review

    NARCIS (Netherlands)

    Sizoo, Eefje M.; Pasman, H. Roeline W.; Dirven, Linda; Marosi, Christine; Grisold, Wolfgang; Stockhammer, Günther; Egeter, Jonas; Grant, Robin; Chang, Susan; Heimans, Jan J.; Deliens, Luc; Reijneveld, Jaap C.; Taphoorn, Martin J. B.

    2014-01-01

    High-grade gliomas (HGG) are rare and incurable; yet, these neoplasms result in a disproportionate share of cancer morbidity and mortality. Treatment of HGG patients is directed not merely towards prolonging life but also towards quality of life, which becomes the major goal in the end of life

  1. Advance Directive in End of Life Decision-Making among the Yoruba of South-Western Nigeria.

    Science.gov (United States)

    Jegede, Ayodele Samuel; Adegoke, Olufunke Olufunsho

    2016-11-01

    End-of-life decision making is value-laden within the context of culture and bioethics. Also, ethics committee role is difficult to understand on this, thus need for ethnomethodological perspective in an expanding bioethical age. Anthropological approach was utilized to document Yoruba definition and perspective of death, cultural beliefs about end-of-life decision making, factors influencing it and ethics committee role. Interviews were conducted among selected Yoruba resident in Akinyele LGA, Oyo State, Nigeria. Content analytical approach was used for data analysis. Yoruba culture, death is socially constructed having spiritual, physical and social significance. Relationship between the dying and significant others influences decision making. Hierarchy of authority informs implementing traditional advance directive. Socialization, gender, patriarchy, religious belief and tradition are major considerations in end-of-life decision making. Awareness, resource allocation and advocacy are important ethics committees' roles. Further research into cultural diversity of end-of-life decision making will strengthen ethical practice in health care delivery.

  2. End of life care in chronic obstructive pulmonary disease: in search of a good death

    Directory of Open Access Journals (Sweden)

    Anna Spathis

    2008-03-01

    Full Text Available Anna Spathis, Sara BoothPalliative Care Service, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England, UKAbstract: Chronic obstructive pulmonary disease (COPD is an incurable, progressive illness that is the fourth commonest cause of death worldwide. Death tends to occur after a prolonged functional decline associated with uncontrolled symptoms, emotional distress and social isolation. There is increasing evidence that the end of life needs of those with advanced COPD are not being met by existing services. Many barriers hinder the provision of good end of life care in COPD, including the inherent difficulties in determining prognosis. This review provides an evidence-based approach to overcoming these barriers, summarising current evidence and highlighting areas for future research. Topics include end of life needs, symptom control, advance care planning, and service development to improve the quality of end of life care.Keywords: chronic obstructive pulmonary disease (MeSH, palliative care (MeSH, dyspnoea (MeSH, advance care planning (MeSH

  3. A preliminary categorization of end-of-life electrical and electronic equipment as secondary metal resources

    International Nuclear Information System (INIS)

    Oguchi, Masahiro; Murakami, Shinsuke; Sakanakura, Hirofumi; Kida, Akiko; Kameya, Takashi

    2011-01-01

    Highlights: → End-of-life electrical and electronic equipment (EEE) as secondary metal resources. → The content and the total amount of metals in specific equipment are both important. → We categorized 21 EEE types from contents and total amounts of various metals. → Important equipment types as secondary resources were listed for each metal kind. → Collectability and possible collection systems of various EEE types were discussed. - Abstract: End-of-life electrical and electronic equipment (EEE) has recently received attention as a secondary source of metals. This study examined characteristics of end-of-life EEE as secondary metal resources to consider efficient collection and metal recovery systems according to the specific metals and types of EEE. We constructed an analogy between natural resource development and metal recovery from end-of-life EEE and found that metal content and total annual amount of metal contained in each type of end-of-life EEE should be considered in secondary resource development, as well as the collectability of the end-of-life products. We then categorized 21 EEE types into five groups and discussed their potential as secondary metal resources. Refrigerators, washing machines, air conditioners, and CRT TVs were evaluated as the most important sources of common metals, and personal computers, mobile phones, and video games were evaluated as the most important sources of precious metals. Several types of small digital equipment were also identified as important sources of precious metals; however, mid-size information and communication technology (ICT) equipment (e.g., printers and fax machines) and audio/video equipment were shown to be more important as a source of a variety of less common metals. The physical collectability of each type of EEE was roughly characterized by unit size and number of end-of-life products generated annually. Current collection systems in Japan were examined and potentially appropriate collection

  4. Effect of irradiation on quality, shelf life and consumer acceptance of traditional Nigerian meat and fish products

    International Nuclear Information System (INIS)

    Aworh, O.C.; Okparanta, R.N.; Oyedokun, E.O

    2002-01-01

    The effect of low dose irradiation, up to 6 kGy, on quality, shelf life and consumer acceptance of three traditional Nigerian meat and fish products was investigated. Irradiation inhibited microbial growth in 'suya' and 'kilishi' with substantial reduction in total aerobic counts, yeasts and molds and Staphylococcus aureus. Nonirradiated smoked-dried catfish (Clarias gariepinus) had a shelf life of less than one week at tropical ambient temperature (21-31 deg. C) due to insect infestation. Irradiated 'kilishi' and smoked dried catfish packed in sealed polyethylene bags (0.04 mm thick) were shelf stable for a period of 4-6 months and remained free from moldiness, infestation and were considered acceptable in sensory quality by a consumer panel of 32 assessors. There was a slight increase in TBA values of irradiated 'kilishi' stored for 4 months relative to non-irradiated controls. (author)

  5. Eco-Efficiency Assessment of Bioplastics Production Systems and End-of-Life Options

    Directory of Open Access Journals (Sweden)

    Kunnika Changwichan

    2018-03-01

    Full Text Available Bioplastics demand has been increased globally due to concerns regarding environmentally friendly consumption and production. Polylactic acid (PLA, polyhydroxyalkanoates (PHAs, and polybutylene succinate (PBS are promising bioplastics with bio-based feedstocks and property of biodegradability. They are produced by bacterial fermentation of sugars from carbohydrate sources. With flexibility in their properties, PLA, PHAs, and PBS can potentially substitute conventional plastics such as polypropylene (PP, polyethylene terephthalate (PET, and polystyrene (PS. This study aims at evaluating the environmental and economic sustainability of bioplastics production together with end-of-life (EOL options. The combination of environmental and economic indicators, eco-efficiency (E/E, was selected to investigate the performance of PLA, PHAs, and PBS from sugarcane and cassava in comparison with PP. The environmental impacts were determined using life cycle assessment. The product cost was used to represent the economic value. The E/E results showed that the environmental and economic sustainability could be enhanced with 100% mechanical recycling of all kinds of studied plastics. It is also important to highlight that mechanical recycling showed a better performance in terms of E/E than composting of bioplastics.

  6. The temporary structures for Expo Milan 2015: environmental assessment and solutions for the end of life management

    Directory of Open Access Journals (Sweden)

    Monica Lavagna

    2014-05-01

    Full Text Available Politecnico di Milano University worked for the Italian Ministry of Environment, land and sea on the sustainability assessment of Expo Milan 2015 self-built temporary pavilions. The work has been focused on the improvement of the buildings environmental performances. Given the buildings short durability in place (Expo lasts for 6 months, the strategies for their end of life are of great importance for the carbon footprint reduction. Starting from the specific work on Expo Milan 2015, the Politecnico di Milano working group proceeded with the methodology research about this issue, applicable also to future events. This paper presents the different relevant aspects of mega events temporary buildings end of life management; dealing with methodological, technical and managerial aspects.

  7. End-of-life decision-making and terminal sedation among very old patients.

    Science.gov (United States)

    De Gendt, Cindy; Bilsen, Johan; Mortier, Freddy; Vander Stichele, Robert; Deliens, Luc

    2009-01-01

    About half of the persons who die in developed countries are very old (aged 80 years or older) and this proportion is still rising. In general, there is little information available concerning the circumstances and quality of the end of life of this group. This study aims (1) to describe the incidence and characteristics of medical end-of-life decisions with a possible or certain life-shortening effect (ELDs) and terminal sedation among very old patients who died nonsuddenly, (2) to describe the characteristics of the preceding decision-making process, and (3) to compare this with the deaths of younger patients. A sample of 5,005 death certificates was selected from all deaths in Flanders (Belgium) in the second half of 2001 (before euthanasia was legalized). Questionnaires were mailed to the certifying physicians. Response rate was 58.9%. An ELD was made for 53.6% very old (aged 80+) patients who died nonsuddenly (vs. 63.3% for the younger patients). Use of life-ending drugs occurred among 1.1% (six times less frequently than in younger patients), with no euthanasia cases, pain and symptom alleviation with a possible life-shortening effect among 27.3% (two times less frequently), and withholding or withdrawing life-prolonging treatments among 25.2% (slightly more frequently). Terminal sedation occurred among 6.9% of the cases, two times less frequently than for the younger patients. ELDs were not often discussed with very old patients. Among competent patients this was less than compared with younger patients. ELDs are less common for very old than for younger patients. Physicians seem to have a more reluctant attitude towards the use of lethal drugs, terminal sedation and participation in decision-making when dealing with very old patients. Advance care planning should increase the involvement of very old competent and noncompetent patients in end-of-life decision-making. (c) 2008 S. Karger AG, Basel.

  8. Planning for Future Care and the End of Life: A Qualitative Analysis of Gay, Lesbian, and Heterosexual Couples.

    Science.gov (United States)

    Thomeer, Mieke Beth; Donnelly, Rachel; Reczek, Corinne; Umberson, Debra

    2017-12-01

    Two key components of end-of-life planning are (1) informal discussions about future care and other end-of-life preferences and (2) formal planning via living wills and other legal documents. We leverage previous work on the institutional aspects of marriage and on sexual-minority discrimination to theorize why and how heterosexual, gay, and lesbian married couples engage in informal and formal end-of-life planning. We analyze qualitative dyadic in-depth interviews with 45 midlife gay, lesbian, and heterosexual married couples ( N = 90 spouses). Findings suggest that same-sex spouses devote considerable attention to informal planning conversations and formal end-of-life plans, while heterosexual spouses report minimal formal or informal planning. The primary reasons same-sex spouses give for making end-of-life preparations are related to the absence of legal protections and concerns about discrimination from families. These findings raise questions about future end-of-life planning for same- and different-sex couples given a rapidly shifting legal and social landscape.

  9. Uses of irradiation or sodium tripolyphosphate for shelf-life extension of quail carcasses

    International Nuclear Information System (INIS)

    Rady, A.H.; Khalaf, H.H.; Afifi, E.A.; Nasr, E.H.

    2002-01-01

    this investigation aims to study the possibility of using gamma iraadiation or sodium tripolyphoshate (STPP) for increasing shelf-life of quail carcasses during cold storage. The quail carcasses were gamma irradiated at 4, 6 and 8 kGy or soaked in 3% STPP. The effect of these treatments on the organoleptic, microbiological aspects and chemical properties of samples under investigation were evaluated during cold storage (4± 1C degree). The results indicated that, the chemical compositions of samples did not alter by gamma irradiation or soaking in STPP. Futhermore, treatment had no deterious effects on the organoleptic properties of quail samples. Meanwhile, irradiation of samples at doses of 4, 6 and 8 kGy or soaking in STPP greatly reduced its microbial count and prolonged the shelf-life for 15,21,24 and 9 days at 4 ± 1 Cdegree in comparison with 6 days for control samples. Moreover, the acid value (A.V), peroxide value (P.V) and thiobarbituric acid (TBA) value were increased after irradiation, while total volatile basic nitrogen (TVBN) content had no real change by this treatment. On the other hand, soakking in STPP treatment decreased these values and gradual increases were observed during cold storage

  10. General Practitioners' Attitudes towards Essential Competencies in End-of-Life Care: A Cross-Sectional Survey.

    Science.gov (United States)

    Giezendanner, Stéphanie; Jung, Corinna; Banderet, Hans-Ruedi; Otte, Ina Carola; Gudat, Heike; Haller, Dagmar M; Elger, Bernice S; Zemp, Elisabeth; Bally, Klaus

    2017-01-01

    Identifying essential competencies in end-of-life care, as well as general practitioners' (GPs) confidence in these competencies, is essential to guide training and quality improvement efforts in this domain. To determine which competencies in end-of-life care are considered important by GPs, to assess GPs' confidence in these competencies in a European context and their reasons to refer terminally ill patients to a specialist. Cross-sectional postal survey involving a stratified random sample of 2000 GPs in Switzerland in 2014. Survey development was informed by a previous qualitative exploration of relevant end-of-life GP competencies. Main outcome measures were GPs' assessment of the importance of and confidence in 18 attributes of end-of-life care competencies, and reasons for transferring care of terminally-ill patients to a specialist. GP characteristics associated with main outcome measures were tested using multivariate regression models. The response rate was 31%. Ninety-nine percent of GPs considered the recognition and treatment of pain as important, 86% felt confident about it. Few GPs felt confident in cultural (16%), spiritual (38%) and legal end-of-life competencies such as responding to patients seeking assisted suicide (35%) although more than half of the respondents regarded these competencies as important. Most frequent reasons to refer terminally ill patients to a specialist were lack of time (30%), better training of specialists (23%) and end-of-life care being incompatible with other duties (19%). In multiple regression analyses, confidence in end-of-life care was positively associated with GPs' age, practice size, home visits and palliative training. GPs considered non-somatic competencies (such as spiritual, cultural, ethical and legal aspects) nearly as important as pain and symptom control. Yet, few GPs felt confident in these non-somatic competencies. These findings should inform training and quality improvement efforts in this domain, in

  11. Combination of irradiation with other treatments to improve the shelf-life and quality of meat and meat products

    International Nuclear Information System (INIS)

    Paul, P.; Chawla, S.P.; Kanatt, S.R.

    1998-01-01

    The effects were studied of low dose gamma irradiation in combination with other treatments (acetic acid and a sodium tripolyphosphate dip for buffalo meat; a hot water dip for lamb meat; ascorbic acid for chicken and curing for meat products) on the shelf-life of prepacked meats at chilled and ambient temperatures in terms of the microbiological, chemical and sensory qualities. Meats irradiated at 2.5 kGy had a shelf-life of 4 weeks at 0-3 deg. C, 2 weeks at 7-10 deg. C and 42 h at 28-30 deg. C, and showed a remarkable improvement in the microbiological quality. irradiation resulted in the reduction/elimination of microorganisms of public health significance, e.g. Enterobacteriaceae, Salmonella, staphylococci and faecal coliforms. In contrast, the corresponding control samples had a shelf-life of less than 2 weeks at 0-3 deg. C, 1 week at 7-10 deg. C and 18 h at ambient temperature (28-30 deg. C). A high level of microorganisms such as Enterobacteriaceae, staphylococci, Salmonella and sulphite reducing Clostridia were detected in the control samples during storage. A combination of acetic acid/hot water pretreatment and irradiation further improved the microbiological quality of the meats, while a pretreatment of sodium tripolyphosphate enhanced the retention of colour and the juiciness of the meat samples. The effects were observed at all the storage temperatures. For the meat products, a low dose of irradiation reduced the total viable counts by 1-2 log cycles, and also eliminated Enterobacteriaceae, staphylococci and Salmonella throughout the storage period. The irradiated meat products had a shelf-life of 2 weeks at 0-3 deg. C and 24 h at 28-30 deg. C, while the non-irradiated meat products had a shelf-life of 1 week at 0-3 deg. C and 18 h at 28-30 deg. C. (author)

  12. Matters of spirituality at the end of life in the pediatric intensive care unit.

    Science.gov (United States)

    Robinson, Mary R; Thiel, Mary Martha; Backus, Meghan M; Meyer, Elaine C

    2006-09-01

    Our objective with this study was to identify the nature and the role of spirituality from the parents' perspective at the end of life in the PICU and to discern clinical implications. A qualitative study based on parental responses to open-ended questions on anonymous, self-administered questionnaires was conducted at 3 PICUs in Boston, Massachusetts. Fifty-six parents whose children had died in PICUs after the withdrawal of life-sustaining therapies participated. Overall, spiritual/religious themes were included in the responses of 73% (41 of 56) of parents to questions about what had been most helpful to them and what advice they would offer to others at the end of life. Four explicitly spiritual/religious themes emerged: prayer, faith, access to and care from clergy, and belief in the transcendent quality of the parent-child relationship that endures beyond death. Parents also identified several implicitly spiritual/religious themes, including insight and wisdom; reliance on values; and virtues such as hope, trust, and love. Many parents drew on and relied on their spirituality to guide them in end-of-life decision-making, to make meaning of the loss, and to sustain them emotionally. Despite the dominance of technology and medical discourse in the ICU, many parents experienced their child's end of life as a spiritual journey. Staff members, hospital chaplains, and community clergy are encouraged to be explicit in their hospitality to parents' spirituality and religious faith, to foster a culture of acceptance and integration of spiritual perspectives, and to work collaboratively to deliver spiritual care.

  13. Performance degradation of ferrofluidic feedthroughs in a mixed irradiation field

    Science.gov (United States)

    Simos, Nikolaos; Fernandes, S.; Mittig, Wolfgang; Pellemoine, Frederique; Avilov, M.; Kostin, M.; Mausner, L.; Ronningen, R.; Schein, M.; Bollen, G.

    2017-01-01

    Ferrofluidic feedthrough (FF) rotary seals containing either NdFeB or SmCo-type permanent magnets have been considered for use in the target and beam dump systems of the Facility for Rare Isotope Beams (FRIB). To evaluate their performance under irradiation three FF seals were irradiated in a mixed field consisting of fast neutrons, protons and γ-rays to an average absorbed dose of 0.2, 2.0, and 20.0 MGy at the Brookhaven Linac Isotope Producer facility (BLIP). The radiation types and energy profiles mimic those expected at the FRIB facility. Degradation of the operational performance of these devices due to irradiation is expected to be the result of the de-magnetization of the permanent magnets contained within the seal and the changes in the ferrofluid properties. Post-irradiation performance was evaluated by determining the ferrofluidic seal vacuum tightness and torque under static and dynamic conditions. The study revealed that the ferrofluidic feedthrough seal irradiated to a dose of 0.2 MGy maintained its vacuum tightness under both static and rotational condition while the one irradiated to a dose of 2.0 MGy exhibited signs of ferrofluid damage but no overall performance loss. At 20 MGy dose the effects of irradiation on the ferrofluid properties (viscosity and particle agglomeration) were shown to be severe. Furthermore, limited de-magnetization of the annular shaped Nd2Fe14B and Sm2Co17 magnets located within the irradiated FFs was observed for doses of 0.2 MGy and 20 MGy respectively.

  14. Occupational Variation in End-of-Life Care Intensity.

    Science.gov (United States)

    Hyder, Joseph A; Haring, R Sterling; Sturgeon, Daniel; Gazarian, Priscilla K; Jiang, Wei; Cooper, Zara; Lipsitz, Stuart R; Prigerson, Holly G; Weissman, Joel S

    2018-03-01

    End-of-life (EOL) care intensity is known to vary by secular and geographic patterns. US physicians receive less aggressive EOL care than the general population, presumably the result of preferences shaped by work-place experience with EOL care. We investigated occupation as a source of variation in EOL care intensity. Across 4 states, we identified 660 599, nonhealth maintenance organization Medicare beneficiaries aged ≥66 years who died between 2004 and 2011. Linking death certificates, we identified beneficiaries with prespecified occupations: nurses, farmers, clergy, mortuary workers, homemakers, first-responders, veterinary workers, teachers, accountants, and the general population. End-of-life care intensity over the last 6 months of life was assessed using 5 validated measures: (1) Medicare expenditures, rates of (2) hospice, (3) surgery, (4) intensive care, and (5) in-hospital death. Occupation was a source of large variation in EOL care intensity across all measures, before and after adjustment for sex, education, age-adjusted Charlson Comorbidity Index, race/ethnicity, and hospital referral region. For example, absolute and relative adjusted differences in expenditures were US$9991 and 42% of population mean expenditure ( P EOL care intensity measures, teachers (5 of 5), homemakers (4 of 5), farmers (4 of 5), and clergy (3 of 5) demonstrated significantly less aggressive care. Mortuary workers had lower EOL care intensity (4 of 5) but small numbers limited statistical significance. Occupations with likely exposure to child development, death/bereavement, and naturalistic influences demonstrated lower EOL care intensity. These findings may inform patients and clinicians navigating choices around individual EOL care preferences.

  15. American Society for Pain Management Nursing position statement: pain management at the end of life.

    Science.gov (United States)

    Reynolds, Janice; Drew, Debra; Dunwoody, Colleen

    2013-09-01

    Pain at the end of life continues to be of great concern as it may be unrecognized or untreated. While nurses have an ethical obligation to reduce suffering at the end of life, barriers remain regarding appropriate and adequate pain management at the end of life. This position statement from the American Society for Pain Management Nursing contains recommendations for nurses, prescribers, and institutions that would improve pain management for this vulnerable population. Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  16. End-of-life resource recovery from emerging electronic products

    DEFF Research Database (Denmark)

    Parajuly, Keshav; Habib, Komal; Cimpan, Ciprian

    2016-01-01

    Integrating product design with appropriate end-of-life (EoL) processing is widely recognized to have huge potentials in improving resource recovery from electronic products. In this study, we investigate both the product characteristics and EoL processing of robotic vacuum cleaner (RVC), as a case...... of emerging electronic product, in order to understand the recovery fate of different materials and its linkage to product design. Ten different brands of RVC were dismantled and their material composition and design profiles were studied. Another 125 RVCs (349 kg) were used for an experimental trial...... at a conventional ‘shred-and-separate’ type preprocessing plant in Denmark. A detailed material flow analysis was performed throughout the recycling chain. The results show a mismatch between product design and EoL processing, and the lack of practical implementation of ‘Design for EoL’ thinking. In the best...

  17. Influence of gamma irradiation and low temperature storage on the quality and shelf life of squid (Doryteuthis sibogae

    Directory of Open Access Journals (Sweden)

    Manjanaik, B.

    2017-08-01

    Full Text Available Irradiation is considered as an efficient method for the reduction of microorganisms in food. It has been used to improve the safety and shelf life of food products. The present investigation is aimed at studying the influence of gamma irradiation (3 and 5 kGy and subsequent storage at refrigeration temperature (4oC on the chemical, microbial qualities and extended shelf life of squid (Doryteuthis sibogae. The total volatile base nitrogen (TVB-N and trimethyl amine nitrogen values (TMA-N of the irradiated squid samples significantly decreased in comparison with the control (non-irradiated stored at 4oC. The thiobarbituric acid values for the irradiated squid was significantly lower than of the non-irradiated samples stored at 4oC (p<0.05. The pH value of the squid was affected significantly by both, irradiation dose and storage temperature (p<0.05. The total microbial load for the non-irradiated squid samples was higher than those of irradiated samples at 4oC temperature. The results revealed that the combination of irradiation and refrigerated storage resulted in a significant reduction of microbial growth and stabilized the biochemical characteristics of squid.

  18. Changes with age in swimming performance of X-irradiated mice

    International Nuclear Information System (INIS)

    Norimura, T.; Yoshikawa, I.; Okajima, S.

    1980-01-01

    The time required to swim 250 cm was determined once weekly for the entire life of fifteen pairs of male dd/K mice. The irradiated group was exposed to a single 224 rad of X-rays at 20 weeks of age. Median survival time (ST 50 ) for the control was 88.9 weeks and that for the irradiated group was 77.4 weeks, and both regression lines relating to death rate and age were parallel. The swimming ability of control mice began to decrease when the mice were 40 weeks of age, after which there was a gradual reduction with age at 0.00646/day. In the irradiated group, the swimming ability decreased from seven weeks after irradiation. The time of 50% reduction of swimming speed (TRS 50 ) for the control was 78.9 weeks and that for the irradiated group was 66.3 weeks, and the slopes of the regression lines relating reduction rate and age were similar. Differences between ST 50 and TRS 50 were 10 weeks in the control and 11 weeks in the irradiated group, respectively. These results indicate that there is no basic difference in the reduction in swimming ability between control and irradiated mice. The X-irradiation may simply mean that the reduction in the swimming ability is displaced to an earlier time with no alteration in the rate of reduction, and that the earlier appearance in the irradiated group is related to premature aging as induced by irradiation. (author)

  19. Structural health monitoring tools for late and end of life management of offshore wind turbines

    DEFF Research Database (Denmark)

    McGugan, Malcolm; McKirdy, Scott

    2016-01-01

    The late and end of life stages in an offshore wind turbines (OWT) life cycle have unique features that must be considered. The initial focus on risks associated with start-up issues due to design, manufacturing or process elements gives way to a stable period of operation and maintenance...... margins and the predominance of low redundancy structures, accurate structural health monitoring can play a strong role in safe management and enable increased operating time at end of life and decommissioning. Late life operations of offshore wind farms can pose significant challenges, balancing...

  20. Physician perspectives on legal processes for resolving end-of-life disputes.

    Science.gov (United States)

    Chidwick, Paula; Sibbald, Robert

    2011-01-01

    In order to understand how to effectively approach end-of-life disputes, this study surveyed physicians' attitudes towards one process for resolving end-of-life disputes, namely, the Consent and Capacity Board of Ontario. In this case, the process involved examining interpretation of best interests between substitute decision-makers and medical teams. Physicians who made "Form G" applications to the Consent and Capacity Board of Ontario that resulted in a decision posted on the open-access database, Canadian Legal Information Institute (CanLii), were identified and surveyed. This purposive sample led to 13 invitations to participate and 12 interviews (92% response rate). Interviews were conducted using a prescribed interview guide. No barriers to the Consent and Capacity Board process were reported. Applications were made when physicians reached an impasse with the family and further treatment was perceived to be "unethical." The most significant challenge reported was the delay when appeals were launched. Appeals extended the process for an indefinite period of time making it so lengthy it negated any perceived benefits of the process. Benefits included that a neutral third party, namely the Consent and Capacity Board, was able to assess best interests. Also, when decisions were timely, further harm to the patient was minimized. Physicians reported this particular approach, namely the Consent and Capacity Board has a mechanism that is worthwhile, patient centred, process oriented, orderly and efficient for resolving end-of-life disputes and, in particular, determining best interests. However, unless the appeal process can be adjusted to respond to the ICU context there is a risk of not serving the best interest of patients. Physicians would recommend framing end-of-life treatment plans in the positive instead of negative, for example, propose palliative care and no escalation of treatment as opposed to withdrawal.

  1. Discussing Death, Dying, and End-of-Life Goals of Care: A Communication Skills Training Module for Oncology Nurses.

    Science.gov (United States)

    Coyle, Nessa; Manna, Ruth; Shen, Megan; Banerjee, Smita C; Penn, Stacey; Pehrson, Cassandra; Krueger, Carol A; Maloney, Erin K; Zaider, Talia; Bylund, Carma L

    2015-12-01

    Effective communication, particularly at the end of life, is an essential skill for oncology nurses, but few receive formal training in this area. The aim of this article is to adapt an end-of-life care communication skills training (CST) module, originally developed for oncologists, for oncology nurses and to evaluate participants' confidence in using the communication skills learned and their satisfaction with the module. The adapted end-of-life care module consisted of a 45-minute didactic, exemplary video and 90 minutes of small group interaction and experiential role play with a simulated patient. Using a five-point Likert-type scale, 247 inpatient oncology nurses completed pre-/post-workshop surveys rating their confidence in discussing death, dying, and end-of-life goals of care with patients, as well as overall satisfaction with the module. Nurses' confidence in discussing death, dying, and end-of-life goals of care increased significantly after attending the workshop. Nurse participants indicated satisfaction with the module by agreeing or strongly agreeing to all six items assessing satisfaction 90%-98% of the time. Nurses' CST in discussing death, dying, and end-of-life care showed feasibility, acceptability, and potential benefit at improving confidence in having end-of-life care discussions.

  2. End-of-Life Transitions and Hospice Utilization for Adolescents: Does Having a Usual Source of Care Matter?

    Science.gov (United States)

    Keim-Malpass, Jessica; Lindley, Lisa C

    2017-08-01

    Adolescents with life-limiting illnesses have intensive end-of-life trajectories and could benefit from initiation of hospice services. The medical home model, which includes having a usual source of primary care, may help facilitate quality outcomes at the end-of-life for adolescents. The purpose of this study was to determine the relationship between having a usual source of primary care on hospice utilization and end-of-life transitions among adolescents between 15-20 years with a life-limiting illness. A retrospective cohort design used 2007-2010 California Medicaid claims data (n=585). Our dependent variables were hospice utilization (i.e., hospice enrollment, hospice length of stay) and the independent variable was usual source of primary care. Multivariate regression techniques including least squares regression, multivariate logistic regression, and negative binomial regression were used in the analysis of the relationship between usual source of primary care and hospice utilization and end-of-life transitions. Ten percent of our sample utilized hospice services. Having a usual source of primary care was associated with an increase in hospice enrollment, hospice length of stay, and end-of-life transitions. Adolescents with a cancer diagnosis were more likely to enroll in hospice services. For adolescents at the end of life, having a usual source of primary care had a significant impact on hospice enrollment and length of stay. This study is among the first to demonstrate a relationship between primary care and hospice use among this vulnerable population.

  3. Performance of irradiated CVD diamond micro-strip sensors

    International Nuclear Information System (INIS)

    Adam, W.; Berdermann, E.; Bergonzo, P.; Bertuccio, G.; Bogani, F.; Borchi, E.; Brambilla, A.; Bruzzi, M.; Colledani, C.; Conway, J.; D'Angelo, P.; Dabrowski, W.; Delpierre, P.; Deneuville, A.; Dulinski, W.; Eijk, B. van; Fallou, A.; Fizzotti, F.; Foulon, F.; Friedl, M.; Gan, K.K.; Gheeraert, E.; Hallewell, G.; Han, S.; Hartjes, F.; Hrubec, J.; Husson, D.; Kagan, H.; Kania, D.; Kaplon, J.; Kass, R.; Koeth, T.; Krammer, M.; Logiudice, A.; Lu, R.; Mac Lynne, L.; Manfredotti, C.; Meier, D.; Mishina, M.; Moroni, L.; Noomen, J.; Oh, A.; Pan, L.S.; Pernicka, M.; Peitz, A.; Perera, L.; Pirollo, S.; Procario, M.; Riester, J.L.; Roe, S.; Rousseau, L.; Rudge, A.; Russ, J.; Sala, S.; Sampietro, M.; Schnetzer, S.; Sciortino, S.; Stelzer, H.; Stone, R.; Suter, B.; Tapper, R.J.; Tesarek, R.; Trischuk, W.; Tromson, D.; Vittone, E.; Walsh, A.M.; Wedenig, R.; Weilhammer, P.; Wetstein, M.; White, C.; Zeuner, W.; Zoeller, M.; Plano, R.; Somalwar, S.V.; Thomson, G.B.

    2002-01-01

    CVD diamond detectors are of interest for charged particle detection and tracking due to their high radiation tolerance. In this article, we present, for the first time, beam test results from recently manufactured CVD diamond strip detectors and their behavior under low doses of electrons from a β-source and the performance before and after intense (>10 15 /cm 2 ) proton- and pion-irradiations. We find that low dose irradiation increase the signal-to-noise ratio (pumping of the signal) and slightly deteriorate the spatial resolution. Intense irradiation with protons 2.2x10 15 p/cm 2 lowers the signal-to-noise ratio slightly. Intense irradiation with pions 2.9x10 15 π/cm 2 lowers the signal-to-noise ratio more. The spatial resolution of the diamond sensors improves after irradiations

  4. Performance of irradiated CVD diamond micro-strip sensors

    Science.gov (United States)

    Adam, W.; Berdermann, E.; Bergonzo, P.; Bertuccio, G.; Bogani, F.; Borchi, E.; Brambilla, A.; Bruzzi, M.; Colledani, C.; Conway, J.; D'Angelo, P.; Dabrowski, W.; Delpierre, P.; Deneuville, A.; Dulinski, W.; van Eijk, B.; Fallou, A.; Fizzotti, F.; Foulon, F.; Friedl, M.; Gan, K. K.; Gheeraert, E.; Hallewell, G.; Han, S.; Hartjes, F.; Hrubec, J.; Husson, D.; Kagan, H.; Kania, D.; Kaplon, J.; Kass, R.; Koeth, T.; Krammer, M.; Logiudice, A.; Lu, R.; mac Lynne, L.; Manfredotti, C.; Meier, D.; Mishina, M.; Moroni, L.; Noomen, J.; Oh, A.; Pan, L. S.; Pernicka, M.; Peitz, A.; Perera, L.; Pirollo, S.; Procario, M.; Riester, J. L.; Roe, S.; Rousseau, L.; Rudge, A.; Russ, J.; Sala, S.; Sampietro, M.; Schnetzer, S.; Sciortino, S.; Stelzer, H.; Stone, R.; Suter, B.; Tapper, R. J.; Tesarek, R.; Trischuk, W.; Tromson, D.; Vittone, E.; Walsh, A. M.; Wedenig, R.; Weilhammer, P.; Wetstein, M.; White, C.; Zeuner, W.; Zoeller, M.; Plano, R.; Somalwar, S. V.; Thomson, G. B.

    2002-01-01

    CVD diamond detectors are of interest for charged particle detection and tracking due to their high radiation tolerance. In this article, we present, for the first time, beam test results from recently manufactured CVD diamond strip detectors and their behavior under low doses of electrons from a β-source and the performance before and after intense (>10 15/cm 2) proton- and pion-irradiations. We find that low dose irradiation increase the signal-to-noise ratio (pumping of the signal) and slightly deteriorate the spatial resolution. Intense irradiation with protons 2.2×10 15 p/ cm2 lowers the signal-to-noise ratio slightly. Intense irradiation with pions 2.9×10 15 π/ cm2 lowers the signal-to-noise ratio more. The spatial resolution of the diamond sensors improves after irradiations.

  5. Sustainable design for automotive products: dismantling and recycling of end-of-life vehicles.

    Science.gov (United States)

    Tian, Jin; Chen, Ming

    2014-02-01

    The growth in automotive production has increased the number of end-of-life vehicles (ELVs) annually. The traditional approach ELV processing involves dismantling, shredding, and landfill disposal. The "3R" (i.e., reduce, reuse, and recycle) principle has been increasingly employed in processing ELVs, particularly ELV parts, to promote sustainable development. The first step in processing ELVs is dismantling. However, certain parts of the vehicle are difficult to disassemble and use in practice. The extended producer responsibility policy requires carmakers to contribute in the processing of scrap cars either for their own developmental needs or for social responsibility. The design for dismantling approach can be an effective solution to the existing difficulties in dismantling ELVs. This approach can also provide guidelines in the design of automotive products. This paper illustrates the difficulty of handling polymers in dashboards. The physical properties of polymers prevent easy separation and recycling by using mechanical methods. Thus, dealers have to rely on chemical methods such as pyrolysis. Therefore, car designers should use a single material to benefit dealers. The use of materials for effective end-of-life processing without sacrificing the original performance requirements of the vehicle should be explored. Copyright © 2013 Elsevier Ltd. All rights reserved.

  6. Extension of shelf life of paneer by sorbic acid and irradiation

    International Nuclear Information System (INIS)

    Singh, L.; Murali, H.S.; Sankaran, R.

    1991-01-01

    Paneer, an acid and heat coagulated milk product, is highly perishable because of high moisture (58-60%) and low acidity (pH 5.6-5.8). The product had 430 total plate count, 120 proteolytic bacteria, 170 lipolytic bacteria and 40 fungi/g of sample with a shelf life of few hr. Treatment with sorbic acid and/or gamma irradiation reduced the microbial load. Combination treatment of 0.10% sorbic acid in milk and irradiation of the product at 2.5 kGy preserved the paneer for 30 days at ambient temperature (25-35degC) with good acceptance. (author). 14 refs., 3 tabs., 2 figs

  7. Effect of irradiated food on life cycle of Trogoderma granarium by gamma irradiations infesting stored barley (Hordum vulgare)

    International Nuclear Information System (INIS)

    Sisodiya, Manju; Singhvi, P.M.

    2012-01-01

    To study the effect of irradiated food on the life cycle of Trogoderma granarium crushed barley were irradiated by Gamma irradiations. Fresh eggs were collected from stock culture for getting newly hatched first instar larvae. Twenty, first instar larvae were collected and transferred to the culture tubes containing irradiated food. The larva was observed till the emergence of adults. To calculate the survivality of insects the newly emerged adults were counted daily till the last adult and the emerged beetles were removed. The observation was also made in regard to the time required for adult emergence. The test insect was reared on Gamma irradiated food and survival rate, developmental period and growth index were recorded in different does as 0.1, 0.2, 0.3, 0.4 and 0.5 KGy. The survival rate, developmental period and growth rate of test insect were recorded as 95%, 26.00 and 0.049 respectively at highest dose of 0.5 KGy. Where as 96.67%, 25.33 and 0.051 at lowest dose of 0.1 KGy was recorded. In control condition, they were 98.33%, 29.67 and 0.043 respectively. Irradiation against barley grains had no such effect on the developmental period, survival rate and growth index of Trogoderma granarium. It provides effective alternative to fumigants chemical pesticides which have numerous hazards and create environmental pollution. (author)

  8. Irradiation performance updates on Korean advanced fuels for PWRs

    International Nuclear Information System (INIS)

    Jang, Y.K.; Jeon, K.L.; Kim, Y.H.; Yoo, J.S.; Kim, J.I.; Shin, J.C.; Chung, J.G.; Park, J.R.; Chung, S.K.; Kim, T.W.; Yoon, Y.B.; Park, K.M.; Yoo, M.J.; Kim, M.S.; Lee, T.H.

    2010-01-01

    The developments of advanced nuclear fuels for PWRs were started in 1999 and in 2001, respectively: PLUS7 TM for eight operating optimized power reactors of 1000 MWe class (OPR1000) and four advanced power reactors of 1400 MWe class (APR1400) under construction, and 16ACE7 TM and 17ACE7 TM for an operating 16x16 Westinghouse type plant and six operating 17x17 Westinghouse type plants. The design targets were as follows: batch average burnup up to 55 GWD/MTU, over 10% thermal margin increase, improvement of the mechanical integrity of higher seismic capability, higher debris or grid fretting wear performance, higher control rod insertion capability, increase of neutron economy, improvement of manufacturability, solving incomplete rod insertion (IRI) issue and top nozzle screw failure issue, etc. in comparison of the existing nuclear fuels. The irradiation tests using each four LTAs (Lead Test Assemblies) during 3 cycles were completed in three Korean nuclear reactors until 2009. The eight irradiation performance items which are assembly growth, rod growth, grid width growth, assembly bow, rod bow, assembly twist, rod diameter and cladding oxidation were examined in pool-side after each cycle and evaluated. The irradiation tests could be continued by expecting the good performances for next cycle from the previous cycle. After 2 cycle irradiations, the region implementation could be started in 15 nuclear power plants. Even though the verifications using the LTAs were completed, each surveillance program was launched and the irradiation performance data were being updated during region implementation. In addition to pool-side examinations (PSEs) by assembly-wise during irradiation tests, six rod-wise performance items were also examined in pool-side using each LTA after discharge. All performance items met their design criteria as a result of the evaluation. Even though the interesting ones among the irradiation performance parameters were assembly and grid growths

  9. MARS-LMR modeling for the post-test analysis of Phenix End-of-Life natural circulation

    International Nuclear Information System (INIS)

    Jeong, Hae Yong; Ha, Kwi Seok; Chang, Won Pyo; Lee, Kwi Lim

    2011-01-01

    For a successful design and analysis of Sodium cooled Fast Reactor (SFR), it is required to have a reliable and well-proven system analysis code. To achieve this purpose, KAERI is enhancing the modeling capability of MARS code by adding the SFR-specific models such as pressure drop model, heat transfer model and reactivity feedback model. This version of MARS-LMR will be used as a basic tool in the design and analysis of future SFR systems in Korea. Before wide application of MARS-LMR code, it is required to verify and validate the code models through analyses for appropriate experimental data or analytical results. The end-of-life test of Phenix reactor performed by the CEA provided a unique opportunity to have reliable test data which is very valuable in the validation and verification of a SFR system analysis code. The KAERI joined this international program of the analysis of Phenix end-of-life natural circulation test coordinated by the IAEA from 2008. The main test of natural circulation was completed in 2009. Before the test the KAERI performed the pre-test analysis based on the design condition provided by the CEA. Then, the blind post-test analysis was also performed based on the test conditions measured during the test before the CEA provide the final test results. Finally, the final post-test analysis was performed recently to predict the test results as accurate as possible. This paper introduces the modeling approach of the MARS-LMR used in the final post-test analysis and summarizes the major results of the analysis

  10. Emotional Numbness Modifies the Effect of End-of-Life Discussions on End-of-Life Care

    Science.gov (United States)

    Maciejewski, Paul K.; Prigerson, Holly G.

    2012-01-01

    Context Overall, end-of-life (EOL) discussions are unrelated to psychological distress and associated with lower rates of aggressive care near death. Nevertheless, patients who report they feel emotionally numb about their illness might encounter difficulties cognitively processing an EOL discussion. Objectives We hypothesized that emotional numbness would modify the influence of EOL discussions on the receipt of less aggressive EOL care. Methods Data were derived from structured interviews with 290 participants in the federally-funded Coping with Cancer Study, a multisite, prospective cohort study of advanced cancer patients followed through their death. Patients’ reports of EOL discussions with their physician and emotional numbness were assessed a median of 4.6 months before death. Information about aggressive EOL care (i.e., ventilation, resuscitation in the last week of life, death in the Intensive Care Unit) was obtained from postmortem caregiver interviews and medical charts. Main and interactive effects of EOL discussions and emotional numbness on aggressive EOL care, adjusting for potential confounds, were evaluated using multiple logistic regression. Results The likelihood of aggressive EOL care associated with having EOL discussions increased by a factor of nine (adjusted odds ratio=9.02, 95% confidence interval 1.37, 59.6, P=0.022) for every unit increase in a patient’s emotional numbness score. Conclusion Emotional numbness diminishes a patient’s capacity to benefit from EOL discussions. EOL decision making may be more effective if clinical communications with emotionally numb patients are avoided. PMID:22926093

  11. Third-year Australian nursing students' attitudes, experiences, knowledge, and education concerning end-of-life care.

    Science.gov (United States)

    Adesina, Oluwatomilayo; DeBellis, Anita; Zannettino, Lana

    2014-08-01

    Nurses have a vital role in providing end-of-life care to patients and their families, and it is important that nursing students are adequately prepared for this role. This article reports on qualitative findings from research that explored a cohort of third-year undergraduate Australian nursing students' attitudes, experiences, knowledge, and education concerning end-of-life care. The study used open-ended questions in a purpose-designed, self-administered questionnaire and thematic analysis of the responses. Five themes emerged from the analysis: the importance of the students' values and beliefs, the influence of experience, their views on what constitutes a good or bad death, their knowledge of ethics and legislation surrounding end-of-life care, and how they perceived their level of education and knowledge. The need for more education on end-of-life care has implications for curriculum development in undergraduate nursing programmes, which need to provide graduating nurses with the necessary knowledge and skills to deliver quality care to patients who are dying and their families.

  12. Shelf-life extension of minimally processed and gamma irradiated red beet (Beta vulgaris ssp. vulgaris L.), Cv. early wonder

    International Nuclear Information System (INIS)

    Hernandes, Nilber Kenup; Vital, Helio de Carvalho; Coneglian, Regina Celi Cavestre

    2007-01-01

    This work investigated the effects of gamma irradiation on the shelf-life extension and safety of minimally processed red beet (Beta vulgaris ssp. vulgaris L.) by performing microbiological, chemical and sensory analyses. Red beets were harvested 73 days after transplanting and their tuberous parts were minimally processed and separated in two groups: control (non-irradiated) and irradiated (0.5, 1.0 and 1.5 kGy). Tests for Salmonella sp., total and fecal coliforms, total count of aerobic mesophilic and lactic-acid bacteria were performed during the 21-day storage at 8 deg C. They indicated that the samples irradiated with 1.0 and 1.5 kGy remained in good conditions throughout storage while the unirradiated samples did not last 7 days. Chemical analyses indicated that the concentrations of vitamins B1 and B2 were not affected by irradiation. In contrast the amounts of fructose and glucose increased during storage while the one for sucrose decreased. In addition four series of sensory evaluations including appearance and aroma indicated that the samples irradiated with 1.0 and 1.5 kGy remained good for consumption for 20 days. Therefore it was concluded that the use of the doses of 1.0 and 1.5 kGy produced the best effects on the conservation of the samples without harming the sensory characteristics and nutritional constituents tested. (author)

  13. Continuous induction of unscheduled DNA synthesis by gamma irradiation

    International Nuclear Information System (INIS)

    Weniger, P.; Klein, W.; Ott, E.; Kocsis, F.; Altmann, H.

    1990-01-01

    The induction of DNA-synthesis in non-S-phase cells is a very sensitive measure of a preceding damage of DNA. Usually, in an in vivo - in vitro test (treatment of an animal, incorporation of H3-thymidine in a cell suspension) the damaging of DNA takes place hours to days before the evaluation. In this case, the time course of the UDS-induction after a single dose of 1 Gy gamma irradiation was observed over a long period of time (21 months). C57 black mice served as test animals. In an age of about 80 days they were irradiated and the induction of unscheduled DNA synthesis was measured at ten time intervals during the whole life-span of the animals. Although the repair in this gamma radiation damage in DNA is a very quick process - with centrifugation in alkaline sucrose a half-life of some minutes is found - an induction of unscheduled DNA synthesis could be seen at the irradiated animals until the end of their life (640 days). The reason for this could be permanent disorders in cellular regulation caused by the gamma irradiation. (author) 4 figs

  14. Questioning care at the end of life.

    Science.gov (United States)

    Ruopp, Patricia; Good, Mary-Jo Delvecchio; Lakoma, Matthew; Gadmer, Nina M; Arnold, Robert M; Block, Susan D

    2005-06-01

    The goal of the larger study was to explore physicians' emotional responses to the death of their patients; this study analyzed a subset of physician transcripts to elucidate the construct of questioning care, which emerged from the larger study. To analyzes how physicians question care-expressing concern, unease, or uncertainty about treatment decisions and practices, errors, or adverse events-as they attend dying patients. Retrospective interview study of physicians caring for randomly selected deaths on the medical service of a major academic teaching hospital, using qualitative and quantitative measures. SETTING, SUBJECTS: 188 attendings, residents, and interns on the internal medical services of two academic medical centers were part of the larger study. A subsample of 75 physician narratives was selected for qualitative data analysis for this study. Qualitative measures included open-ended questions eliciting physicians' stories of the most recent and a most emotionally powerful patient death they have experienced. Grounded theory was used to analyze physician narratives. Quantitative instruments measured physician attitudes toward end-of-life care and responses to the most recent and most emotional patient death. Physicians question care more frequently in most emotional deaths (42%) than in most recent deaths (34%). Physicians question communication with patients and families and within medical teams, medical judgment and technique, standards of practice, and high-risk treatments, often assigning responsibility for medical management they perceive as inappropriate, futile, overly aggressive, or mistakes in judgment and technique. Responsibility ranges from the distal (the culture of medicine) to the proximal (personal). Frustration, guilt, and anger are more frequently expressed in these narratives when care is questioned. A typology of questioning care emerged from these physicians' narratives that parallels and reflects recent and classic research on

  15. End-of-life decisions for people with intellectual disabilities, an interview study with patient representatives.

    Science.gov (United States)

    Wagemans, Annemieke M A; Van Schrojenstein Lantman-de Valk, Henny M J; Proot, Ireen M; Metsemakers, Job; Tuffrey-Wijne, Irene; Curfs, Leopold M G

    2013-09-01

    Not much is known about the process of end-of-life decision-making for people with intellectual disabilities. To clarify the process of end-of-life decision-making for people with intellectual disabilities from the perspective of patient representatives. A qualitative study based on semi-structured interviews, recorded digitally and transcribed verbatim. Data were analysed using Grounded Theory procedures. We interviewed 16 patient representatives after the deaths of 10 people with intellectual disabilities in the Netherlands. The core category 'Deciding for someone else' describes the context in which patient representatives took end-of-life decisions. The patient representatives felt highly responsible for the outcomes. They had not involved the patients in the end-of-life decision-making process, nor any professionals other than the doctor. The categories of 'Motives' and 'Support' were connected to the core category of 'Deciding for someone else'. 'Motives' refers to the patient representatives' ideas about quality of life, prevention from suffering, patients who cannot understand the burden of interventions and emotional reasons reported by patient representatives. 'Support' refers to the support that patient representatives wanted the doctors to give to them in the decision-making process. From the perspective of the patient representatives, the process of end-of-life decision-making can be improved by ensuring clear roles and an explicit description of the tasks and responsibilities of all participants. Regular discussion between everyone involved including people with intellectual disabilities themselves can improve knowledge about each other's motives for end-of-decisions and can clarify expectations towards each other.

  16. Diabetes and end of life: ethical and methodological issues in gathering evidence to guide care.

    Science.gov (United States)

    Dunning, Trisha; Duggan, Nicole; Savage, Sally; Martin, Peter

    2013-03-01

    Providing palliative care for people with diabetes at the end of life is part of the chronic disease care trajectory, but end of life care is complex and the presence of diabetes further complicates management. The aim of the paper is to discuss the ethical and methodological issues encountered when undertaking research to develop guidelines for managing diabetes at the end of life and the strategies used to address the issues. The issues emerged as we developed guidelines for managing diabetes at the end of life, which included conducting individual interviews with 14 people with diabetes requiring palliative care and 10 family members. A reflexive researcher journal was maintained throughout the guideline development process. The interview transcripts and researcher's journal were analysed to determine key methodological, ethical and researcher-related issues. Key themes were vulnerability of the sampling population, methodological issues included recruiting participants and ensuring rigor, ethical issues concerned benefit and risk, justice, autonomy, privacy, professional boundaries and informed consent. Researcher-related issues were identified such as managing participant distress and their own emotional distress. People were willing to discuss end of life diabetes management preferences. Undertaking research with people at the end of life is complex because of their vulnerability and the ethical issues involved. However, the ethical principles of autonomy and justice apply and people should be given the relevant information and opportunity to decide whether to participate or not. © 2012 The Authors. Scandinavian Journal of Caring Sciences © 2012 Nordic College of Caring Science.

  17. Shelf-life extension of preservative-free hydrated feed using gamma pasteurization and its effect on growth performance of eel

    Science.gov (United States)

    Kim, Dongho; Song, Hyunpa; Lim, Sangyong; Jo, Minho; Song, Duseop; Jo, Cheorun

    2012-08-01

    Hydrated feed (HF) promotes the growth performance and shortens the feeding time of fish by increasing the efficiency of digestion. However, the shelf-life of HF is a concern due to its relatively higher water content. In this study, radiation pasteurization was applied to improve the shelf-life and microbiological quality of HF for fish farming. Preservative-free HF containing 25% moisture was gamma-irradiated and its microbiological and nutritional properties evaluated in addition to a practical feeding trial carried out using eel. The viable counts of bacteria and fungi in HF were 106 and 104 CFU/g, respectively. All coliform bacteria and yeast in HF were eliminated by irradiation at a dose of 5 kGy, and total aerobic bacteria were eliminated at 10 kGy. The shelf-life of the preservative-free and irradiated (10 kGy) HF was estimated as 6 months under ambient conditions. The nutritional composition of HF was stable up to 10 kGy of irradiation. Based on a feeding trial, it was proven that eel fed HF had about 20% higher growth rate than that fed dried feed.

  18. Current Status of the LIFE Fast Reactors Fuel Performance Codes

    International Nuclear Information System (INIS)

    Yacout, A.M.; Billone, M.C.

    2013-01-01

    The LIFE-4 (Rev. 1) code was calibrated and validated using data from (U,Pu)O2 mixed-oxide fuel pins and UO2 blanket rods which were irradiation tested under steady-state and transient conditions. – It integrates a broad material and fuel-pin irradiation database into a consistent framework for use and extrapolation of the database to reactor design applications. – The code is available and running on different computer platforms (UNIX & PC) – Detailed documentations of the code’s models, routines, calibration and validation data sets are available. LIFE-METAL code is based on LIFE4 with modifications to include key phenomena applicable to metallic fuel, and metallic fuel properties – Calibrated with large database from irradiations in EBR-II – Further effort for calibration and detailed documentation. Recent activities with the codes are related to reactor design studies and support of licensing efforts for 4S and KAERI SFR designs. Future activities are related to re-assessment of the codes calibration and validation and inclusion of models for advanced fuels (transmutation fuels)

  19. End-of-life decisions for people with intellectual disabilities, an interview study with patient representatives

    NARCIS (Netherlands)

    Wagemans, A.M.; Schrojenstein Lantman-de Valk, H.M. van; Proot, I.M.; Metsemakers, J.; Tuffrey-Wijne, I.; Curfs, L.M.G.

    2013-01-01

    Background: Not much is known about the process of end-of-life decision-making for people with intellectual disabilities. Aim: To clarify the process of end-of-life decision-making for people with intellectual disabilities from the perspective of patient representatives. Design: A qualitative study

  20. End-of-life decisions: an important theme in the care for people with intellectual disabilities.

    NARCIS (Netherlands)

    Wagemans, A.; Schrojenstein Lantman, H.M.J. van; Tuffrey-Wijne, I.; Widdershoven, G.; Curfs, L.M.G.

    2010-01-01

    BACKGROUND: While end-of-life decisions in the general population have received attention in several countries, not much is known about this in people with intellectual disabilities (IDs). Therefore, the prevalence and nature of end-of-life decisions were investigated in a Dutch centre providing

  1. Use of Irradiation to Extend the Shelf Life of Dried White Oyster Mushroom (Pleurotus ostreatus)

    International Nuclear Information System (INIS)

    Idrus Kadir

    2010-01-01

    Irradiation is an alternative technology to extend the shelf life of food-stuffs. White oyster mushroom (Pleurotus ostreatus) which is a perishable food stuff having a short shelf life. Effects of gamma irradiation at the dose of 5 kGy on the quality of dried white oyster mushroom during storage was observed. The objective of the experiment was to improve the hygienic quality and to extend the shelf life of dried white oyster mushroom using irradiation technology. Fresh mushroom was cleaned, sorted, washed, and drained. The mushroom was then dried in two ways, namely: sun drying method and electrical oven drying method. Dried mushroom was vacuum packed in polypropylene (PP) pouch then irradiated at a of dose 5 kGy and an unirradiated control was also applied. The vacuum packed samples was stored at low temperature (18-20 o C) with a relative humidity (RH) of 65-70% and observed periodically every month up to 3 months of storage. The samples were analyzed according to the following parameters i.e, : total bacterial count, total mould and yeast count, moisture content, pH, a w , contents of protein, fat, carbohydrate, carotenoid and organoleptic properties, respectively. The results showed that irradiation at the dose of 5 kGy could eliminate significantly microbial growth 2 log cycle in the samples, while there were no changes in physico-chemical and organoleptic properties up to 3 months of storage, while control samples were still acceptable only up to 2 months of storage. (author)

  2. Changes in Properties of Cement and Lime Mortars When Incorporating Fibers from End-of-Life Tires

    Directory of Open Access Journals (Sweden)

    Lluís Gil

    2016-02-01

    Full Text Available This paper studies the addition of fibers from end-of-life tires to commercial mortar mixtures. Two different types of mortar, one lime-plastic and other cement-fluid, are mixed with different percentage of fibers ranging from 0% to 1%. The changes in bulk density, consistency, compressive and flexural strength, dynamic Young modulus and water absorption are studied. According to the results, consistency is the property that shows more relevant changes for an addition of 0.25% fibers. Consistency is related to workability and affects the water absorption and the Young modulus values. On the contrary, bulk density and mechanical properties did not change with the addition of fibers. The results prove that this fiber, considered a waste from recycling of end-of-life tires, can be used in commercial mixtures without losing strength. On the other hand, mortar workability limits the amount of fibers that can be included in the mixture and this parameter determines the performance of the mortar.

  3. Developing the science of end-of-life and palliative care research: National Institute of Nursing Research summit.

    Science.gov (United States)

    Csikai, Ellen L

    2011-01-01

    A rare opportunity to examine accomplishments and identify ways to advance research in end-of-life and palliative care was offered by the National Institute of Nursing Research (NINR) through a summit meeting held in August 2011. The Science of Compassion: Future Directions in End-of-Life and Palliative Care brought together nationally recognized leaders in end-of-life and palliative care research, including grantees of NINR, as well as more than 700 attendees from all disciplines. It was an exciting affirmation of the importance of moving forward in the field. Presented in this article is a summary of the summit and a call to action for end-of-life and palliative care social workers to engage in seeking funding to conduct needed research and to ensure our unique perspective is represented.

  4. Electron beam irradiation process applied to primary and secondary recycled high density polyethylene

    International Nuclear Information System (INIS)

    Cardoso, Jéssica R.; Moura, Eduardo de; Geraldo, Áurea B.C.

    2017-01-01

    Plastic bags, packaging and furniture items are examples of plastic utilities always present in life. However, the end-of-life of plastics impacts the environment because of this ubiquity and also often their high degradation time. Recycling processes are important in this scenario because they offer many solutions to this problem. Basically, four ways are known for plastic recycling: primary recycling, which consists in re-extrusion of clean plastic scraps from a production plant; secondary recycling, that uses end-of-life products that generally are reduced in size by extrusion to obtain a more desirable shape for reprocessing (pellets and powder); tertiary recover which is related to thermo-chemical methods to produce fuels and petrochemical feedstock; and quaternary route, that is related to energy recovery and it is done in appropriate reactors. In this work, high density polyethylene (HDPE) was recovered to simulate empirically the primary and secondary recycling ways using materials which ranged from pristine to 20-fold re-extrused materials. The final 20-fold recycled thermoplastic was irradiated in an electron beam accelerator under a dose rate of 22.4 kGy/s and absorbed doses of 50 kGy and 100 kGy. The characterization of HDPE in distinct levels of recovering was performed by infrared spectroscopy (FTIR) and thermogravimetric degradation. In the HDPE recycling, degradation and crosslinking are consecutive processes; degradation is very noticeable in the 20-fold recycled product. Despite this, the 20-fold recycled product presents crosslinking after irradiation process and the post-irradiation product presents similarities in spectroscopic and thermal degradation characteristics of pristine, irradiated HDPE. These results are discussed. (author)

  5. Electron beam irradiation process applied to primary and secondary recycled high density polyethylene

    Energy Technology Data Exchange (ETDEWEB)

    Cardoso, Jéssica R.; Moura, Eduardo de; Geraldo, Áurea B.C., E-mail: ageraldo@ipen.br [Instituto de Pesquisas Energéticas e Nucleares (IPEN/CNEN-SP), São Paulo, SP (Brazil)

    2017-07-01

    Plastic bags, packaging and furniture items are examples of plastic utilities always present in life. However, the end-of-life of plastics impacts the environment because of this ubiquity and also often their high degradation time. Recycling processes are important in this scenario because they offer many solutions to this problem. Basically, four ways are known for plastic recycling: primary recycling, which consists in re-extrusion of clean plastic scraps from a production plant; secondary recycling, that uses end-of-life products that generally are reduced in size by extrusion to obtain a more desirable shape for reprocessing (pellets and powder); tertiary recover which is related to thermo-chemical methods to produce fuels and petrochemical feedstock; and quaternary route, that is related to energy recovery and it is done in appropriate reactors. In this work, high density polyethylene (HDPE) was recovered to simulate empirically the primary and secondary recycling ways using materials which ranged from pristine to 20-fold re-extrused materials. The final 20-fold recycled thermoplastic was irradiated in an electron beam accelerator under a dose rate of 22.4 kGy/s and absorbed doses of 50 kGy and 100 kGy. The characterization of HDPE in distinct levels of recovering was performed by infrared spectroscopy (FTIR) and thermogravimetric degradation. In the HDPE recycling, degradation and crosslinking are consecutive processes; degradation is very noticeable in the 20-fold recycled product. Despite this, the 20-fold recycled product presents crosslinking after irradiation process and the post-irradiation product presents similarities in spectroscopic and thermal degradation characteristics of pristine, irradiated HDPE. These results are discussed. (author)

  6. Qualities of Patin Fishball Irradiated by Gamma Rays (60Co)

    International Nuclear Information System (INIS)

    Yarosita FS; Bustami I; Winarti Z; Rindy PT

    2004-01-01

    An experiment on patin fishball quality using gamma irradiation ( 60 Co) has been conducted. Samples were irradiated at 0, 1, 3 and 5 kGy and stored in refrigerator at temperature 10 o C for sixty days. Samples were analysed every fifteen days, except content of fat and protein that analysed only at the beginning and the end of storage. The purpose of this experiment is to know the quality changes of patin fishball irradiated during storage, by measuring of chemical (content of fat, protein, water, TVB value, pH value) and microbiology (TPC aerobic and anaerobic bacteria) changes. The results showed that irradiation did not affect macro nutrient contents (content of fat, protein and water) of patin fishball during storage but irradiation can affect TVB and pH values. Irradiation at 1 kGy can reduce one logarithmic cycle of total aerobic and anaerobic bacteria. The storage life of irradiated patin fishball treated at 1, 3 and 5 kGy could be extended up to 15, 30 and 60 days, respectively. Control samples the storage life could be extended less than 15 days. (author)

  7. TU-D-201-02: Physicist’s Responsibility On “End-Of-Life for Brachytherapy Devices and Software

    International Nuclear Information System (INIS)

    Butler, W.

    2015-01-01

    Brachytherapy devices and software are designed to last for a certain period of time. Due to a number of considerations, such as material factors, wear-and-tear, backwards compatibility, and others, they all reach a date when they are no longer supported by the manufacturer. Most of these products have a limited duration for their use, and the information is provided to the user at time of purchase. Because of issues or concerns determined by the manufacturer, certain products are retired sooner than the anticipated date, and the user is immediately notified. In these situations, the institution is facing some difficult choices: remove these products from the clinic or perform tests and continue their usage. Both of these choices come with a financial burden: replacing the product or assuming a potential medicolegal liability. This session will provide attendees with the knowledge and tools to make better decisions when facing these issues. Learning Objectives: Understand the meaning ofend-of-life or “life expectancy” for brachytherapy devices and software Review items (devices and software) affected by “end-of-life” restrictions Learn how to effectively formulate “end-of-life” policies at your institution Learn about possible implications ofend-of-life” policy Review other possible approaches to “end-of-life” issue

  8. The broad spectrum of unbearable suffering in end of life cancer studied in dutch primary care

    NARCIS (Netherlands)

    Ruijs, C.D.M.; Kerkhof, A.J.F.M.; van der Wal, G.; Onwuteaka-Philipsen, B.D.

    2012-01-01

    Background: Unbearable suffering most frequently is reported in end-of-life cancer patients in primary care. However, research seldom addresses unbearable suffering. The aim of this study was to comprehensively investigate the various aspects of unbearable suffering in end-of-life cancer patients

  9. Exploring end-of-life care for South Asian kidney patients: interviewer reflections.

    Science.gov (United States)

    Wilkinson, Emma; Waqar, Muhammad; Gill, Balbir; Hoque, Pina; Jetha, Champa; Bola, Kulwinder Kaur; Mahmood, Riffat; Mahmood, Sultan; Saujani, Rita; Randhawa, Gurch

    2017-03-16

    The reduction of inequalities in access to quality care has been a central tenet of UK health policy. Ethnic minorities may experience additional inequalities because of language and other cultural barriers. This article reports interviewer reflections of conducting interviews with South Asian kidney patients about their experiences of end-of-life care. It explores themes which emerged from the analysis of a focus group held with eight bilingual research interviewers. The relevance of these themes to understanding inequalities and access to end-of-life care is discussed; together with the potential for the research process to contribute to service improvement.

  10. Performance of irradiated CVD diamond micro-strip sensors

    Energy Technology Data Exchange (ETDEWEB)

    Adam, W.; Berdermann, E.; Bergonzo, P.; Bertuccio, G.; Bogani, F.; Borchi, E.; Brambilla, A.; Bruzzi, M.; Colledani, C.; Conway, J.; D' Angelo, P.; Dabrowski, W.; Delpierre, P.; Deneuville, A.; Dulinski, W.; Eijk, B. van; Fallou, A.; Fizzotti, F.; Foulon, F.; Friedl, M.; Gan, K.K.; Gheeraert, E.; Hallewell, G.; Han, S.; Hartjes, F.; Hrubec, J.; Husson, D.; Kagan, H.; Kania, D.; Kaplon, J.; Kass, R.; Koeth, T.; Krammer, M.; Logiudice, A.; Lu, R.; Mac Lynne, L.; Manfredotti, C.; Meier, D. E-mail: dirk.meier@cern.ch; Mishina, M.; Moroni, L.; Noomen, J.; Oh, A.; Pan, L.S.; Pernicka, M.; Peitz, A.; Perera, L.; Pirollo, S.; Procario, M.; Riester, J.L.; Roe, S.; Rousseau, L.; Rudge, A.; Russ, J.; Sala, S.; Sampietro, M.; Schnetzer, S.; Sciortino, S.; Stelzer, H.; Stone, R.; Suter, B.; Tapper, R.J.; Tesarek, R.; Trischuk, W.; Tromson, D.; Vittone, E.; Walsh, A.M.; Wedenig, R.; Weilhammer, P.; Wetstein, M.; White, C.; Zeuner, W.; Zoeller, M.; Plano, R.; Somalwar, S.V.; Thomson, G.B

    2002-01-11

    CVD diamond detectors are of interest for charged particle detection and tracking due to their high radiation tolerance. In this article, we present, for the first time, beam test results from recently manufactured CVD diamond strip detectors and their behavior under low doses of electrons from a {beta}-source and the performance before and after intense (>10{sup 15}/cm{sup 2}) proton- and pion-irradiations. We find that low dose irradiation increase the signal-to-noise ratio (pumping of the signal) and slightly deteriorate the spatial resolution. Intense irradiation with protons 2.2x10{sup 15} p/cm{sup 2} lowers the signal-to-noise ratio slightly. Intense irradiation with pions 2.9x10{sup 15} {pi}/cm{sup 2} lowers the signal-to-noise ratio more. The spatial resolution of the diamond sensors improves after irradiations.

  11. Performance of irradiated CVD diamond micro-strip sensors

    CERN Document Server

    Adam, W; Bergonzo, P; Bertuccio, G; Bogani, F; Borchi, E; Brambilla, A; Bruzzi, Mara; Colledani, C; Conway, J; D'Angelo, P; Dabrowski, W; Delpierre, P A; Deneuville, A; Dulinski, W; van Eijk, B; Fallou, A; Fizzotti, F; Foulon, F; Friedl, M; Gan, K K; Gheeraert, E; Hallewell, G D; Han, S; Hartjes, F G; Hrubec, Josef; Husson, D; Kagan, H; Kania, D R; Kaplon, J; Kass, R; Koeth, T W; Krammer, Manfred; Lo Giudice, A; Lü, R; MacLynne, L; Manfredotti, C; Meier, D; Mishina, M; Moroni, L; Noomen, J; Oh, A; Pan, L S; Pernicka, Manfred; Peitz, A; Perera, L P; Pirollo, S; Procario, M; Riester, J L; Roe, S; Rousseau, L; Rudge, A; Russ, J; Sala, S; Sampietro, M; Schnetzer, S R; Sciortino, S; Stelzer, H; Stone, R; Suter, B; Tapper, R J; Tesarek, R J; Trischuk, W; Tromson, D; Vittone, E; Walsh, A M; Wedenig, R; Weilhammer, Peter; Wetstein, M; White, C; Zeuner, W; Zöller, M

    2002-01-01

    CVD diamond detectors are of interest for charged particle detection and tracking due to their high radiation tolerance. In this article we present, for the first time, beam test results from recently manufactured CVD diamond strip detectors and their behavior under low doses of electrons from a $\\beta$-source and the performance before and after intense ($>10^{15}/{\\rm cm^2}$) proton- and pion-irradiations. We find that low dose irradiations increase the signal-to-noise ratio (pumping of the signal) and slightly deteriorate the spatial resolution. Intense irradiations with protons ($2.2\\times 10^{15}~p/{\\rm cm^2}$) lowers the signal-to-noise ratio slightly. Intense irradiation with pions ($2.9\\times 10^{15}~\\pi/{\\rm cm^2}$) lowers the signal-to-noise ratio more. The spatial resolution of the diamond sensors improves after irradiations.

  12. Irradiation performance of HTGR recycle fissile fuel

    International Nuclear Information System (INIS)

    Homan, F.J.; Long, E.L. Jr.

    1976-08-01

    The irradiation performance of candidate HTGR recycle fissile fuel under accelerated testing conditions is reviewed. Failure modes for coated-particle fuels are described, and the performance of candidate recycle fissile fuels is discussed in terms of these failure modes. The bases on which UO 2 and (Th,U)O 2 were rejected as candidate recycle fissile fuels are outlined, along with the bases on which the weak-acid resin (WAR)-derived fissile fuel was selected as the reference recycle kernel. Comparisons are made relative to the irradiation behavior of WAR-derived fuels of varying stoichiometry and conclusions are drawn about the optimum stoichiometry and the range of acceptable values. Plans for future testing in support of specification development, confirmation of the results of accelerated testing by real-time experiments, and improvement in fuel performance and reliability are described

  13. [Organising and supporting the end of life when faced with a refusal of care].

    Science.gov (United States)

    Rautureau, Pascal

    2018-04-01

    Often ethically complex, end-of-life situations can mean nursing teams are confronted with a refusal of care. Through a representative clinical situation, a nurse describes the support provided by a multidisciplinary team, in the home, to comply with the wishes of a person at the end of life, support the family, anticipate possible difficulties and organise adapted care which respects all those concerned. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

  14. Effect of Thai banana (Musa AA group) in reducing accumulation of oxidation end products in UVB-irradiated mouse skin.

    Science.gov (United States)

    Leerach, Nontaphat; Yakaew, Swanya; Phimnuan, Preeyawass; Soimee, Wichuda; Nakyai, Wongnapa; Luangbudnark, Witoo; Viyoch, Jarupa

    2017-03-01

    Chronic UVB exposure causes skin disorders and cancer through DNA strand breaks and oxidation of numerous functional groups of proteins and lipids in the skin. In this study, we investigated the effects of Thai banana (Musa AA group, "Khai," and Musa ABB group, "Namwa") on the prevention of UVB-induced skin damage when fed to male ICR mice. Mice were orally fed banana (Khai or Namwa) fruit pulps at dose of 1mg/g body weight/day for 12weeks. The shaved backs of the mice were irradiated with UVB for 12weeks. The intensity dose of UVB-exposure was increased from 54mJ/cm 2 /exposure at week 1 to 126mJ/cm 2 /exposure at week 12. A significant increase in skin thickness, lipid peroxidation, protein oxidation end products, and expression of MMP-1 was observed in UVB-irradiated mouse skin. A reduction in the accumulation of oxidation end products was found in the skin of UVB-irradiated mice receiving Khai. This occurred in conjunction with a reduction in MMP-1 expression, inhibition of epidermal thickening, and induction of γ-GCS expression. The dietary intake of Khai prevented skin damage from chronic UVB exposure by increased γ-GCS expression and reduced oxidation end products included carbonyls, malondialdehyde and 4-hydroxynonenal. Copyright © 2017 Elsevier B.V. All rights reserved.

  15. Clinical review: Ethics and end-of-life care for critically ill patients in China.

    Science.gov (United States)

    Li, Li Bin

    2013-12-04

    Critical care medicine in China has made great advances in recent decades. This has led to an unavoidable issue: end-of-life ethics. With advances in medical technology and therapeutics allowing the seemingly limitless maintenance of life, the exact time of death of an individual patient is often determined by the decision to limit life support. How to care for patients at the end of life is not only a medical problem but also a social, ethical, and legal issue. A lot of factors, besides culture, come into play in determining a person's ethical attitudes or behaviors, such as experience, education, religion, individual attributes, and economic considerations. Chinese doctors face ethical problems similar to those of their Western counterparts; however, since Chinese society is different from that of Western countries in cultural traditions, customs, religious beliefs, and ethnic backgrounds, there is a great difference between China and the Western world in regard to ethics at the end of life, and there is also a huge controversy within China.

  16. What parents want from doctors in end-of-life decision-making for children.

    Science.gov (United States)

    Sullivan, J; Monagle, P; Gillam, L

    2014-03-01

    End-of-life decision-making is difficult for everyone involved, as many studies have shown. Within this complexity, there has been little information on how parents see the role of doctors in end-of-life decision-making for children. This study aimed to examine parents' views and experiences of end-of-life decision-making. A qualitative method with a semistructured interview design was used. Parent participants were living in the community. Twenty-five bereaved parents. Parents reported varying roles taken by doctors: being the provider of information without opinion; giving information and advice as to the decision that should be taken; and seemingly being the decision maker for the child. The majority of parents found their child's doctor enabled them to be the ultimate decision maker for their child, which was what they very clearly wanted to be, and consequently enabled them to exercise their parental autonomy. Parents found it problematic when doctors took over decision-making. A less frequently reported, yet significant role for doctors was to affirm decisions after they had been made by parents. Other important aspects of the doctor's role were to provide follow-up support and referral. Understanding the role that doctors take in end-of-life decisions, and the subsequent impact of that role from the perspective of parents can form the basis of better informed clinical practice.

  17. Privacy at end of life in ICU: A review of the literature.

    Science.gov (United States)

    Timmins, Fiona; Parissopoulos, Stelios; Plakas, Sotirios; Naughton, Margaret T; de Vries, Jan Ma; Fouka, Georgia

    2018-06-01

    To explore the issues surrounding privacy during death in ICU. While the provision of ICU care is vital, the nature and effect of the potential lack of privacy during death and dying in ICUs have not been extensively explored. A literature search using CINAHL and Pubmed revealed articles related to privacy, death and dying in ICU. Keywords used in the search were "ICU," "Privacy," "Death" and "Dying." A combination of these terms using Boolean operators "or" or "and" revealed a total of 23 citations. Six papers were ultimately deemed suitable for inclusion in the review and were subjected to code analysis with Atlas.ti v8 QDA software. The analysis of the studies revealed eight themes, and this study presents the three key themes that were found to be recurring and strongly interconnected to the experience of privacy and death in ICU: "Privacy in ICU," "ICU environment" and "End-of-Life Care". Research has shown that patient and family privacy during the ICU hospitalisation and the provision of the circumstances that lead to an environment of privacy during and after death remains a significant challenge for ICU nurses. Family members have little or no privacy in shared room and cramped waiting rooms, while they wish to be better informed and involved in end-of-life decisions. Hence, death and dying for many patients takes place in open and/or shared spaces which is problematic in terms of both the level of privacy and respect that death ought to afford. It is best if end-of-life care in the ICU is planned and coordinated, where possible. Nurses need to become more self-reflective and aware in relation to end-of-life situations in ICU in order to develop privacy practices that are responsive to family and patient needs. © 2018 John Wiley & Sons Ltd.

  18. An X-Ray facility to perform irradiation tests and TID studies on electronics and detectors

    CERN Document Server

    Brundu, Davide; Cadeddu, Sandro; Wyllie, Ken; Ciambrone, Paolo

    2018-01-01

    The X-Ray irradiation system of the LHCb group, installed in Cagliari, is presented; with a particular focus on the setup configuration and dose rate calibration. The system can be used to perform Total Ionizing Dose (TID) studies for detectors, readout and front-end electronics. It was already used to test the nSYNC chip, an ASIC for the readout of the LHCb upgraded muon system.

  19. Nurses' knowledge of advance directives and perceived confidence in end-of-life care: a cross-sectional study in five countries.

    LENUS (Irish Health Repository)

    Coffey, Alice

    2016-01-28

    Nurses\\' knowledge regarding advance directives may affect their administration and completion in end-of-life care. Confidence among nurses is a barrier to the provision of quality end-of-life care. This study investigated nurses\\' knowledge of advance directives and perceived confidence in end-of-life care, in Hong Kong, Ireland, Israel, Italy and the USA using a cross-sectional descriptive design (n = 1089). In all countries, older nurses and those who had more professional experience felt more confident managing patients\\' symptoms at end-of-life and more comfortable stopping preventive medications at end-of-life. Nurses in the USA reported that they have more knowledge and experience of advance directives compared with other countries. In addition, they reported the highest levels of confidence and comfort in dealing with end-of-life care. Although legislation for advance directives does not yet exist in Ireland, nurses reported high levels of confidence in end-of-life care.

  20. SME2EM: Smart mobile end-to-end monitoring architecture for life-long diseases.

    Science.gov (United States)

    Serhani, Mohamed Adel; Menshawy, Mohamed El; Benharref, Abdelghani

    2016-01-01

    Monitoring life-long diseases requires continuous measurements and recording of physical vital signs. Most of these diseases are manifested through unexpected and non-uniform occurrences and behaviors. It is impractical to keep patients in hospitals, health-care institutions, or even at home for long periods of time. Monitoring solutions based on smartphones combined with mobile sensors and wireless communication technologies are a potential candidate to support complete mobility-freedom, not only for patients, but also for physicians. However, existing monitoring architectures based on smartphones and modern communication technologies are not suitable to address some challenging issues, such as intensive and big data, resource constraints, data integration, and context awareness in an integrated framework. This manuscript provides a novel mobile-based end-to-end architecture for live monitoring and visualization of life-long diseases. The proposed architecture provides smartness features to cope with continuous monitoring, data explosion, dynamic adaptation, unlimited mobility, and constrained devices resources. The integration of the architecture׳s components provides information about diseases׳ recurrences as soon as they occur to expedite taking necessary actions, and thus prevent severe consequences. Our architecture system is formally model-checked to automatically verify its correctness against designers׳ desirable properties at design time. Its components are fully implemented as Web services with respect to the SOA architecture to be easy to deploy and integrate, and supported by Cloud infrastructure and services to allow high scalability, availability of processes and data being stored and exchanged. The architecture׳s applicability is evaluated through concrete experimental scenarios on monitoring and visualizing states of epileptic diseases. The obtained theoretical and experimental results are very promising and efficiently satisfy the proposed

  1. Irradiation versus methyl bromide fumigation or heating as procedures for increasing shelf life of dry date varieties

    International Nuclear Information System (INIS)

    El-Samahy, S.K.; Abd El-Hady, S.A.; Swailam, H.M.

    2004-01-01

    The objective of this study is to evaluate the use of irradiation as an alternative method and comparing it with the traditional methods such as fumigation and heating for increasing shelf life dry date varieties. two varieties of dry dates, Malakaby and Gandilla, were obtained from Aswan, Upper Egypt and were used in this study. The irradiation was carried out with different doses of gamma rays to select the recommended dose to increase shelf life of dry dates. The fumigated, heated and irradiated samples were stored at room temperature after packaging in polyethylene plus cloth bags. The date characteristics such as insect infestation percent, weight loss, microbiological analyses, and firmness and chemical analyses were evaluated. The results obtained indicated that irradiation as a procedure for insect disinfestation and increasing shelf life of dry dates was better than both fumigation and heating methods. Where, irradiation of date fruits at dose of 1.0 kGy inhibited the insect infestation and improved the microbial quality of the date fruits during storage up to 18 months. Adding cloths to polyethylene packages raised the percentage of intact dry date fruits

  2. 76 FR 59145 - Submission for OMB Review; Comment Request; NINR End-of-Life and Palliative Care Science Needs...

    Science.gov (United States)

    2011-09-23

    ...; Comment Request; NINR End-of-Life and Palliative Care Science Needs Assessment: Funding Source (Survey of... End-of-Life and Palliative Care Science Needs Assessment: Funding Source (Survey of Authors). Type of Information Collection Request: NEW. Need and Use of Information Collection: The NINR End-of-Life Science...

  3. Perceived risks around choice and decision making at end-of-life: a literature review.

    Science.gov (United States)

    Wilson, F; Gott, M; Ingleton, C

    2013-01-01

    the World Health Organization identifies meeting patient choice for care as central to effective palliative care delivery. Little is known about how choice, which implies an objective balancing of options and risks, is understood and enacted through decision making at end-of-life. to explore how perceptions of 'risk' may inform decision-making processes at end-of-life. an integrative literature review was conducted between January and February 2010. Papers were reviewed using Hawker et al.'s criteria and evaluated according to clarity of methods, analysis and evidence of ethical consideration. All literature was retained as background data, but given the significant international heterogeneity the final analysis specifically focused on the UK context. the databases Medline, PsycINFO, Assia, British Nursing Index, High Wire Press and CINAHL were explored using the search terms decision*, risk, anxiety, hospice and palliative care, end-of-life care and publication date of 1998-2010. thematic analysis of 25 papers suggests that decision making at end-of-life is multifactorial, involving a balancing of risks related to caregiver support; service provider resources; health inequalities and access; challenges to information giving; and perceptions of self-identity. Overall there is a dissonance in understandings of choice and decision making between service providers and service users. the concept of risk acknowledges the factors that shape and constrain end-of-life choices. Recognition of perceived risks as a central factor in decision making would be of value in acknowledging and supporting meaningful decision making processes for patients with palliative care needs and their families.

  4. The effect of gamma irradiation on fertile eggs and hatched chick performance

    International Nuclear Information System (INIS)

    Mekkawy, S.H.

    1995-01-01

    Two handier fertile white arber acers eggs were exposed to gamma irradiation (Co 6 0) at the following levels 0, 100, 150 and 200 rad. They Were then hatched with the control eggs and hatchability, growth rate, feed consumption, feed conversion, carcass quality, carcass analysis and the blood analysis were determined. Hatchability was reduced gradually with increased radiation, but significantly, no differences in body weight between irradiated and control chicks were apparent at hatching time. At the end of the experimental 45 days, the mean heavight was that of the irradiation dose of 150 rad. The feed conversion efficiency was enhanced by the irradiation treatments, especially with the dose of 200 rad. There were no differences in the carcass quality and carcass composition between the treated and non-treated birds. The results demonstrated that, the irradiation treatments had no effects on the blood analysis of the birds. 7 tabs

  5. Hospice family members’ perceptions and experiences with end-of-life care in the nursing home

    Science.gov (United States)

    Washington, Karla; Kruse, Robin L.; Albright, David L; Lewis, Alexandria; Demiris, George

    2014-01-01

    Objective Despite the fact that more than 25% of Americans die in nursing homes, end-of-life care has consistently been found to be less than adequate in this setting. Even for those residents on hospice, end-of-life care has been found to be problematic. This study had two research questions; 1) How do family members of hospice nursing home residents differ in their anxiety, depression, quality of life, social networks, perceptions of pain medication, and health compared to family members of community dwelling hospice patients? 2) What are family members’ perceptions of and experiences with end-of-life care in the nursing home setting? Methods This study is a secondary mixed methods analysis of interviews with family members of hospice nursing home residents and a comparative statistical analysis of standard outcome measures between family members of hospice patients in the nursing home and family member of hospice patients residing in the community. Results Outcome measures for family members of nursing home residents were compared (n=176) with family members of community dwelling hospice patients (n=267). The family members of nursing home residents reported higher quality of life however, levels of anxiety, depression, perceptions of pain medicine, and health were similar for hospice family members in the nursing home and in the community. Lending an understanding to the stress for hospice family members of nursing home residents concerns were found with collaboration between the nursing home and the hospice, nursing home care that did not meet family expectations, communication problems, and resident care concerns including pain management. Some family members reported positive end-of-life care experiences in the nursing home setting. Conclusion These interviews identify a multitude of barriers to quality end-of-life care in the nursing home setting, and demonstrate that support for family members is an essential part of quality end-of-life care for

  6. Ethical Decision Making With End-of-Life Care: Palliative Sedation and Withholding or Withdrawing Life-Sustaining Treatments

    Science.gov (United States)

    Olsen, Molly L.; Swetz, Keith M.; Mueller, Paul S.

    2010-01-01

    Palliative sedation (PS) is the use of medications to induce decreased or absent awareness in order to relieve otherwise intractable suffering at the end of life. Although uncommon, some patients undergoing aggressive symptom control measures still have severe suffering from underlying disease or therapy-related adverse effects. In these circumstances, use of PS is considered. Although the goal is to provide relief in an ethically acceptable way to the patient, family, and health care team, health care professionals often voice concerns whether such treatment is necessary or whether such treatment equates to physician-assisted suicide or euthanasia. In this review, we frame clinical scenarios in which PS may be considered, summarize the ethical underpinnings of the practice, and further differentiate PS from other forms of end-of-life care, including withholding and/or withdrawing life-sustaining therapy and physician-assisted suicide and euthanasia. PMID:20805544

  7. Condition Assessment and End-of-Life Prediction System for Electric Machines and Their Loads

    Science.gov (United States)

    Parlos, Alexander G.; Toliyat, Hamid A.

    2005-01-01

    An end-of-life prediction system developed for electric machines and their loads could be used in integrated vehicle health monitoring at NASA and in other government agencies. This system will provide on-line, real-time condition assessment and end-of-life prediction of electric machines (e.g., motors, generators) and/or their loads of mechanically coupled machinery (e.g., pumps, fans, compressors, turbines, conveyor belts, magnetic levitation trains, and others). In long-duration space flight, the ability to predict the lifetime of machinery could spell the difference between mission success or failure. Therefore, the system described here may be of inestimable value to the U.S. space program. The system will provide continuous monitoring for on-line condition assessment and end-of-life prediction as opposed to the current off-line diagnoses.

  8. Parental Physical Proximity in End-of-Life Care in the PICU.

    Science.gov (United States)

    Falkenburg, Jeannette L; Tibboel, Dick; Ganzevoort, Ruard R; Gischler, Saskia; Hagoort, Jacobus; van Dijk, Monique

    2016-05-01

    Health professionals in PICUs support both child and parents when a child's death is imminent. Parents long to stay connected to their dying child but the high-tech environment and treatment implications make it difficult to stay physically close. This study explores in what sense physical aspects of end-of-life care in the PICU influence the parent-child relationship. Retrospective, qualitative interview study. Level 3 PICU in Erasmus Medical Center in the Netherlands. Thirty-six parents of 20 children who had died in this unit 5 years previously. Parents vividly remembered the damage done to the child's physical appearance, an inevitable consequence of medical treatment. They felt frustrated and hurt when they could not hold their child. Yet they felt comforted if facilitated to be physically close to the dying child, like lying with the child in one bed, holding the child in the hour of death, and washing the child after death. End-of-life treatment in the PICU presents both a barrier and an opportunity for parents to stay physically connected to their child. Parents' experiences suggest that aspects of physicality in medical settings deserve more attention. Better understanding of the significance of bodily aspects-other than pain and symptom management-improves end-of-life support and should be part of the humane approach to families.

  9. Hospice or community network? Choices in end-of-life care in Jamaica.

    Science.gov (United States)

    Mendoza, Roger Lee

    2017-09-01

    Now considered a subspecialty of medicine and nursing, palliative care is a critical aspect of healthcare at the end of life. National and international healthcare agencies typically attribute its slow or haphazard growth in developing countries to various resource constraints. However, this study provides evidence of the substantial and widening gap between policy advocacy and patient choices in end-of-life care. It does so by establishing the incentives and risks that underlie decision-making by patients and providers against the relative scarcity of palliative care and hospices in these countries. Jamaica offers an illustrative case. It shares the socioeconomic conditions and isolated provision of hospice and palliative care that remain prevalent in many developing countries. Empirical information was collected from all Jamaican hospices, along with agency and media reports, for comparative institutional analysis. Financial and infrastructural challenges hamper hospice expansion and integration into formal healthcare systems in developing countries. Yet, other equally vital considerations are too often neglected. These include the high transaction costs of decision-making, which account for limited hospice accessibility, affordability, and efficiency, particularly to underserved populations. Risk and payoff calculations by patients and their families as well as hospices and their providers lead to two strategic options in maximizing hospice value and/or minimizing transaction costs in end-of-life care. Policy formulation and advocacy for hospice and palliative care should match aggregate demand. The socio-cultural milieu of care is critical and should be equally considered. Otherwise, providing and expanding free or subsidized palliative care at the end-of-life stage can become cost-inefficient relative to robust family and grassroots community networks.

  10. Vigilant at the end of life: family advocacy in the nursing home.

    Science.gov (United States)

    Shield, Renee R; Wetle, Terrie; Teno, Joan; Miller, Susan C; Welch, Lisa C

    2010-05-01

    Increasing numbers of Americans die in nursing homes. Little is known about the roles and experiences of family members of persons who die in nursing homes. The authors conducted 54 qualitative telephone interviews of close family or friends of individuals who had spent at least 48 hours in the last month of life in a nursing home. Respondents had earlier participated in a national survey that found 587 of 1578 decedents (37.2%) received end-of-life nursing home care. In qualitative interviews respondents described the last year of life, focusing on the nursing home experience. Interviews were analyzed by a multidisciplinary team to identify key themes of areas of concern. An important interview theme revealed families often felt the need to advocate for their dying relative because of low expectations or experiences with poor quality nursing home care. They noted staff members who did not fully inform them about what to expect in the dying process. Respondents reported burden and gratification in care they themselves provided, which sometimes entailed collaboration with staff. Interviews also identified ways hospice care impacted families, including helping to relieve family burden. End-of-life advocacy takes on increased urgency when those close to the dying resident have concerns about basic care and do not understand the dying course. Enhancing communication, preparing families at the end of life, and better understanding of hospice are likely to increase family trust in nursing home care, improve the care of dying residents, and help reduce family burden.

  11. Ethics and end of life care: the Liverpool Care Pathway and the Neuberger Review.

    Science.gov (United States)

    Wrigley, Anthony

    2015-08-01

    The Liverpool Care Pathway for the Dying has recently been the topic of substantial media interest and also been subject to the independent Neuberger Review. This review has identified clear failings in some areas of care and recommended the Liverpool Care Pathway be phased out. I argue that while the evidence gathered of poor incidences of practice by the Review is of genuine concern for end of life care, the inferences drawn from this evidence are inconsistent with the causes for the concern. Seeking to end an approach that is widely seen as best practice and which can genuinely deliver high quality care because of negative impressions that have been formed from failing to implement it properly is not a good basis for radically overhauling our approach to end of life care. I conclude that improvements in training, communication and ethical decision-making, without the added demand to end the Liverpool Care Pathway, would have resulted in a genuine advance in end of life care. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  12. The end-of-life phase of high-grade glioma patients: a systematic review

    NARCIS (Netherlands)

    Sizoo, E.M.; Pasman, H.R.W.; Dirven, L.; Marosi, C.; Grisold, W.; Stockhammer, G.; Egeter, J.; Grant, R.; Chang, S.; Heimans, J.J.; Deliens, L.; Reijneveld, J.C.; Taphoorn, M.J.B.

    2014-01-01

    Background: High-grade gliomas (HGG) are rare and incurable; yet, these neoplasms result in a disproportionate share of cancer morbidity and mortality. Treatment of HGG patients is directed not merely towards prolonging life but also towards quality of life, which becomes the major goal in the end

  13. [Is there any deontology of accompanying people at the end of life?].

    Science.gov (United States)

    Glorion, B

    1999-01-01

    The thought on ethics, enhances by accompanying patients or human-beings reaching end of life, belong to major themes which have for years been dealt with by philosophers and monks. The physicians, who by nature accompany and live with their patient this life period a sometimes close relationship, have conceived within deontology a wonderful expression of what ethics inspired them. Reading articles 37 and 38 of the Code of Ethics brings a clear, precise and qualified answer to the question raised by the title. We easily find out the main principles which would be the guideline to the doctor's behaviour coping with this situation: providing suitable and continue cares to maintain the quality of a life which comes to end, respecting dignity. Relieving suffers, morally assisting, comforting the family, knowing to limit the cares reasonably. The sensitive and human expression sums up pretty well the particularities essential to all (physicians, health professionals or volunteers) who have accepted this heavy task.

  14. Shelf Life of Tilapia Fillets Treated with low dose Gamma Irradiation

    International Nuclear Information System (INIS)

    Mohamed, W.S.; El-Mossalami, I.I.

    2009-01-01

    The bacterial load (total bacterial count), Psychrophilic count, chemical and sensory examinations in Tilapia fish fillets were determined to evaluate its sanitary status and to increase its storage period during storage at -18 degree C for one year. The experiment was carried out at the time of receiving the samples and after gamma radiation treatment with dose levels of 1, 2 and 3 kGy. The initial total bacterial count was 5.4x10 0 cfu/gm and the psychrophilic count was 4x10 5 cfu/gm; it was slightly increased during freezing storage. The chemical parameters were more indicative in evaluating the shelf life of frozen fish; as they exceeded the permissible limits, so that the frozen non-irradiated samples were rejected after 6 months. The exposure to gamma irradiation at a dose of 1 kGy extended the storage time of the samples to 9 months while irradiation with 3 kGy extended the storage time of the samples to 12 months without changing its quality attributes. The quality during storage at -18 degree C of non irradiated and irradiated fish fillets was investigated every 3 months for one year by measuring the bacterial counts, chemical parameters and sensorial evaluation of the samples to study the effect of irradiation on increasing the storage time of fish fillets. So, it is recommended that fish fillets should be properly cleaned, packaged and exposed to gamma irradiation at a dose of 3 kGy to extend its freezing storage period

  15. Life cycle thinking and assessment tools on environmentally-benign electronics: Convergent optimization of materials use, end-of-life strategy and environmental policies

    Science.gov (United States)

    Zhou, Xiaoying

    The purpose of this study is to integrate the quantitative environmental performance assessment tools and the theory of multi-objective optimization within the boundary of electronic product systems to support the selection among design alternatives in terms of environmental impact, technical criteria, and economic feasibility. To meet with the requirements that result from emerging environmental legislation targeting electronics products, the research addresses an important analytical methodological approach to facilitate environmentally conscious design and end-of-life management with a life cycle viewpoint. A synthesis of diverse assessment tools is applied on a set of case studies: lead-free solder materials selection, cellular phone design, and desktop display technology assessment. In the first part of this work, an in-depth industrial survey of the status and concerns of the U.S. electronics industry on the elimination of lead (Pb) in solders is described. The results show that the trade-offs among environmental consequences, technology challenges, business risks, legislative compliance and stakeholders' preferences must be explicitly, simultaneously, and systematically addressed in the decision-making process used to guide multi-faceted planning of environmental solutions. In the second part of this work, the convergent optimization of the technical cycle, economic cycle and environmental cycle is addressed in a coherent and systematic way using the application of environmentally conscious design of cellular phones. The technical understanding of product structure, components analysis, and materials flow facilitates the development of "Design for Disassembly" guidelines. A bottom-up disassembly analysis on a "bill of materials" based structure at a micro-operational level is utilized to select optimal end-of-life strategies on the basis of economic feasibility. A macro-operational level life cycle model is used to investigate the environmental consequences

  16. End-to-end System Performance Simulation: A Data-Centric Approach

    Science.gov (United States)

    Guillaume, Arnaud; Laffitte de Petit, Jean-Luc; Auberger, Xavier

    2013-08-01

    In the early times of space industry, the feasibility of Earth observation missions was directly driven by what could be achieved by the satellite. It was clear to everyone that the ground segment would be able to deal with the small amount of data sent by the payload. Over the years, the amounts of data processed by the spacecrafts have been increasing drastically, leading to put more and more constraints on the ground segment performances - and in particular on timeliness. Nowadays, many space systems require high data throughputs and short response times, with information coming from multiple sources and involving complex algorithms. It has become necessary to perform thorough end-to-end analyses of the full system in order to optimise its cost and efficiency, but even sometimes to assess the feasibility of the mission. This paper presents a novel framework developed by Astrium Satellites in order to meet these needs of timeliness evaluation and optimisation. This framework, named ETOS (for “End-to-end Timeliness Optimisation of Space systems”), provides a modelling process with associated tools, models and GUIs. These are integrated thanks to a common data model and suitable adapters, with the aim of building suitable space systems simulators of the full end-to-end chain. A big challenge of such environment is to integrate heterogeneous tools (each one being well-adapted to part of the chain) into a relevant timeliness simulation.

  17. Cross-current leaching of indium from end-of-life LCD panels

    Energy Technology Data Exchange (ETDEWEB)

    Rocchetti, Laura; Amato, Alessia; Fonti, Viviana [Department of Life and Environmental Sciences, Università Politecnica delle Marche, Via Brecce Bianche, 60131 Ancona (Italy); Ubaldini, Stefano [Institute of Environmental Geology and Geoengineering IGAG, National Research Council, Via Salaria km 29300, 00015 Montelibretti, Rome (Italy); De Michelis, Ida [Department of Industrial Engineering, Information and Economy, University of L’Aquila, Via Giovanni Gronchi 18, 67100, Zona industriale di Pile, L’Aquila (Italy); Kopacek, Bernd [ISL Kopacek KG, Beckmanngasse 51, 1140 Wien (Austria); Vegliò, Francesco [Department of Industrial Engineering, Information and Economy, University of L’Aquila, Via Giovanni Gronchi 18, 67100, Zona industriale di Pile, L’Aquila (Italy); Beolchini, Francesca, E-mail: f.beolchini@univpm.it [Department of Life and Environmental Sciences, Università Politecnica delle Marche, Via Brecce Bianche, 60131 Ancona (Italy)

    2015-08-15

    Graphical abstract: Display Omitted - Highlights: • End-of-life LCD panels represent a source of indium. • Several experimental conditions for indium leaching have been assessed. • Indium is completely extracted with 2 M sulfuric acid at 80 °C for 10 min. • Cross-current leaching improves indium extraction and operating costs are lowered. • Benefits to the environment come from reduction of CO{sub 2} emissions and reagents use. - Abstract: Indium is a critical element mainly produced as a by-product of zinc mining, and it is largely used in the production process of liquid crystal display (LCD) panels. End-of-life LCDs represent a possible source of indium in the field of urban mining. In the present paper, we apply, for the first time, cross-current leaching to mobilize indium from end-of-life LCD panels. We carried out a series of treatments to leach indium. The best leaching conditions for indium were 2 M sulfuric acid at 80 °C for 10 min, which allowed us to completely mobilize indium. Taking into account the low content of indium in end-of-life LCDs, of about 100 ppm, a single step of leaching is not cost-effective. We tested 6 steps of cross-current leaching: in the first step indium leaching was complete, whereas in the second step it was in the range of 85–90%, and with 6 steps it was about 50–55%. Indium concentration in the leachate was about 35 mg/L after the first step of leaching, almost 2-fold at the second step and about 3-fold at the fifth step. Then, we hypothesized to scale up the process of cross-current leaching up to 10 steps, followed by cementation with zinc to recover indium. In this simulation, the process of indium recovery was advantageous from an economic and environmental point of view. Indeed, cross-current leaching allowed to concentrate indium, save reagents, and reduce the emission of CO{sub 2} (with 10 steps we assessed that the emission of about 90 kg CO{sub 2}-Eq. could be avoided) thanks to the recovery of indium

  18. Discussing End-of-Life Decisions in a Clinical Ethics Committee: An Interview Study of Norwegian Doctors' Experience.

    Science.gov (United States)

    Bahus, Marianne K; Førde, Reidun

    2016-09-01

    With disagreement, doubts, or ambiguous grounds in end-of-life decisions, doctors are advised to involve a clinical ethics committee (CEC). However, little has been published on doctors' experiences with discussing an end-of-life decision in a CEC. As part of the quality assurance of this work, we wanted to find out if clinicians have benefited from discussing end-of-life decisions in CECs and why. We will disseminate some Norwegian doctors' experiences when discussing end-of-life decisions in CECs, based on semi-structured interviews with fifteen Norwegian physicians who had brought an end-of-life decision case to a CEC. Almost half of the cases involved conflicts with the patients' relatives. In a majority of the cases, there was uncertainty about what would be the ethically preferable solution. Reasons for referring the case to the CEC were to get broader illumination of the case, to get perspective from people outside the team, to get advice, or to get moral backing on a decision already made. A great majority of the clinicians reported an overall positive experience with the CECs' discussions. In cases where there was conflict, the clinicians reported less satisfaction with the CECs' discussions. The study shows that most doctors who have used a CEC in an end-of-life decision find it useful to have ethical and/or legal aspects illuminated, and to have the dilemma scrutinized from a new perspective. A systematic discussion seems to be significant to the clinicians.

  19. Fatigue performance of HFIR-irradiated Nimonic PE-16 at 4300C

    International Nuclear Information System (INIS)

    Grossbeck, M.L.; Liu, K.C.

    1983-01-01

    Nimonic PE-16 was irradiated in the HFIR to 6 to 9 dpa and 560 to 1000 at. ppM He at 430 0 C. Postirradiation fatigue tests revealed a reduction in fatigue life by about a factor of 10 at 430 0 C. In contrast to AISI type 316 stainless steel, no endurance limit was observed. All irradiated specimens exhibited some intergranular fracture with an increasing tendency toward cleavage-like intragranular fracture for low strain ranges

  20. Doctors' learning experiences in end-of-life care - a focus group study from nursing homes.

    Science.gov (United States)

    Fosse, Anette; Ruths, Sabine; Malterud, Kirsti; Schaufel, Margrethe Aase

    2017-01-31

    Doctors often find dialogues about death difficult. In Norway, 45% of deaths take place in nursing homes. Newly qualified medical doctors serve as house officers in nursing homes during internship. Little is known about how nursing homes can become useful sites for learning about end-of-life care. The aim of this study was to explore newly qualified doctors' learning experiences with end-of-life care in nursing homes, especially focusing on dialogues about death. House officers in nursing homes (n = 16) participated in three focus group interviews. Interviews were audiotaped and transcribed verbatim. Data were analysed with systematic text condensation. Lave & Wenger's theory about situated learning was used to support interpretations, focusing on how the newly qualified doctors gained knowledge of end-of-life care through participation in the nursing home's community of practice. Newly qualified doctors explained how nursing home staff's attitudes taught them how calmness and acceptance could be more appropriate than heroic action when death was imminent. Shifting focus from disease treatment to symptom relief was demanding, yet participants comprehended situations where death could even be welcomed. Through challenging dialogues dealing with family members' hope and trust, they learnt how to adjust words and decisions according to family and patient's life story. Interdisciplinary role models helped them balance uncertainty and competence in the intermediate position of being in charge while also needing surveillance. There is a considerable potential for training doctors in EOL care in nursing homes, which can be developed and integrated in medical education. This practice based learning arena offers newly qualified doctors close interaction with patients, relatives and nurses, teaching them to perform difficult dialogues, individualize medical decisions and balance their professional role in an interdisciplinary setting.

  1. [End of life decisions, the Dutch form through Spanish eyes].

    Science.gov (United States)

    Belloc Rocasalbas, M; Girbes, A R J

    2011-03-01

    Abroad, but also in The Netherlands, there are many misunderstandings concerning end of life decisions and euthanasia. In general, euthanasia does not play any role in the intensive care units, simply because it does not fulfill the conditions to carry it out. However, there is still confusion, merely due to the assumption that the Dutch situation is different because of their legislation on euthanasia. The use of the unclear terminology such as "passive euthanasia", "voluntary euthanasia" or "involuntary euthanasia" contributes to the confusion of lay people and physicians, and should therefore be avoided. End of life decisions in intensive care patients are in fact a structural part of work of intensivists. Collecting all necessary information including the wishes and will of the patient, medical expertise and acknowledging limitations of medical treatment will help to determine futility of treatment goals. Once it is determined that surviving the intensive care unit with a quality of life acceptable for the patient is beyond reach, the goal of treatment should be improved and the dying process optimized. Stopping a treatment modality at the request of a will-competent patient or because of futility is not euthanasia. Copyright © 2010 Elsevier España, S.L. y SEMICYUC. All rights reserved.

  2. End-of-life decisions in Malaysia: Adequacies of ethical codes and developing legal standards.

    Science.gov (United States)

    Kassim, Puteri Nemie Jahn; Alias, Fadhlina

    2015-06-01

    End-of-life decision-making is an area of medical practice in which ethical dilemmas and legal interventions have become increasingly prevalent. Decisions are no longer confined to clinical assessments; rather, they involve wider considerations such as a patient's religious and cultural beliefs, financial constraints, and the wishes and needs of family members. These decisions affect everyone concerned, including members of the community as a whole. Therefore it is imperative that clear ethical codes and legal standards are developed to help guide the medical profession on the best possible course of action for patients. This article considers the relevant ethical, codes and legal provisions in Malaysia governing certain aspects of end-of-life decision-making. It highlights the lack of judicial decisions in this area as well as the limitations with the Malaysian regulatory system. The article recommends the development of comprehensive ethical codes and legal standards to guide end-of-life decision-making in Malaysia.

  3. Effects of non-steady irradiation conditions on fusion materials performance

    International Nuclear Information System (INIS)

    Matsui, H.; Fukumoto, K.; Nagumo, T.; Nita, N.

    2001-01-01

    During startup of fusion reactors, materials are exposed to neutron irradiation under non-steady temperature condition. Since the temperature of irradiation has decisive effects on the microstructural evolution, the non-steady temperature will have important consequences in the performance of fusion reactor materials. In the present study, a series of vanadium based alloys have been irradiated with neutrons in a temperature cycling condition. It has been found from this study that cavity number density is much greater in temperature cycled specimens than in steady temperature irradiation. Keeping the upper temperature constant, cavity number density is greater for smaller difference between the upper and the lower temperature. It follows that relatively small temperature excursions may have rather significant effects on the fusion material performance in service. (author)

  4. Effects of UV-B irradiated algae on life history traits of Daphnia pulex

    NARCIS (Netherlands)

    De Lange, H.J.; Van Donk, E.

    1997-01-01

    1. The impact of ultraviolet-B (UVB)-irradiated phytoplankton on the life history parameters of Daphnia was studied. Three species of Chlorophyceae (Chlamydomonas reinhardtii, Scenedesmus acutus and S. subspicatus) and one species of Cryptophyceae (Cryptamonas pyrenoidifera) were cultured with and

  5. [Decision-making processes in nursing and activities at the end of life in intensive care–An international comparative study].

    Science.gov (United States)

    Kohlen, Helen; McCarthy, Joan; Szylit Buosso, Regina; Gallagher, Ann; Andrews, Tom

    2015-12-01

    Intensive care units (ICUs) are traditionally settings that offer high technologically advanced treatment for those who are in critical situations due to an illness or accident. Questions regarding the withdrawal and withholding as well as the ending of life sustaining treatment are related to ethical dilemmas. Nurses’ decision-making processes and nursing activities in different countries are scarcely studied. Which end-of-life decision-making processes and activities that are performed by nurses can be identified and described? The objective is the identification of a nursing terrain regarding decision-making and activities in patient end-of-life care on the intensive care unit. Semi-structured interviews were conducted with 51 experienced nurses in university or hospital premises: 10 in Brazil, 9 in England, 10 in Germany, 10 in Ireland and 12 nurses in Palestine. The study used grounded theory to inform data collection and analysis. The finding of the study is the identification of a dynamic process in which activities with a focus on cure shift to activities with a focus on end-of-life care. The core category that emerged was ’negotiated reorienting’: The shift of activities implies negotiations between nurses and physicians, relatives as well as with oneself. Moreover the process is characterized by a constant re-orientation that is induced by changing patient data and the realisation of the whole situation. Nurses’ core practices are ’consensus seeking’ and ’emotional holding’ (sub-categories). In all countries a nursing terrain of activities in end-of-life care could be identified and described. However, it is unclear whether nursing activities connected to relatives of the patient are dominant in such a way that relations to dying patients and respect for their autonomy are put into the background. A field study could give answers to this question possible.

  6. End-of-life care in the United States: policy issues and model programs of integrated care

    Directory of Open Access Journals (Sweden)

    Joshua M. Wiener

    2003-05-01

    Full Text Available Background: End-of-life care financing and delivery in the United States is fragmented and uncoordinated, with little integration of acute and long-term care services. Objective: To assess policy issues involving end-of-life care, especially involving the hospice benefit, and to analyse model programs of integrated care for people who are dying. Methods: The study conducted structured interviews with stakeholders and experts in end-of-life care and with administrators of model programs in the United States, which were nominated by the experts. Results: The two major public insurance programs—Medicare and Medicaid—finance the vast majority of end-of-life care. Both programs offer a hospice benefit, which has several shortcomings, including requiring physicians to make a prognosis of a six month life expectancy and insisting that patients give up curative treatment—two steps which are difficult for doctors and patients to make—and payment levels that may be too low. In addition, quality of care initiatives for nursing homes and hospice sometimes conflict. Four innovative health systems have overcome these barriers to provide palliative services to beneficiaries in their last year of life. Three of these health systems are managed care plans which receive capitated payments. These providers integrate health, long-term and palliative care using an interdisciplinary team approach to management of services. The fourth provider is a hospice that provides palliative services to beneficiaries of all ages, including those who have not elected hospice care. Conclusions: End-of-life care is deficient in the United States. Public payers could use their market power to improve care through a number of strategies.

  7. Factors That Impact End-of-Life Decision Making in African Americans With Advanced Cancer

    Science.gov (United States)

    Campbell, Cathy L.; Williams, Ishan C.; Orr, Tamara

    2013-01-01

    Significance African Americans with cancer are less likely to use hospice services and more likely to die in the hospital than white patients with the same diagnosis. However, there is much that is not understood about the factors that lead African Americans to choose options for end-of-life care. Design A qualitative, descriptive design was used in this pilot study. Methods Interviews were conducted with two groups of African Americans with advanced-stage cancer (people enrolled in hospice and those who were not under hospice care). Findings End-of-life decisions were primarily guided by clinical factors, the patient-related physical, emotional, and cognitive symptoms that are sequelae of the underlying disease or medical treatments. The physician was the healthcare provider most likely to be involved in decision making with patients, family members, and caregivers. Individual factors, such as personal beliefs, influenced end-of-life decision making. Religion and spirituality were a topic in many interviews, but they did not consistently influence decision making. Discussion Future studies should include interviews with family members, caregivers, and healthcare professionals so that factors that impact end-of-life decision making can be fully described. Strategies to facilitate recruitment will need to be added to future protocols. PMID:23645999

  8. On end-to-end performance of MIMO multiuser in cognitive radio networks

    KAUST Repository

    Yang, Yuli

    2011-12-01

    In this paper, a design for the multiple-input-multiple-output (MIMO) multiuser transmission in the cognitive radio network is developed and its end-to-end performance is investigated under spectrum-sharing constraints. Firstly, the overall average packet error rate is analyzed by considering the channel state information feedback delay and the multiuser scheduling. Then, we provide corresponding numerical results to measure the performance evaluation for several separate scenarios, which presents a convenient tool for the cognitive radio network design with multiple secondary MIMO users. © 2011 IEEE.

  9. On end-to-end performance of MIMO multiuser in cognitive radio networks

    KAUST Repository

    Yang, Yuli; Aissa, Sonia

    2011-01-01

    In this paper, a design for the multiple-input-multiple-output (MIMO) multiuser transmission in the cognitive radio network is developed and its end-to-end performance is investigated under spectrum-sharing constraints. Firstly, the overall average packet error rate is analyzed by considering the channel state information feedback delay and the multiuser scheduling. Then, we provide corresponding numerical results to measure the performance evaluation for several separate scenarios, which presents a convenient tool for the cognitive radio network design with multiple secondary MIMO users. © 2011 IEEE.

  10. Use of Simulation in End-of-Life Care Education.

    Science.gov (United States)

    Grabow, Debra

    Death and dying encompasses the period when individuals present with a limited prognosis and are near death or have recently died. Using simulation to educate nurses on end-of-life (EOL) care helps focus more on the needs of the learner rather than the patient, and allows the learner to process feelings in preparation for a real experience. Incorporating simulation with a spiritual perspective is essential and needed in EOL nursing care.

  11. Irradiation performance of uranium-molybdenum alloy dispersion fuels

    International Nuclear Information System (INIS)

    Almeida, Cirila Tacconi de

    2005-01-01

    The U-Mo-Al dispersion fuels of Material Test Reactors (MTR) are analyzed in terms of their irradiation performance. The irradiation performance aspects are associated to the neutronic and thermal hydraulics aspects to propose a new core configuration to the IEA-R1 reactor of IPEN-CNEN/SP using U-Mo-Al fuels. Core configurations using U-10Mo-Al fuels with uranium densities variable from 3 to 8 gU/cm 3 were analyzed with the computational programs Citation and MTRCR-IEA R1. Core configurations for fuels with uranium densities variable from 3 to 5 gU/cm 3 showed to be adequate to use in IEA-R1 reactor e should present a stable in reactor performance even at high burn-up. (author)

  12. Extending the shelf-life of citrus fruits using irradiation and/or other treatments I. 'Balady' oranges

    International Nuclear Information System (INIS)

    Abd-Allah, M.A.; Khallaf, M.F.; Mahmoud, A.A.; Salem, M.H.

    1996-01-01

    Irradiation process (0, 1.50 and 2.50 kGy) gamma radiation with or without other treatments before irradiation, i.e. soaking in CaCl 2 solution or waxing were used in this study to investigate the effect of such treatments on the shelf-life of 'Balady' orange fruits at room temperature. Marketable properties (browning, decay and texture) in addition to the organoleptic evaluation of firmness, appearance, odour, colour and taste were detected. Results showed the preferability of waxing treatment before irradiation processes. On the other hand, statistical analysis of the organoleptic evaluation revealed that the shelf-life of untreated sample (control) was 20 days at room temperature, while samples exposed to the different suggested treatments were rejected after 30 days under the same conditions. (author)

  13. Policies to improve end-of-life decisions in Flemish hospitals: communication, training of health care providers and use of quality assessments

    Directory of Open Access Journals (Sweden)

    Noortgate Nele

    2009-12-01

    Full Text Available Abstract Background The prevalence and implementation of institutional end-of-life policies has been comprehensively studied in Flanders, Belgium, a country where euthanasia was legalised in 2002. Developing end-of-life policies in hospitals is a first step towards improving the quality of medical decision-making at the end-of-life. Implementation of policies through quality assessments, communication and the training and education of health care providers is equally important in improving actual end-of-life practice. The aim of the present study is to report on the existence and nature of end-of-life policy implementation activities in Flemish acute hospitals. Methods A cross-sectional mail survey was sent to all acute hospitals (67 main campuses in Flanders (Belgium. The questionnaire asked about hospital characteristics, the prevalence of policies on five types of end-of-life decisions: euthanasia, palliative sedation, alleviation of symptoms with possible life-shortening effect, do-not-resuscitate decision, and withdrawing or withholding of treatment, the internal and external communication of these policies, training and education on aspects of end-of-life care, and quality assessments of end-of-life care on patient and family level. Results The response rate was 55%. Results show that in 2007 written policies on most types of end-of-life decisions were widespread in acute hospitals (euthanasia: 97%, do-not-resuscitate decisions: 98%, palliative sedation: 79%. While standard communication of these policies to health care providers was between 71% and 91%, it was much lower to patients and/or family (between 17% and 50%. More than 60% of institutions trained and educated their caregivers in different aspects on end-of-life care. Assessment of the quality of these different aspects at patient and family level occurred in 25% to 61% of these hospitals. Conclusions Most Flemish acute hospitals have developed a policy on end-of-life practices

  14. Policies to improve end-of-life decisions in Flemish hospitals: communication, training of health care providers and use of quality assessments.

    Science.gov (United States)

    D'Haene, Ina; Vander Stichele, Robert H; Pasman, H Roeline W; Noortgate, Nele Van den; Bilsen, Johan; Mortier, Freddy; Deliens, Luc

    2009-12-30

    The prevalence and implementation of institutional end-of-life policies has been comprehensively studied in Flanders, Belgium, a country where euthanasia was legalised in 2002. Developing end-of-life policies in hospitals is a first step towards improving the quality of medical decision-making at the end-of-life. Implementation of policies through quality assessments, communication and the training and education of health care providers is equally important in improving actual end-of-life practice. The aim of the present study is to report on the existence and nature of end-of-life policy implementation activities in Flemish acute hospitals. A cross-sectional mail survey was sent to all acute hospitals (67 main campuses) in Flanders (Belgium). The questionnaire asked about hospital characteristics, the prevalence of policies on five types of end-of-life decisions: euthanasia, palliative sedation, alleviation of symptoms with possible life-shortening effect, do-not-resuscitate decision, and withdrawing or withholding of treatment, the internal and external communication of these policies, training and education on aspects of end-of-life care, and quality assessments of end-of-life care on patient and family level. The response rate was 55%. Results show that in 2007 written policies on most types of end-of-life decisions were widespread in acute hospitals (euthanasia: 97%, do-not-resuscitate decisions: 98%, palliative sedation: 79%). While standard communication of these policies to health care providers was between 71% and 91%, it was much lower to patients and/or family (between 17% and 50%). More than 60% of institutions trained and educated their caregivers in different aspects on end-of-life care. Assessment of the quality of these different aspects at patient and family level occurred in 25% to 61% of these hospitals. Most Flemish acute hospitals have developed a policy on end-of-life practices. However, communication, training and the education of health care

  15. Talking about end-of-life care in a timely manner

    NARCIS (Netherlands)

    Smeenk, Frank W. J. M.; Schrijver, Laurien A; van Bavel, Hennie C. J.; van de Laar, Eric F. J.

    2017-01-01

    In 2014, a group of physicians of the Catharina Hospital in Eindhoven (The Netherlands) started a project called “Talking about end-of-life care in a timely manner”. Just like others in the country, the Eindhoven group noticed that regularly, very frail elderly people were admitted to hospital in

  16. Effect of gamma irradiation on microbial load, chemical and sensory evaluation of chicken meat

    International Nuclear Information System (INIS)

    Al-Bachir, M.

    2009-01-01

    The effect of gamma irradiation on microbial load, chemical sensory characteristics of chicken meat has been evaluated. Chicken meat were irradiated at doses of 0, 2, 4 and 6 kGy of gamma irradiation. Irradiated and unirradiated meat were kept in a refrigerator (1-4 Degree Centigrade). Immediately after irradiation, general composition, microbiological and sensory evaluation of chicken meat were done. Microbiological and chemical analysis of chicken meat were evaluated at weekly up to end of the storage period. The results indicated that all doses of gamma irradiation reduced the microbial load, and increased the shelf-life of chicken meat. Total acidity, volatile basic nitrogen (VBN) and lipid oxidation value in chicken meat were not affected by gamma irradiation. Sensory evaluation showed no significant differences between irradiated and un-irradiated chicken meat. (author)

  17. Effect of gamma irradiation on microbial load, chemical and sensory evaluation of chicken meat

    International Nuclear Information System (INIS)

    Al-Bachir, M.

    2008-03-01

    The effect of gamma irradiation on microbial load, chemical sensory characteristics of chicken meat has been evaluated. Chicken meat were irradiated at doses of 0, 2, 4 and 6 kGy of gamma irradiation. Irradiated and unirradiated meat were kept in a refrigerator (1-4 Degree Centigrade). Immediately after irradiation, general composition, microbiological and sensory evaluation of chicken meat were done. Microbiological and chemical analysis of chicken meat were evaluated at weekly up to end of the storage period. The results indicated that all doses of gamma irradiation reduced the microbial load, and increased the shelf-life of chicken meat. Total acidity, volatile basic nitrogen (VBN) and lipid oxidation value in chicken meat were not affected by gamma irradiation. Sensory evaluation showed no significant differences between irradiated and un-irradiated chicken meat. (author)

  18. The development and prospects of the end-of-life vehicle recycling system in Taiwan.

    Science.gov (United States)

    Chen, Kuan-chung; Huang, Shih-han; Lian, I-wei

    2010-01-01

    Automobiles usually contain toxic substances, such as lubricants, acid solutions and coolants. Therefore, inappropriate handling of end-of-life vehicles (ELVs) will result in environmental pollution. ELV parts, which include metallic and non-metallic substances, are increasingly gaining recycling value due to the recent global shortage of raw materials. Hence, the establishment of a proper recycling system for ELVs will not only reduce the impact on the environment during the recycling process, but it will also facilitate the effective reuse of recycled resources. Prior to 1994, the recycling of ELVs in Taiwan was performed by related operators in the industry. Since the publishing of the "End-of-life vehicle recycling guidelines" under the authority of the Waste Disposal Act by the Environmental Protection Administration (EPA) in 1994, the recycling of ELVs in Taiwan has gradually become systematic. Subsequently, the Recycling Fund Management Board (RFMB) of the EPA was established in 1998 to collect a Collection-Disposal-Treatment Fee (recycling fee) from responsible enterprises for recycling and related tasks. Since then, the recycling channels, processing equipment, and techniques for ELVs in Taiwan have gradually become established. This paper reviews the establishment of the ELV recycling system, analyzes the current system and its performance, and provides some recommendations for future development. The reduction of auto shredder residue (ASR) is a key factor in maximizing the resource recovery rate and recycling efficiency. The RFMB needs to provide strong economic incentives to further increase the recycling rate and to encourage the automobile industry to design and market greener cars. 2010 Elsevier Ltd. All rights reserved.

  19. Truncated Autonomy: Neocortical Selves, Reverse Reductionism and End-of-Life Care

    OpenAIRE

    Wackers, Ger

    2016-01-01

    Published version. Source at http://dx.doi.org/10.5772/66044 In professional guidelines for palliative sedation in end-of life care, a particular notion of conscious life experience is associated with specific cognitivist notion of frontal lobe autonomy. Drawing on Turner and Fauconnier’s work in cognitive linguistics I argue in this chapter that even our most central notions like human subjectivity and autonomy are conceptual blends. This chapter explores the origins and eme...

  20. Technological feasibility of irradiating pineapples for shelf-life extension

    International Nuclear Information System (INIS)

    Sharma, Jiten

    2001-01-01

    The spoilage of food caused by infestation, contamination and deterioration of the world's food supply is enormous in the developing countries where warm and humid climate favour the growth of spoilage organisms and hasten deterioration of stored food. Particularly, in a country like India where the population growth has already attained one billion, any preventable loss of food is intolerable. Since food security of a nation also largely determines the economic stability as well as self-reliance, this problem draws utmost attention not only of the food scientists but also of the food policy makers. From these above facts, it may be concluded that radiation technology can be safely used for extending shelf-life of pineapple fruits thereby maximizing the transportation and marketing potentials. Consumption of such irradiated pineapples simultaneously does not pose any immediate or long-term human health risks. Keeping these techno-economic considerations in view establishment of large scale industrial operations for irradiating fruits, vegetables, cereals etc. are of immense importance

  1. Effect of irradiation in extending the storage life of boiled Chub mackerel (Rastrelliger spp.)

    Energy Technology Data Exchange (ETDEWEB)

    Loaharanu, P; Prompubesara, C; Songprasertchai, S; Kraisorn, K

    1972-12-31

    Effect of irradiation at doses of 0.1, 0.2, or 0.3 Mrad in extending the storage life of boiled Chub mackerel held at room temperature was described. Total aerobic count, trimethylamine nitrogen, and total volatile basic nitrogen contents were used and objective indices of quality in comparison with sensory evaluation of the product. Boiled fish irradiated at 0.1, 0.2, or 0.3 Mrad were found to be in good quality for 10, 15, and 17 days respectively, compared with 3 days for the unirradiated control. Trimethylamine nitrogen and total volatile basic nitrogen contents were found to be useful indices of quality, which showed fair correlation with sensory evaluation of the irradiated product. Total aerobic count showed little value as a quality index. Bacillus, Staphylococcus, and Micrococcus predominated in both unirradiated and irradiated boiled fish. The product was found to be free of faocal coliform. Safety of the irradiated boiled fish concerning botulism was discussed.

  2. Aging Prisoners’ Treatment Selection: Does Prospect Theory Enhance Understanding of End-of-Life Medical Decisions?

    Science.gov (United States)

    Phillips, Laura L.; Allen, Rebecca S.; Harris, Grant M.; Presnell, Andrew H.; DeCoster, Jamie; Cavanaugh, Ronald

    2011-01-01

    Purpose: With the rapid growth in the older inmate population and the economic impact of end-of-life treatments within the cash-strapped prison system, consideration should be given to inmate treatment preferences. We examined end-of-life treatment preferences and days of desired life for several health scenarios among male inmates incarcerated primarily for murder. Design and Methods: Inmates over the age of 45 who passed a cognitive screening completed face-to-face interviews (N = 94; mean age = 57.7; SD = 10.68). Results: We found a 3-way interaction indicating that the effect of parole expectation on desire for life-sustaining treatment varied by race/ethnicity and treatment. Minority inmates desired cardiopulmonary resuscitation or feeding tubes only if they believed that they would be paroled. The model predicting desire for palliative care was not significant. Future days of desired life were related to prospective health condition, fear of death, negative affect, and trust in prison health care. Caucasian inmates expressed a desire for more days of life out of prison, whereas minority inmates did not differ in days of desired life either in or out of prison. Minorities wanted more days of life than Caucasians but only if they believed that they would be paroled. Implications: End-of-life care for the burgeoning inmate population is costly, and active life-sustaining treatments may not be desired under certain conditions. Specifically, expectation of parole but not current functional ability interacts with future illness condition in explaining inmates’ desire for active treatment or days of desired life in the future. PMID:21593007

  3. Drug treatment at the end of life: an epidemiologic study in nursing homes.

    Science.gov (United States)

    Jansen, Kristian; Schaufel, Margrethe Aase; Ruths, Sabine

    2014-12-01

    To examine drug treatment in nursing home patients at the end of life, and identify predictors of palliative drug therapy. A historical cohort study. Three urban nursing homes in Norway. All patients admitted from January 2008 and deceased before February 2013. Drug prescriptions, diagnoses, and demographic data were collected from electronic patient records. Palliative end-of-life drug treatment was defined on the basis of indication, drug, and formulation. 524 patients were included, median (range) age at death 86 (19-104) years, 59% women. On the day of death, 99.4% of the study population had active prescriptions; 74.2% had palliative drugs either alone (26.9%) or concomitantly with curative/preventive drugs (47.3%). Palliative drugs were associated with nursing home, length of stay > 16 months (AOR 2.10, 95% CI 1.12-3.94), age (1.03, 1.005-1.05), and a diagnosis of cancer (2.12, 1.19-3.76). Most initiations of palliative drugs and withdrawals of curative/preventive drugs took place on the day of death. Palliative drug therapy and drug therapy changes are common for nursing home patients on the last day of life. Improvements in end-of-life care in nursing homes imply addressing prognostication and earlier response to palliative needs.

  4. Gender Differences in Caregiving at End of Life: Implications for Hospice Teams.

    Science.gov (United States)

    Washington, Karla T; Pike, Kenneth C; Demiris, George; Parker Oliver, Debra; Albright, David L; Lewis, Alexandria M

    2015-12-01

    Researchers have identified important gender differences in the experience of caring for a family member or friend living with advanced disease; however, trends suggest that these differences may be diminishing over time in response to changing gender roles. In addition, while many studies have found caregiving experiences and outcomes to be poorer among female caregivers, noteworthy exceptions exist. The primary aim of this exploratory study was to determine how, if at all, current day caregiving at end of life varies by gender. We conducted a secondary analysis of data from a multisite randomized controlled trial of a family caregiving intervention performed between 2010 and 2014. We compared female and male hospice family caregivers on baseline variables using χ(2) tests for association of categorical variables and t-tests for continuous variables. Our sample included 289 family caregivers of individuals receiving services from one of two hospice agencies located in the northwestern United States. Demographic data and other categorical variables of interest were provided via caregiver self-report using an instrument created specifically for this study. Reaction to caregiving and caregiving burden were measured using the Caregiver Reaction Assessment (CRA). As it related to caregiving, females had significantly lower self-esteem and more negative impact on their schedule, health, and family support than males. No gender differences were detected with regard to the impact of caregiving on individuals' finances. Despite changing social expectations, pronounced gender differences persist in caregiving at the end of life.

  5. Making the case for talking to patients about the costs of end-of-life care.

    Science.gov (United States)

    Donley, Greer; Danis, Marion

    2011-01-01

    Costs at the end of life disproportionately contribute to health care costs in the United States. Addressing these costs will therefore be an important component in making the U.S. health care system more financially sustainable. In this paper, we explore the moral justifications for having discussions of end-of-life costs in the doctor-patient encounter as part of an effort to control costs. As health care costs are partly shared through pooled resources, such as insurance and taxation, and partly borne by individuals through out-of-pocket expenses, we separate our defense for, and approach to, discussing both pooled and individual aspects of cost. We argue that there needs to be a shift away from formulating the options as a dichotomous choice of paying attention to end-of-life costs versus ignoring such costs. The question should be how personal costs will be managed and how societal expenditures should be allocated. These are issues that we believe patients care about and need to have addressed in a manner with which they are comfortable. Conversations about how money will be spent at the end of life should begin before the end is near. We propose discussing costs from the onset of chronic illness and incorporating financial issues in advance care planning. Through these approaches one can avoid abruptly and insensitively introducing financial issues at the very conclusion of a person's life when one would prefer to address the painful and important issues of spiritual and existential loss that are appropriately the focus when a person is dying. © 2011 American Society of Law, Medicine & Ethics, Inc.

  6. Interventions at the end of life – a taxonomy for ‘overlapping consensus’ [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    David Clark

    2017-02-01

    Full Text Available Context: Around the world there is increasing interest in end of life issues. An unprecedented number of people dying in future decades will put new strains on families, communities, services and governments.  It will also have implications for representations of death and dying within society and for the overall orientation of health and social care. What interventions are emerging in the face of these challenges? Methods: We conceptualize a comprehensive taxonomy of interventions, defined as ‘organized responses to end of life issues’. Findings: We classify the range of end of life interventions into 10 substantive categories: policy, advocacy, educational, ethico-legal, service, clinical, research, cultural, intangible, self-determined. We distinguish between two empirical aspects of any end of life intervention: the ‘locus’ refers to the space or spaces in which it is situated; the ‘focus’ captures its distinct character and purpose. We also contend that end of life interventions can be seen conceptually in two ways – as ‘frames’ (organized responses that primarily construct a shared understanding of an end of life issue or as ‘instruments’ (organized responses that assume a shared understanding and then move to act in that context. Conclusions: Our taxonomy opens up the debate about end of life interventions in new ways to provide protagonists, activists, policy makers, clinicians, researchers and educators with a comprehensive framework in which to place their endeavours and more effectively to assess their efficacy. Following the inspiration of political philosopher John Rawls, we seek to foster an ‘overlapping consensus’ on how interventions at the end of life can be construed, understood and assessed.

  7. Dying means suffocating: perceptions of people living with severe COPD facing the end of life.

    Science.gov (United States)

    Hall, Sylvie; Legault, Alan; Côté, José

    2010-09-01

    The purpose of this research was to describe the perceptions of people living with severe chronic obstructive pulmonary disease (COPD) with respect to the end of life. For this descriptive exploratory qualitative study, semi-structured interviews were conducted with six participants suffering from severe COPD hospitalized in the past year following an exacerbation episode. The data were analyzed using the method developed by Miles and Huberman (2003), which comprises three main steps: data reduction, data display, and conclusion drawing/verification. The analysis yielded four themes that reflect the perceptions of participants with respect to the end of life, namely: living and seeing oneself decline, living and preparing to die, dying of COPD means suffocating, and dying in hospital surrounded by family and friends. What emerges from the study is that persons living with severe COPD wish to die without suffocating, in hospital, surrounded by family and friends, all the while hoping to go on living. This study contributes to a more comprehensive understanding of the end-of-life experience. It shows the importance of accompanying these persons properly towards the end of life and at the moment of dying. The study proposes a series of avenues for future research and makes recommendations for practice.

  8. Artificial Nutrition (Food) and Hydration (Fluids) at the End of Life

    Science.gov (United States)

    Artificial Nutrition (Food) and Hydration (Fluids) at the End of Life It is very common for doctors to provide ... or recovering from surgery. This is called “artificial nutrition and hydration” and like all medical treatments, it ...

  9. Identifying care actions to conserve dignity in end-of-life care.

    Science.gov (United States)

    Brown, Hilary; Johnston, Bridget; Ostlund, Ulrika

    2011-05-01

    Community nurses have a central role in the provision of palliative and end-of-life care; helping people to die with dignity is an important component of this care. To conserve dignity, care should comprise a broad range of actions addressing the distress that might impact on the patient's sense of dignity. These care actions need to be defined. This study aims to suggest care actions that conserve dignity at the end of life based on evidence from local experience and community nursing practice. Data were collected by focus group interviews and analysed by framework analysis using the Chochinov model of dignity as a predefined framework. Suggestions on care actions were given in relation to all themes. As part of a multi-phase project developing and testing a dignity care pathway, this study might help community nurses to conserve dying patients' dignity.

  10. Shelf-life extension of bread by heat and irradiation treatment [Bangladesh

    International Nuclear Information System (INIS)

    Begum, F.; Siddique, A.K.; Choudhury, N.; Mollah, R.A.

    1994-01-01

    Bread slices were given irradiation treatment 0.5, 1.0, 1.5, and 2.0 KGy and heat treatment at 60 deg. C for 20 min to control mould growth. Mould growth was reladed at ambient temperature by 3, 4, 6 and 8 days after 0.5, 1.0, 1.5 and 2.0 KGy treatments, respectively, compared to 2 days in case of control sample and 3 days for heat treatment alone. Combination of heat with irradiation at 0.5, 1.0, 1.5 and 2.0 KGy retarded mould growth up to 4, 6, 7 an 9 days, respectively. Organoleptically, the irradiated bread slices were acceptable up to 3 to 6 days depending on the treatment. The combination method treated slices were acceptable up to 8 days. The application of radiation dose exceeding 2.0 KGy caused off flavour. Mild heat treatment and radiation in combination resulted in a synergistic antifungal effect and enhanced shelf-life of bread

  11. Analysis of Phenix end-of-life natural convection test with the MARS-LMR code

    International Nuclear Information System (INIS)

    Jeong, H. Y.; Ha, K. S.; Lee, K. L.; Chang, W. P.; Kim, Y. I.

    2012-01-01

    The end-of-life test of Phenix reactor performed by the CEA provided an opportunity to have reliable and valuable test data for the validation and verification of a SFR system analysis code. KAERI joined this international program for the analysis of Phenix end-of-life natural circulation test coordinated by the IAEA from 2008. The main objectives of this study were to evaluate the capability of existing SFR system analysis code MARS-LMR and to identify any limitation of the code. The analysis was performed in three stages: pre-test analysis, blind posttest analysis, and final post-test analysis. In the pre-test analysis, the design conditions provided by the CEA were used to obtain a prediction of the test. The blind post-test analysis was based on the test conditions measured during the tests but the test results were not provided from the CEA. The final post-test analysis was performed to predict the test results as accurate as possible by improving the previous modeling of the test. Based on the pre-test analysis and blind test analysis, the modeling for heat structures in the hot pool and cold pool, steel structures in the core, heat loss from roof and vessel, and the flow path at core outlet were reinforced in the final analysis. The results of the final post-test analysis could be characterized into three different phases. In the early phase, the MARS-LMR simulated the heat-up process correctly due to the enhanced heat structure modeling. In the mid phase before the opening of SG casing, the code reproduced the decrease of core outlet temperature successfully. Finally, in the later phase the increase of heat removal by the opening of the SG opening was well predicted with the MARS-LMR code. (authors)

  12. QoS Modeling for End-to-End Performance Evaluation over Networks with Wireless Access

    Directory of Open Access Journals (Sweden)

    Gómez Gerardo

    2010-01-01

    Full Text Available This paper presents an end-to-end Quality of Service (QoS model for assessing the performance of data services over networks with wireless access. The proposed model deals with performance degradation across protocol layers using a bottom-up strategy, starting with the physical layer and moving on up to the application layer. This approach makes it possible to analytically assess performance at different layers, thereby facilitating a possible end-to-end optimization process. As a representative case, a scenario where a set of mobile terminals connected to a streaming server through an IP access node has been studied. UDP, TCP, and the new TCP-Friendly Rate Control (TFRC protocols were analyzed at the transport layer. The radio interface consisted of a variable-rate multiuser and multichannel subsystem, including retransmissions and adaptive modulation and coding. The proposed analytical QoS model was validated on a real-time emulator of an end-to-end network with wireless access and proved to be very useful for the purposes of service performance estimation and optimization.

  13. Thermal annealing response following irradiation of a CMOS imager for the JUICE JANUS instrument

    Science.gov (United States)

    Lofthouse-Smith, D.-D.; Soman, M. R.; Allanwood, E. A. H.; Stefanov, K. D.; Holland, A. D.; Leese, M.; Turne, P.

    2018-03-01

    ESA's JUICE (JUpiter ICy moon Explorer) spacecraft is an L-class mission destined for the Jovian system in 2030. Its primary goals are to investigate the conditions for planetary formation and the emergence of life, and how does the solar system work. The JANUS camera, an instrument on JUICE, uses a 4T back illuminated CMOS image sensor, the CIS115 designed by Teledyne e2v. JANUS imager test campaigns are studying the CIS115 following exposure to gammas, protons, electrons and heavy ions, simulating the harsh radiation environment present in the Jovian system. The degradation of 4T CMOS device performance following proton fluences is being studied, as well as the effectiveness of thermal annealing to reverse radiation damage. One key parameter for the JANUS mission is the Dark current of the CIS115, which has been shown to degrade in previous radiation campaigns. A thermal anneal of the CIS115 has been used to accelerate any annealing following the irradiation as well as to study the evolution of any performance characteristics. CIS115s have been irradiated to double the expected End of Life (EOL) levels for displacement damage radiation (2×1010 protons, 10 MeV equivalent). Following this, devices have undergone a thermal anneal cycle at 100oC for 168 hours to reveal the extent to which CIS115 recovers pre-irradiation performance. Dark current activation energy analysis following proton fluence gives information on trap species present in the device and how effective anneal is at removing these trap species. Thermal anneal shows no quantifiable change in the activation energy of the dark current following irradiation.

  14. End-of-life medical spending in last twelve months of life is lower than previously reported

    NARCIS (Netherlands)

    French, E.; Klein, Tobias; a., e.

    Although end-of-life medical spending is often viewed as a major component of aggregate medical expenditure, accurate measures of this type of medical spending are scarce. We used detailed health care data for the period 2009–11 from Denmark, England, France, Germany, Japan, the Netherlands, Taiwan,

  15. Quality of Life in End Stage Renal Failure Patients Undergoing ...

    African Journals Online (AJOL)

    We assessed the quality of life of 45 patients with end stage renal failure undergoing dialysis in Mauritius using the standard United Kingdom version of the Short Form 36 Items Health Survey (SF36) questionnaire. Our findings showed that gender, level of social and emotional support, marital status, and travel time were ...

  16. 'Older peoples' attitudes towards euthanasia and an end-of-life pill in The Netherlands: 2001-2009

    NARCIS (Netherlands)

    Buiting, H.M.; Deeg, D.J.H.; Knol, D.L.; Ziegelmann, J.P.; Pasman, H.R.W.; Widdershoven, G.A.; Onwuteaka-Philipsen, B.D.

    2012-01-01

    Introduction With an ageing population, end-of-life care is increasing in importance. The present work investigated characteristics and time trends of older peoples' attitudes towards euthanasia and an end-of-life pill. Methods Three samples aged 64 years or older from the Longitudinal Ageing Study

  17. Feedback on end-of-life care in dementia: the study protocol of the FOLlow-up project.

    Science.gov (United States)

    Boogaard, Jannie A; van Soest-Poortvliet, Mirjam C; Anema, Johannes R; Achterberg, Wilco P; Hertogh, Cees M P M; de Vet, Henrica C W; van der Steen, Jenny T

    2013-08-07

    End-of-life care in dementia in nursing homes is often found to be suboptimal. The Feedback on End-of-Life care in dementia (FOLlow-up) project tests the effectiveness of audit- and feedback to improve the quality of end-of-life care in dementia. Nursing homes systematically invite the family after death of a resident with dementia to provide feedback using the End-of-Life in Dementia (EOLD) - instruments. Two audit- and feedback strategies are designed and tested in a three-armed Randomized Controlled Trial (RCT): a generic feedback strategy using cumulative EOLD-scores of a group of patients and a patient specific feedback strategy using EOLD-scores on a patient level. A total of 18 nursing homes, three groups of six homes matched on size, geographic location, religious affiliation and availability of a palliative care unit were randomly assigned to an intervention group or the control group. The effect on quality of care and quality of dying and the barriers and facilitators of audit- and feedback in the nursing home setting are evaluated using mixed-method analyses. The FOLlow-up project is the first study to assess and compare the effect of two audit- and feedback strategies to improve quality of care and quality of dying in dementia. The results contribute to the development of practice guidelines for nursing homes to monitor and improve care outcomes in the realm of end-of-life care in dementia. The Netherlands National Trial Register (NTR). NTR3942.

  18. Rural end-of-life care from the experiences and perspectives of patients and family caregivers: A systematic literature review.

    Science.gov (United States)

    Rainsford, Suzanne; MacLeod, Roderick D; Glasgow, Nicholas J; Phillips, Christine B; Wiles, Robert B; Wilson, Donna M

    2017-12-01

    End-of-life care must be relevant to the dying person and their family caregiver regardless of where they live. Rural areas are distinct and need special consideration. Gaining end-of-life care experiences and perspectives of rural patients and their family caregivers is needed to ensure optimal rural care. To describe end-of-life care experiences and perspectives of rural patients and their family caregivers, to identify facilitators and barriers to receiving end-of-life care in rural/remote settings and to describe the influence of rural place and culture on end-of-life care experiences. A systematic literature review utilising the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Four databases (PubMed, CINAHL, Scopus and Web of Science) were searched in January 2016, using a date filter of January 2006 through January 2016; handsearching of included article references and six relevant journals; one author contacted; pre-defined search terms and inclusion criteria; and quality assessment by at least two authors. A total of 27 articles (22 rural/remote studies) from developed and developing countries were included, reporting rural end-of-life care experiences and perspectives of patients and family caregivers. Greatest needs were informational (developed countries) and medications (developing countries). Influence of rural location included distances, inaccessibility to end-of-life care services, strong community support and importance of home and 'country'. Articulation of the rural voice is increasing; however, there still remain limited published rural studies reporting on patient and family caregivers' experiences and perspectives on rural end-of-life care. Further research is encouraged, especially through national and international collaborative work.

  19. Environmental performance of electricity storage systems for grid applications, a life cycle approach

    International Nuclear Information System (INIS)

    Oliveira, L.; Messagie, M.; Mertens, J.; Laget, H.; Coosemans, T.; Van Mierlo, J.

    2015-01-01

    Highlights: • Large energy storage systems: environmental performance under different scenarios. • ReCiPe midpoint and endpoint impact assessment results are analyzed. • Energy storage systems can replace peak power generation units. • Energy storage systems and renewable energy have the best environmental scores. • Environmental performance of storage systems is application dependent. - Abstract: In this paper, the environmental performance of electricity storage technologies for grid applications is assessed. Using a life cycle assessment methodology we analyze the impacts of the construction, disposal/end of life, and usage of each of the systems. Pumped hydro and compressed air storage are studied as mechanical storage, and advanced lead acid, sodium sulfur, lithium-ion and nickel–sodium-chloride batteries are addressed as electrochemical storage systems. Hydrogen production from electrolysis and subsequent usage in a proton exchange membrane fuel cell are also analyzed. The selected electricity storage systems mimic real world installations in terms of capacity, power rating, life time, technology and application. The functional unit is one kW h of energy delivered back to the grid, from the storage system. The environmental impacts assessed are climate change, human toxicity, particulate matter formation, and fossil resource depletion. Different electricity mixes are used in order to exemplify scenarios where the selected technologies meet specific applications. Results indicate that the performance of the storage systems is tied to the electricity feedstocks used during use stage. Renewable energy sources have lower impacts throughout the use stage of the storage technologies. Using the Belgium electricity mix of 2011 as benchmark, the sodium sulfur battery is shown to be the best performer for all the impacts analyzed. Pumped hydro storage follows in second place. Regarding infrastructure and end of life, results indicate that battery systems

  20. Family communication and decision making at the end of life: a literature review.

    Science.gov (United States)

    Wallace, Cara L

    2015-06-01

    Patients and families coping with a terminal illness are faced with a number of decisions over the course of their disease. The role that family communication plays in the process of decision making is an important one. The objectives for this review are to examine the current state of empirical literature on the relationship between family communication and decision making about end-of-life care, to identify gaps, and to discuss implications for policy, practice, and future research. Articles were identified using systematic keyword searches within the following relevant databases: Academic Search Complete, CINAHL Plus, Communications and Mass Media Complete, ERIC, PsychINFO, MEDLINE, SocINDEX, and ProQuest. The three bodies of relevant literature that emerged during this review include: (1) the importance of family communication at the end of life (EoL); (2) family decision making at the EoL; and (3) the interrelationship of communication (both within the family and with healthcare professionals) and decision making at the EoL. While the literature highlights the role of communication between medical professionals and the patient or family members, there is very little focus on the process of how family communication among the family members themselves contributes to decision making at the end of life. Barriers to end-of-life care are important considerations for helping patients to access timely and appropriate services. Understanding the pertinent role of family communication as it relates to the decision for EoL care is the first step in working to provide another avenue for overcoming these barriers.

  1. Pediatrician Ambiguity in Understanding Palliative Sedation at the End of Life.

    Science.gov (United States)

    Henderson, Carrie M; FitzGerald, Michael; Hoehn, K Sarah; Weidner, Norbert

    2017-02-01

    Palliative sedation is a means of relieving intractable symptoms at the end of life, however, guidelines about its use lack consistency. In addition, ethical concerns persist around the practice. There are reports of palliative sedation in the pediatric literature, which highlight various institutional perspectives. This survey of 4786 pediatric providers sought to describe their knowledge of and current practices around pediatric palliative sedation. Our survey was administered to pediatricians who care for children at the end of life. The survey assessed agreement with a definition of palliative sedation, as well as thoughts about its alignment with aggressive symptom management. Bivariate analyses using χ 2 and analysis of variance were calculated to determine the relationship between responses to closed-ended questions. Open-ended responses were thematically coded by the investigators and reviewed for agreement. Nearly half (48.6%) of the respondents indicated that the stated definition of palliative sedation "completely" reflected their own views. Respondents were split when asked if they viewed any difference between palliative sedation and aggressive symptom management: Yes (46%) versus No (54%). Open-ended responses revealed specifics about the nature of variation in interpretation. Responses point to ambiguity surrounding the concept of palliative sedation. Pediatricians were concerned with a decreased level of consciousness as the goal of palliative sedation. Respondents were split on whether they view palliative sedation as a distinct entity or as one broad continuum of care, equivalent to aggressive symptom management. Institutional-based policies are essential to clarify acceptable practice, enable open communication, and promote further research.

  2. Studies on the effect of low dose gamma irradiation on the chemical, microbial quality and shelf life of squid

    International Nuclear Information System (INIS)

    Bojayanaik, Manjanaik; Naroth, Kavya; Shetty, Veena; Hiriyur, Somashekarappa

    2014-01-01

    The present investigation was carried out to study the combined effect of low dose gamma irradiation (1, 3 and 5 kGy) and storage at refrigeration (+4℃) and frozen (-18℃) temperatures, on the shelf life extension of fresh squid. The study was based on microbiological and physico-chemical changes occurring in the squid samples. The biochemical parameters such as total volatile base nitrogen and trimethyl amine nitrogen values for irradiated squid samples were significantly lower than non-irradiated samples at both storage temperatures and the rate of decrease was more pronounced in samples irradiated at the higher dose of 3 and 5 kGy (p<0.05). pH values of squid samples were affected by both irradiation dose and storage temperature (p<0.05). Total microbial load for non- irradiated (control) squid samples were higher than the respective irradiated samples at both storage temperatures. The results revealed that the combination of irradiation and low temperature storage resulted in a significant reduction of microbial growth and extend the shelf life of squid at refrigeration and frozen temperature to about 12 and 90 days respectively. (author)

  3. UV Irradiation and Pleiotropic Effects of Vitamin D in Chronic Kidney Disease - Benefits on Cardiovascular Comorbidities and Quality of Life.

    Science.gov (United States)

    Krause, Rolfdieter; Stange, Rainer; Kaase, Heinrich; Holick, Michael F

    2016-03-01

    Vitamin D3 can be metabolized in the skin to 25(OH)D and 1,25(OH)2D because the skin expresses vitamin D-25-hydroxylase, 25(OH)D-1-alpha-hydroxylase, and the vitamin D receptor. The aim of this review was to discuss the pleiotropic effects after serial suberythemal UVB irradiation with a sun-simulating UV spectrum in end-stage kidney disease patients. Fourteen hemodialysis patients, with a mean age of 51 (range 41-57) years, were whole-body UV irradiated over 6 months. Patients demonstrated an increase in their hematocrit and required less erythropoietin. An increase in maximal oxygen uptake and workload capacity was associated with decreased lactic acid production. The patients demonstrated a decreased heart rate and systolic and diastolic blood pressure with an increase in the R-R-interval and the beat-to-beat-differences. Cardiovascular disease is the most important comorbidity. Exposure to simulated sunlight that contains both UVB and UVA reduce cardiovascular risk factors and improve quality of life. Copyright© 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  4. [Conscience clause in end-of-life care.

    Science.gov (United States)

    De Panfilis, Ludovica; Cattaneo, Daniela; Cola, Luisanna; Gasparini, Maddalena; Porteri, Corinna; Tarquini, Daniela; Tiezzi, Alessandro; Veronese, Simone; Zullo, Silvia; Pucci, Eugenio

    2017-05-01

    The article proposes a critical reflection on issues that appeal to the conscience clause as part of end of life care can produce and what can guarantee freedom of conscience, self-determination of those involved and respect for the dignity of the sick person. After a philosophical and normative analysis, the article is organized on the basis of two important documents for discussion: a position paper of Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva (SIAARTI) signed by several scientific societies "Grandi insufficienze d'organo end stage: cure intensive o cure palliative?" and the Design of Law currently being debated "Norme in materia di consenso informato e di disposizioni anticipate di trattamento". In particular, the conscience clause has been discussed in the light of advance care planning (ACP), which represents the instrument to guarantee the shared planning of care and the shared-decision making. In this context, recourse to the clause of conscience brings out critical ethical and deontological issues that the article discusses, using the position paper SIAARTI and the text of law currently being debated, both built on the assumptions of a shared care relationship, where patient has a key-role in medical decisions.

  5. Hybrid monitoring scheme for end-to-end performance enhancement of multicast-based real-time media

    Science.gov (United States)

    Park, Ju-Won; Kim, JongWon

    2004-10-01

    As real-time media applications based on IP multicast networks spread widely, end-to-end QoS (quality of service) provisioning for these applications have become very important. To guarantee the end-to-end QoS of multi-party media applications, it is essential to monitor the time-varying status of both network metrics (i.e., delay, jitter and loss) and system metrics (i.e., CPU and memory utilization). In this paper, targeting the multicast-enabled AG (Access Grid) a next-generation group collaboration tool based on multi-party media services, the applicability of hybrid monitoring scheme that combines active and passive monitoring is investigated. The active monitoring measures network-layer metrics (i.e., network condition) with probe packets while the passive monitoring checks both application-layer metrics (i.e., user traffic condition by analyzing RTCP packets) and system metrics. By comparing these hybrid results, we attempt to pinpoint the causes of performance degradation and explore corresponding reactions to improve the end-to-end performance. The experimental results show that the proposed hybrid monitoring can provide useful information to coordinate the performance improvement of multi-party real-time media applications.

  6. The end of life decisions -- should physicians aid their patients in dying?

    Science.gov (United States)

    Sharma, B R

    2004-06-01

    Decisions pertaining to end of life whether legalized or otherwise, are made in many parts of the world but not reported on account of legal implications. The highly charged debate over voluntary euthanasia and physician assisted suicide was brought into the public arena again when two British doctors confessed to giving lethal doses of drugs to hasten the death of terminally ill patients. Lack of awareness regarding the distinction between different procedures on account of legal status granted to them in some countries is the other area of concern. Some equate withdrawal of life support measures to physician assisted suicide whereas physician assisted suicide is often misinterpreted as euthanasia. Debate among the medical practitioners, law makers and the public taking into consideration the cultural, social and religious ethos will lead to increased awareness, more safeguards and improvement of medical decisions concerning the end of life. International Human Rights Law can provide a consensual basis for such a debate on euthanasia.

  7. Irradiation and performance evaluation of DUPIC fuel

    International Nuclear Information System (INIS)

    Bae, Ki Kwang; Yang, M. S.; Song, K. C.

    2000-05-01

    The objectives of the project is to establish the performance evaluation system for the experimental verification of DUPIC fuel. The scope and content for successful accomplishment of the phase 1 objectives is established as follows : irradiation test of DUPIC fuel at HANARO using a noninstrument capsule, study on the characteristics of DUPIC pellets, development of the analysis technology on the thermal behaviour of DUPIC fuel, basic design of a instrument capsule. The R and D results of the phase 1 are summarized as follows : - Performance analysis technology development of DUPIC fuel by model development for DUPIC fuel, review on the extendability of code(FEMAXI-IV, FRAPCON-3, ELESTRESS). - Study on physical properties of DUPIC fuel by design and fabrication of the equipment for measuring the thermal property. - HANARO irradiation test of simulated DUPIC fuel by the noninstrument capsule development. - PIE and result analysis

  8. Irradiation and performance evaluation of DUPIC fuel

    Energy Technology Data Exchange (ETDEWEB)

    Bae, Ki Kwang; Yang, M S; Song, K C [and others

    2000-05-01

    The objectives of the project is to establish the performance evaluation system for the experimental verification of DUPIC fuel. The scope and content for successful accomplishment of the phase 1 objectives is established as follows : irradiation test of DUPIC fuel at HANARO using a noninstrument capsule, study on the characteristics of DUPIC pellets, development of the analysis technology on the thermal behaviour of DUPIC fuel, basic design of a instrument capsule. The R and D results of the phase 1 are summarized as follows : - Performance analysis technology development of DUPIC fuel by model development for DUPIC fuel, review on the extendability of code(FEMAXI-IV, FRAPCON-3, ELESTRESS). - Study on physical properties of DUPIC fuel by design and fabrication of the equipment for measuring the thermal property. - HANARO irradiation test of simulated DUPIC fuel by the noninstrument capsule development. - PIE and result analysis.

  9. Trends in End-of-Life Decision Making in Patients With and Without Cancer

    NARCIS (Netherlands)

    Pardon, K.; Chambaere, K.; Pasman, H.R.W.; Deschepper, R.; Rietjens, J.; Deliens, L.

    2013-01-01

    Purpose: Because of cancer's high symptom burden and specific disease course, patients with cancer are more likely than other patients to face end-of-life decisions that have possible or certain life-shortening effects (ELDs). This study examines the incidence of ELDs in patients with cancer

  10. Shelf-life extension of dried shrimps by irradiation and packaging techniques

    International Nuclear Information System (INIS)

    Warunee Varanyanond; Hirata, Takashi; Ishitani, Takasuke

    2000-01-01

    Dried shrimps were air-packaged or N2-packaged in the flexible pouch of oriented polypropylene (OPP), polyvinylidene chloride coated polypropylene (KOP) and ethylene vinyl alcohol copolymer (EVOH). The packages were irradiated with gamma ray from cobalt 60 at 3 and 8 kGy. Non-irradiated dried shrimps were used as a control. The samples were stored at 30 deg C and 70+-5 percent RH for 4 months. Non-enzymatic browning induced the discoloration of dried shrimps, and oxidation of astaxanthin proceeded after irradiation and during storage. The hunter color difference, delta E, of all the samples was increased, especially in the non-irradiated air-packages samples. The decrease in astaxanthin content was found in both air - and N2-packaged samples during storage. The number of microorganisms was reduced by irradiation dose of 3 and 8 kGy from 6.5 to 4.2 and 2.7 log CFU/g, respectively. The decreased concentration of O2 in the package also reduced the number of microorganisms. The air packaged dried shrimps in the OPP pouch deteriorated during storage. Shrinkage of the pouches and growth of halophilic bacteria on the surface of dried shrimps were found at a sub(w) of 0.75. The discoloration of dried shrimps in the OPP pouch was more significant than that in other pouches. Irradiation at 3 and 8 kGy in combination with packaging in KOP and EVOH pouches containing N2 atmosphere was one of the promising methods for prolonging shelf-life of dried shrimps at room temperature

  11. End-of-Life Issues in the United States after Terri Schiavo: Implications for Social Work Practice

    Directory of Open Access Journals (Sweden)

    Darrel Montero

    2011-09-01

    Full Text Available The very public death of Terri Schiavo in 2005 alerted Americans to what is a growing ethical, medical, and social crisis: the status of end-of-life issues and decisions in the United States. Currently, Oregon is the only state to give terminally ill patients the right to end their lives, with physicians’ help, if they so choose. Public opinion data from 1977 to the present show that Americans support greater rights for individuals facing end-of-life decisions--up to and including physician-assisted suicide and euthanasia. This paper considers the status of end-of-life issues in the United States after Terri Schiavo’s death and examines the opportunities for advocacy by social workers who serve clients and families encountering this complex and controversial issue.

  12. Effect of gamma-irradiation on the storage life elongation of fresh strawberries and raspberries

    International Nuclear Information System (INIS)

    Tencheva, S.; Todorov, S.

    1975-01-01

    The possibility of preserving strawberries and raspberries at room temperature by irradiation is studied. The fruits were packed in perforated plastic bags and irradiated on gamma-device (Cobalt-60) at a dose power of 1900 rad/min. Strawberries were irradiated with 250 krad, raspberries of ''Rubin'' variety with 150 or 200 krad. Irratiated and control fruits were stored at 20sup(o) - 22sup(o)C and examined every day until the first signs of microbial decay appeared. It is found that the total number of microorganisms drops immediately after irradiation. The earliest signs of decay in control strawberries appeared on the second day after they had been packed; in irradiated strawberries - on the fourth or fifth day, with a rapid progress of decay thereafter. Decay of control raspberries started on the first day and by the fourth day all packages were completely moldy, while irradiated fruits had a very good appearance. Single mold spots appeared on the third or fourth day after exposure to 150 krad and later than the fifth day after exposure to 200 krad. Physico-chemical studies disclosed a tendency toward decrease in the sugar content immediately after irradiation. A post-irradiation decrease in the content of total pectine substances and ascorbic acid was also observed. At the end of preservation ascorbic acid in strawberries was reduced by 33 per cent and in raspberries by 19 - 70 per cent. The spectra of antecyonic substances showed that during the preservation of irradiated fruits oxidation has been more intensive. (Ch.K.)

  13. Quality Evaluation of Meat Products in Relation to Packaging and Irradiation

    International Nuclear Information System (INIS)

    Noomhorm, A.; Ingles, M.E.A.

    1998-01-01

    The effects of low-dose radiation ( 2 and 80% N 2 gas and stored at 5 degree celsius for eight weeks. Fresh samples were irradiated with 1 kGy while smoked sausages were irradiated to 2 and 4 kGy doses. Quality evaluation were conducted every week. Mechanical properties of films were determined at the start and at the end of the storage period. Vacuum alone extended the shelf life of fresh meat to 40 days while MAP to 44 days. Vacuum packaging or MAP with 1 kGy made meat still acceptable up to the 48th day. Packaging system with NPI and PVNP were able to protect sausages against deterioration for 8 weeks. While two kGy with vacuum and MAP extended the storage life of sausages for more than the eight weeks of storage, 4 kGy dose can double the shelf life of unirradiated samples. Sensory tests showed no effects on the acceptability of the irradiated products. Tensile and tear strength of all films used decreased after storage periol. Irradiation did not significantly affect these properties of film, transmission rates for gas and water vapor through NPI and PVNP

  14. End-of-life decision-making for children with severe developmental disabilities: The parental perspective.

    Science.gov (United States)

    Zaal-Schuller, I H; de Vos, M A; Ewals, F V P M; van Goudoever, J B; Willems, D L

    2016-01-01

    The objectives of this integrative review were to understand how parents of children with severe developmental disorders experience their involvement in end-of-life decision-making, how they prefer to be involved and what factors influence their decisions. We searched MEDLINE, EMBASE, CINAHL and PsycINFO. The search was limited to articles in English or Dutch published between January 2004 and August 2014. We included qualitative and quantitative original studies that directly investigated the experiences of parents of children aged 0-18 years with severe developmental disorders for whom an end-of-life decision had been considered or made. We identified nine studies that met all inclusion criteria. Reportedly, parental involvement in end-of-life decision-making varied widely, ranging from having no involvement to being the sole decision-maker. Most parents preferred to actively share in the decision-making process regardless of their child's specific diagnosis or comorbidity. The main factors that influenced parents in their decision-making were: their strong urge to advocate for their child's best interests and to make the best (possible) decision. In addition, parents felt influenced by their child's visible suffering, remaining quality of life and the will they perceived in their child to survive. Most parents of children with severe developmental disorders wish to actively share in the end-of-life decision-making process. An important emerging factor in this process is the parents' feeling that they have to stand up for their child's interests in conversations with the medical team. Copyright © 2015 Elsevier Ltd. All rights reserved.

  15. Health Care Professionals' Understandings of Cross-Cultural Interaction in End-of-Life Care: A Focus Group Study.

    Science.gov (United States)

    Milberg, Anna; Torres, Sandra; Ågård, Pernilla

    2016-01-01

    The academic debate on cross-cultural interaction within the context of end-of-life care takes for granted that this interaction is challenging. However, few empirical studies have actually focused on what health care professionals think about this interaction. This study aimed to explore health care professionals' understandings of cross-cultural interaction during end-of-life care. Sixty end-of-life care professionals were recruited from eleven care units in Sweden to take part in focus group interviews. These interviews were analyzed using qualitative content analysis. The health care professionals interviewed talked about cross-cultural interaction in end-of-life care as interaction that brings about uncertainty, stress and frustration even though they had limited experience of this type of interaction. The focus group discussions brought attention to four specific challenges that they expected to meet when they care for patients with migrant backgrounds since they took for granted that they would have an ethno-cultural background that is different to their own. These challenges had to do with communication barriers, 'unusual' emotional and pain expressions, the expectation that these patients' families would be 'different' and the anticipation that these patients and their families lack knowledge. At the core of the challenges in question is the idea that cross-cultural interaction means meeting "the unknown". In addition, the end-of-life care professionals interviewed talked about patients whose backgrounds they did not share in homogenizing terms. It is against this backdrop that they worried about their ability to provide end-of-life care that is individualized enough to meet the needs of these patients. The study suggests that end-of-life care professionals who regard cross-cultural interaction in this manner could face actual challenges when caring for patients whose backgrounds they regard as "the unknown" since they anticipate a variety of challenges

  16. Health Care Professionals’ Understandings of Cross-Cultural Interaction in End-of-Life Care: A Focus Group Study

    Science.gov (United States)

    Torres, Sandra; Ågård, Pernilla

    2016-01-01

    Objective The academic debate on cross-cultural interaction within the context of end-of-life care takes for granted that this interaction is challenging. However, few empirical studies have actually focused on what health care professionals think about this interaction. This study aimed to explore health care professionals’ understandings of cross-cultural interaction during end-of-life care. Methods Sixty end-of-life care professionals were recruited from eleven care units in Sweden to take part in focus group interviews. These interviews were analyzed using qualitative content analysis. Results The health care professionals interviewed talked about cross-cultural interaction in end-of-life care as interaction that brings about uncertainty, stress and frustration even though they had limited experience of this type of interaction. The focus group discussions brought attention to four specific challenges that they expected to meet when they care for patients with migrant backgrounds since they took for granted that they would have an ethno-cultural background that is different to their own. These challenges had to do with communication barriers, ‘unusual’ emotional and pain expressions, the expectation that these patients’ families would be ‘different’ and the anticipation that these patients and their families lack knowledge. At the core of the challenges in question is the idea that cross-cultural interaction means meeting “the unknown”. In addition, the end-of-life care professionals interviewed talked about patients whose backgrounds they did not share in homogenizing terms. It is against this backdrop that they worried about their ability to provide end-of-life care that is individualized enough to meet the needs of these patients. Conclusions The study suggests that end-of-life care professionals who regard cross-cultural interaction in this manner could face actual challenges when caring for patients whose backgrounds they regard as

  17. Health Care Professionals' Understandings of Cross-Cultural Interaction in End-of-Life Care: A Focus Group Study.

    Directory of Open Access Journals (Sweden)

    Anna Milberg

    Full Text Available The academic debate on cross-cultural interaction within the context of end-of-life care takes for granted that this interaction is challenging. However, few empirical studies have actually focused on what health care professionals think about this interaction. This study aimed to explore health care professionals' understandings of cross-cultural interaction during end-of-life care.Sixty end-of-life care professionals were recruited from eleven care units in Sweden to take part in focus group interviews. These interviews were analyzed using qualitative content analysis.The health care professionals interviewed talked about cross-cultural interaction in end-of-life care as interaction that brings about uncertainty, stress and frustration even though they had limited experience of this type of interaction. The focus group discussions brought attention to four specific challenges that they expected to meet when they care for patients with migrant backgrounds since they took for granted that they would have an ethno-cultural background that is different to their own. These challenges had to do with communication barriers, 'unusual' emotional and pain expressions, the expectation that these patients' families would be 'different' and the anticipation that these patients and their families lack knowledge. At the core of the challenges in question is the idea that cross-cultural interaction means meeting "the unknown". In addition, the end-of-life care professionals interviewed talked about patients whose backgrounds they did not share in homogenizing terms. It is against this backdrop that they worried about their ability to provide end-of-life care that is individualized enough to meet the needs of these patients.The study suggests that end-of-life care professionals who regard cross-cultural interaction in this manner could face actual challenges when caring for patients whose backgrounds they regard as "the unknown" since they anticipate a variety

  18. Affective science and avoidant end-of-life communication: Can the science of emotion help physicians talk with their patients about the end of life?

    Science.gov (United States)

    Soodalter, Jesse A; Siegle, Greg J; Klein-Fedyshin, Michele; Arnold, Robert; Schenker, Yael

    2018-05-01

    Despite believing end-of-life (EOL) discussions with patients are important, doctors often do not have them. Multiple factors contribute to this shortfall, which interventions including reimbursement changes and communication skills training have not significantly improved to date. One commonly cited but under-researched reason for physician avoidance of EOL discussion is emotional difficulty. High occupational demand for frequent difficult discussions may overload physicians' normal emotional functioning, leading to avoidance or failure. We propose that cognitive, behavioral, and neuroscience evidence from affective science may offer helpful insights into this problem. Data from other populations show that strong emotion impairs cognitive performance and multiple demands can overload cognitive resources. We discuss several affective processes that may apply to physicians attempting EOL discussions. We then discuss selected interventions that have been shown to modify some of these processes and associated behavioral outcomes. Evidence for change in behavioral outcomes of interest includes performance and mood enhancement in healthy populations. We suggest that such mechanistically-targeted interventions may be hypothesized to help decrease physician avoidance of EOL discussion. Physicians may be motivated to adopt such interventions in order to enhance normal emotional functioning to meet supra-normal occupational demand. We propose this as a promising area of future study. Copyright © 2017 Elsevier B.V. All rights reserved.

  19. EFFECT OF IRRADIATION AND PACKAGING MATERIALS TYPES ON SHELF-LIFE AND QUALITY ATTRIBUTES OF MINCED MEAT DURING COLD STORAGE

    International Nuclear Information System (INIS)

    OSHEBA, A.S.; NAGY, KH.S.; ANWAR, M.M.

    2008-01-01

    Minced meat is considered one of the most meat products that exposed to contamination which led to many changes in its quality and reduced its shelf-life.Therefore, this investigation was carried out to extend the shelf-life of minced meat for consumption and maintaining its quality during cold storage by using irradiation with various doses (3, 6 and 9 kGy) and different packing materials. The results indicated that irradiation,especially at 3 and 6 kGy, had no effect on chemical composition and some physical properties of minced meat. On the other hand, pH values of all irradiated samples were slightly decreased with decreasing irradiation doses.Irradiation at the highest dose used, i.e. 9 kGy, slightly increased total volatile nitrogen (TVN) of minced meat. Thiobarbituric acid (TBA) value of irradiated samples was tended to increase with increasing irradiation dose from 3 to 9 kGy either directly after irradiation or during storage.Regardless of irradiation effect on TVN and TBA values at zero time, there were no marked differences in TVN and TBA values of irradiated minced meat according to differentiate packaging materials (PE, PA/PE and PET/Al/PE). During cold storage, the TVN and TBA values of all minced meat samples either non-irradiated or irradiated were progressively increased as the time of cold storage increased. The higher increasing rate in TVN and TBA of irradiated samples was recorded for samples packaged in PE (one layer) followed by PA/PE (two layers) and finally PET/Al/PE (three layers) at the same irradiation dose. Irradiation of minced meat with 3 kGy reduced the counts of total bacteria, coliform bacteria, Staphylococcus aureus and yeasts and molds counts as well as eliminating Salmonella spp. Irradiation doses of 6 and 9 kGy completely eliminated coliform bacteria, Staphylococcus aureus and yeasts and molds. Also, type of packaging materials which used had no effect on counts of all studied microorganisms. Irradiation of minced meat with

  20. Age-based disparities in end-of-life decisions in Belgium: a population-based death certificate survey

    NARCIS (Netherlands)

    Chambaere, K.; Rietjens, J.A.C.; Smets, T.; Bilsen, J.; Deschepper, R.; Pasman, H.R.W.; Deliens, L.

    2012-01-01

    Background: A growing body of scientific research is suggesting that end-of-life care and decision making may differ between age groups and that elderly patients may be the most vulnerable to exclusion of due care at the end of life. This study investigates age-related disparities in the rate of

  1. Using motivational interviewing to facilitate death talk in end-of-life care: an ethical analysis.

    Science.gov (United States)

    Black, Isra; Helgason, Ásgeir Rúnar

    2018-03-21

    Morbidity arising from unprepared bereavement is a problem that affects close personal relations of individuals at the end-of-life. The bereavement studies literature demonstrates that a lack of preparedness for a loved one's death is a risk factor for secondary psychological morbidity among survivors. Short awareness time of death negatively correlates to preparedness for bereavement. The absence of disclosure of end-of-life diagnosis and prognosis to close personal relations ('death talk') between patients and loved ones, or health professionals and loved ones, may contribute to short awareness time of death. To increase awareness time of death, we might attempt to increase patient first-personal disclosure of end-of-life diagnosis and prognosis to loved-ones, and/or patient consent to health professional disclosure of the same. Interventions based on motivational interviewing in end-of-life care whose aim is to facilitate death talk, either by the patient directly, or by a health professional with the patient's consent, may offer a part solution to the problem of unprepared bereavement. This paper evaluates the ethical permissibility of such interventions. We consider two ethical objections to using motivational interviewing in this way: first, that it is inappropriate for practitioners to seek disclosure as an outcome in this setting; second, that aiming at disclosure risks manipulating individuals into death talk. While it need not be impermissible to direct individuals toward disclosure of end-of-life diagnosis/prognosis, the objection from manipulation implies that it is pro tanto ethically preferable to use motivational interviewing in a non-directive mode in death talk conversations. However, insofar as non-directive motivational interviewing requires more advanced skills, and thus may be more difficult to learn and to practise, we advance that it may be ethically permissible, all things considered, to employ directional, or specific outcome

  2. Theories of Health Care Decision Making at the End of Life: A Meta-Ethnography.

    Science.gov (United States)

    Kim, Kyounghae; Heinze, Katherine; Xu, Jiayun; Kurtz, Melissa; Park, Hyunjeong; Foradori, Megan; Nolan, Marie T

    2017-08-01

    The aim of this meta-ethnography is to appraise the types and uses of theories relative to end-of-life decision making and to develop a conceptual framework to describe end-of-life decision making among patients with advanced cancers, heart failure, and amyotrophic lateral sclerosis (ALS) and their caregivers or providers. We used PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases to extract English-language articles published between January 2002 and April 2015. Forty-three articles were included. The most common theories included decision-making models ( n = 14) followed by family-centered ( n = 11) and behavioral change models ( n = 7). A conceptual framework was developed using themes including context of decision making, communication and negotiation of decision making, characteristics of decision makers, goals of decision making, options and alternatives, and outcomes. Future research should enhance and apply these theories to guide research to develop patient-centered decision-making programs that facilitate informed and shared decision making at the end of life among patients with advanced illness and their caregivers.

  3. Traditional expectations versus US realities: first- and second-generation Asian Indian perspectives on end-of-life care.

    Science.gov (United States)

    Sharma, Rashmi K; Khosla, Nidhi; Tulsky, James A; Carrese, Joseph A

    2012-03-01

    Although end-of-life care preferences vary across racial/ethnic groups, little is known about how cultural values affect end-of-life care preferences among South Asian immigrants and their offspring in the US. To examine the perspectives of first- and second-generation South Asians living in the US regarding end-of-life care. Focus group study. Discussions explored participant preferences and experiences with family members facing the end of life. Twelve first-generation and 11 second-generation self-identified Asian Indians living in the mid-Atlantic region. Content analysis of focus group transcripts. First-generation participants ranged in age from 41 to 76 years and were evenly split by gender. Second-generation participants ranged in age from 23 to 36 years and included seven women and four men. All participants were highly educated, and two thirds were either studying or working in a health care field. All but two subjects were Hindu. Several themes emerged that highlighted cultural differences and challenges for this population in the context of end-of-life care: attitudes toward death and suffering; family duty; and preferences for information disclosure and decision making. Participants described cultural challenges due to the evolution of traditional roles, lack of explicit discussion between patients and family members about preferences and care expectations, and a tension between wanting to meet traditional expectations and the challenges in doing so given US social realities. Traditional cultural values, such as duty to family, greatly influenced end-of-life care preferences and retained importance across generations. Clinicians caring for Asian Indian patients at the end of life may be better able to assess care preferences after exploring the complex interplay between traditional expectations and specific social realities for each patient. Particular attention should be given to attitudes toward death and suffering, family duty, and preferences for

  4. The lived experience of family caregivers who provided end-of-life care to persons with advanced dementia.

    Science.gov (United States)

    Peacock, Shelley; Duggleby, Wendy; Koop, Priscilla

    2014-04-01

    Dementia is a terminal illness, and family caregivers play a vital role in providing end-of-life care to their relative. The present study begins to address the paucity of research regarding end-of-life caregiving experience with dementia. This study utilized Munhall's methodology for interpretive phenomenology. Seven women and four men were interviewed two to three times within a year of their relative's death; interviews were transcribed verbatim and hermeneutically analyzed. Findings reveal two essential aspects of end-of-life dementia caregiving: being-with and being-there. Further findings are organized according to the existential life worlds. Examination of the life worlds demonstrates that 1) spatiality provided a sense or lack of feeling welcome to provide end-of-life care; 2) temporality was an eternity or time melting away quickly, or the right or wrong time to die; 3) corporeality revealed feelings of exhaustion; and 4) relationality was felt as a closeness to others or in tension-filled relationships. An understanding from bereaved caregivers' perspectives will help healthcare practitioners better support and empathize with family caregivers. Further research is warranted that focuses on other places of death and differences in experience based on gender or relationship to the care receiver.

  5. Paediatric end-of-life care needs in Switzerland: current practices, and perspectives from parents and professionals. A study protocol.

    Science.gov (United States)

    Bergstraesser, Eva; Zimmermann, Karin; Eskola, Katri; Luck, Patricia; Ramelet, Anne-Sylvie; Cignacco, Eva

    2015-08-01

    To present a protocol for a multi-phase study about the current practice of end-of-life care in paediatric settings in Switzerland. In Switzerland, paediatric palliative care is usually provided by teams, who may not necessarily have specific training. There is a lack of systematic data about specific aspects of care at the end of a child's life, such as symptom management, involvement of parents in decision-making and family-centred care and experiences and needs of parents, and perspectives of healthcare professionals. This retrospective nationwide multicentre study, Paediatric End-of-LIfe CAre Needs in Switzerland (PELICAN), combines quantitative and qualitative methods of enquiry. The PELICAN study consists of three observational parts, PELICAN I describes practices of end-of-life care (defined as the last 4 weeks of life) in the hospital and home care setting of children (0-18 years) who died in the years 2011-2012 due to a cardiac, neurological or oncological disease, or who died in the neonatal period. PELICAN II assesses the experiences and needs of parents during the end-of-life phase of their child. PELICAN III focuses on healthcare professionals and explores their perspectives concerning the provision of end-of-life care. This first study across Switzerland will provide comprehensive insight into the current end-of-life care in children with distinct diagnoses and the perspectives of affected parents and health professionals. The results may facilitate the development and implementation of programmes for end-of-life care in children across Switzerland, building on real experiences and needs. ClinicalTrials.gov Identifier: NCT01983852. © 2015 John Wiley & Sons Ltd.

  6. Combination of potassium sorbate and irradiation treatments to extend the shelf-life cured fish products

    International Nuclear Information System (INIS)

    Maha, M.; Sudarman, H.; Chosdu, R.; Siagian, E.G.; Nasran, S.

    1981-01-01

    Studies on shelf-life extension of three kinds of cured fish product, i.e. salted chub mackerel (Rastrelliger neglectus), boiled chub mackerel (Rastrelliger neglectus) and smoked milkfish (Chanos chanos) have been done using a combined potassium sorbate and irradiation treatment. An integrated process for the preparation of each cured product provided with the combined treatment is described. Total bacterial count, total volatile base nitrogen, content of volatile reducing substances and mould growth were used as objective indices of quality in comparison with sensory evaluation to determine the shelf-life of the products held at ambient conditions. It was found that potassium sorbate residue of 0.1% level followed by irradiation up to 4 kGy could retard mould growth on the products and extend the shelf-life considerably in comparison with the commercially prepared products. (author)

  7. Trends and determinants of end-of-life practices in ALS in the Netherlands.

    Science.gov (United States)

    Maessen, M; Veldink, Jan H; Onwuteaka-Philipsen, B D; de Vries, J M; Wokke, J H J; van der Wal, G; van den Berg, L H

    2009-09-22

    In the Netherlands, the proportion of patients with amyotrophic lateral sclerosis (ALS) who choose the option of euthanasia or physician-assisted suicide (PAS) is relatively high (20%). The objective of this study was to determine which factors influence end-of-life practices in ALS and whether rates are changing over time. In a cohort survey, 204 physicians and 198 informal caregivers (response rates 75% and 80%) of patients with ALS who died between 2000 and 2005 filled out questionnaires of the end-of-life circumstances of the patient. Results were compared with those of a similar study performed during the period 1994-1998. In 2000-2005, 16.8% of the patients decided on euthanasia or PAS compared to 20.2% in 1994-1998. Thirty-one (14.8%) patients died during continuous deep sedation (CDS) in 2000-2005. Euthanasia or PAS, but not CDS, were significantly associated with religion not being important to the patient, being more educated, and dying at home. Euthanasia or PAS were not associated with quality of care items or symptoms of depression. Loss of function was similar in both groups. Informal caregivers of patients who died after euthanasia or PAS more frequently reported fear of choking (p = 0.003), no chance of improvement (p = 0.001), loss of dignity (p = 0.02), being dependent on others (p = 0.002), and fatigue (p = 0.018) as reasons for shortening life. Hopelessness was associated with euthanasia or PAS, as with CDS. The frequency of euthanasia or physician-assisted suicide (PAS) in amyotrophic lateral sclerosis (ALS) appeared stable over time and 1 in 7 patients died during CDS. CDS is relatively common in ALS, but appears to have other determinants than euthanasia or PAS. Subjective factors may be important in explaining euthanasia or PAS in ALS.

  8. Stability of the Hall sensors performance under neutron irradiation

    International Nuclear Information System (INIS)

    Duran, I.; Hron, M.; Stockel, J.; Viererbl, L.; Vsolak, R.; Cerva, V.; Bolshakova, I.; Holyaka, R.; Vayakis, G.

    2004-01-01

    A principally new diagnostic method must be developed for magnetic measurements in steady state regime of operation of fusion reactor. One of the options is the use of transducers based on Hall effect. The use of Hall sensors in ITER is presently limited by their questionable radiation and thermal stability. Issues of reliable operation in ITER like radiation and thermal environment are addressed in the paper. The results of irradiation tests of candidate Hall sensors in LVR-15 and IBR-2 experimental fission reactors are presented. Stable operation (deterioration of sensitivity below one percent) of the specially prepared sensors was demonstrated during irradiation by the total fluence of 3.10 16 n/cm 2 in IBR-2 reactor. Increasing the total neutron fluence up to 3.10 17 n/cm 2 resulted in deterioration of the best sensor's output still below 10% as demonstrated during irradiation in LVR-15 fission reactor. This level of neutron is already higher than the expected ITER life time neutron fluence for a sensor location just outside the ITER vessel. (authors)

  9. Impact of Treatment Subsidies and Cash Payouts on Treatment Choices at the End of Life.

    Science.gov (United States)

    Finkelstein, Eric; Malhotra, Chetna; Chay, Junxing; Ozdemir, Semra; Chopra, Akhil; Kanesvaran, Ravindran

    To examine the extent to which financial assistance, in the form of subsidies for life-extending treatments (LETs) or cash payouts, distorts the demand for end-of-life treatments. A discrete choice experiment was administered to 290 patients with cancer in Singapore to elicit preferences for LETs and only palliative care (PC). Responses were fitted to a latent class conditional logistic regression model. We also quantified patients' willingness to pay to avoid and willingness to accept a less effective LET or PC-only. We then simulated the effects of various LET subsidy and cash payout policies on treatment choices. We identified three classes of patients according to their preferences. The first class (26.1% of the sample) had a strong preference for PC and were willing to give up life expectancy gains and even pay for receiving only PC. The second class (29.8% of the sample) had a strong preference for LETs and preferred to extend life regardless of cost or quality of life. The final class (44.1% of the sample) preferred LETs to PC, but actively traded off costs and length and quality of life when making end-of-life treatment choices. Policy simulations showed that LET subsidies increase demand for LETs at the expense of demand for PC, but an equivalent cash payout was not shown to distort demand. Patients with cancer have heterogeneous end-of-life preferences. LET subsidies and cash payouts have differing effects on the use of LETs. Policymakers should be mindful of these differences when designing health care financing schemes for patients with life-limiting illnesses. Copyright © 2016. Published by Elsevier Inc.

  10. Preliminary investigation on the extension of shelf-life of boiled Chub mackerel by irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Loaharanu, P; Prombubesara, C; Songprasertchai, S

    1971-12-31

    The influence of irradiation on the extension of shelf-life of boiled Chub mackerel stored at room temperature (25-30{sup 0}C) was investigated. It was found that boiled Chub mackerel irradiated at 0.1, 0.2, or 0.3 Mrad could be kept with good organoleptic properties at room temperature for 5, 8, and 11 days respectively; while the unirradiated sample could be kept for only 2 days. Boiled Chub mackerel used in this study was found to be heavily contaminated with microorganisms. Irradiation at doses mentioned caused reduction of more than 99% of bacteria. Bacillus and Acinetobacter were found to predominate in the irradiated boiled mackerel. The predominant flora in unirradiated boiled mackerel included Micrococcus, Staphylococcus, Bacillus, Acinetobacter, and Proteus. E. coli was always detected in unirradiated samples and was occasionally detected only in samples irradiated at 0.1 Mrad. Trimethylamine nitrogen (TMA-N) content, total volatile basic nitrogen (TVB-N) content, and total bacterial count (TBC) were used as indices of decomposition of both irradiated and unirradiated samples. TMA-N and TBC were found to be good indices of quality of only unirradiated boiled Chub mackerel, whereas TVB-N was found to be a good index of quality of both irradiated and unirradiated samples.

  11. Current and emerging practice of end-of-life care in British prisons: findings from an online survey of prison nurses.

    Science.gov (United States)

    Papadopoulos, Irena; Lay, Margaret

    2016-03-01

    There are concerns about prisoners and detainees not having equal access to end-of-life care while in prison. There is a lack of existing literature about the standards of end-of-life care in UK prisons. The aim of this study was to investigate the views of current and former prison nurses with regard to the end-of-life care being provided in UK prisons. Prison nurses were invited to participate in an online survey and asked about their role in the prison, prisoners' access to healthcare facilities, and any barriers and good practices to end-of-life care. The survey included open-ended and closed questions. The closed questions were analysed using descriptive statistics. The open-ended responses were coded and grouped into themes. 31 (N=31) prison nurses responded to the survey. The reported barriers to end-of-life care included some prison regimes, lack of appropriate care and visiting facilities, lack of privacy and inadequate visiting hours. Respondents also reported examples of good practice, including having access to specialist palliative care and specialist equipment, and being able to receive visits from family and friends. The findings suggest that there is considerable variability in the end-of-life care provided to prisoners in the UK. Further research is needed in order to reduce the health inequalities and improve the quality of end-of-life care experienced by prisoners in the UK. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  12. Shelf-life Extension and Improvement of the Microbiological Quality of Fresh Sausage by Irradiation

    International Nuclear Information System (INIS)

    Hammad, A.A.I.; El-Mongy, T.M.; Mabrouk, A.K.

    2000-01-01

    Fifty samples of fresh sausage were randomly collected from different meat products markets in Great Cairo. They were analysed for microbiological quality. The results showed that 26 (52%) samples had total aerobic bacterial counts more than 10 7 cfu/g. Staphylococcus aureus was present in all samples and 19 (38%) samples had counts more than maximum permissible level (10 3 cfu/g). Enterococcus faecalis numbers more than 10 5 cfu/g were found in 14 (28%) samples. Coliform bacteria were present in all sausage samples and 19(38%) samples had counts more than 10 3 cfu/g, while salmonella was detected in only 5 (10%) samples. Therefore, fresh sausages in local market were highly contaminated with different microorganisms including spoilage and pathogenic bacteria. Irradiation dose of 4 kGy greatly reduced the numbers of aerobic and anaerobic bacteria, lactobacilli and yeasts without affecting the organoleptic properties of the samples. It extended the shelf-life of fresh sausage up to about 15 days at refrigeration temperature (5+-1) while the shelf-life was only 5 days for unirradiated samples. Irradiation dose of 6 kGy had greater effect on the microbiological counts and extended the shelf-life of fresh sausage more than 25 days, however, it slightly affected its organoleptic properties. Sausage samples exposed to this irradiation dose was microbiologically safe, being free from Enterobacteriaceae, Staph, aureus, Ent, faecalis, coliform bacteria, Salmonella and moulds

  13. Family caregivers' conceptualisation of quality end-of-life care for people with dementia: A qualitative study.

    Science.gov (United States)

    Davies, Nathan; Rait, Greta; Maio, Laura; Iliffe, Steve

    2017-09-01

    People with dementia have been described as the 'disadvantaged dying' with poor end-of-life care. Towards the end of life, people with dementia cannot report on the care they receive. It is therefore important to talk to caregivers; however, few have explored the views about end-of-life care from the caregivers' perspective. The majority of research on family caregivers has focussed on the burden and psychological impact of caring for a relative with dementia. This study aimed to explore the views of family caregivers about quality end-of-life care for people with dementia. Qualitative study using in-depth interviews and analysed using thematic analysis. Purposive sampling from a third sector organisation's caregiver network was used to recruit 47 caregivers in England (2012-2013), consisting of (1) family caregivers of someone who had recently received a diagnosis of dementia, (2) family caregivers currently caring for someone with dementia and (3) bereaved family caregivers. Three over-arching themes were derived from the interviewees' discourse, including maintaining the person within, fostering respect and dignity and showing compassion and kindness. End-of-life care for people with dementia does not differ from care throughout the dementia trajectory. Throughout the findings, there is an implicit underlying theme of conflict: conflict between family caregivers and an increasingly systematised service of care and conflict between family caregivers and professionals. This study has in particular demonstrated the importance of the psycho-social aspects of care, aligning with the holistic definition of palliative care.

  14. Training needs of nurses and social workers in the end-of-life care for people with intellectual disabilities: a national survey.

    Science.gov (United States)

    Bekkema, Nienke; de Veer, Anke J E; Albers, Gwenda; Hertogh, Cees M P M; Onwuteaka-Philipsen, Bregje D; Francke, Anneke L

    2014-04-01

    Nurses and social workers caring for people with intellectual disabilities are increasingly confronted with clients in need of end-of-life care. Previous studies, however, suggest that professionals in intellectual disability care services lack knowledge and experience concerning end-of-life care. Moreover, the proportion of nurses within the staff of intellectual disability services has declined in recent years, while the proportion of social workers has increased, which may have consequences for the quality of end-of-life care. To gain insight into the quality of end-of-life care, past vocational training, training needs and expert consultation opportunities of nurses and social workers working in intellectual disability care services. Survey questionnaire study conducted in the Netherlands. Intellectual disability care services. The study sample was recruited from an existing nationally representative research panel of care professionals. In 2011, all 181 nurses and social workers in the research panel who worked in intellectual disability care services were sent our survey questionnaire. Postal survey addressing education, views and needs regarding end-of-life care. The response was 71.8%. Respondents positively evaluated the quality of end-of-life care. However, most respondents felt inadequately trained in end-of-life care issues. Nurses had received more training in end-of-life care and had fewer training needs than social workers. Respondents wished for additional training, especially in supporting clients in dealing with the impending death and farewell process. Half of the respondents were unaware of the availability of external consultation facilities. This study shows that although nurses and social workers positively appraise the quality of end-of-life care for people with intellectual disabilities, the majority feel inadequately trained to provide good end-of-life care. As the number of people with intellectual disability in need of end-of-life care

  15. Role of the irradiation temperature on the modifications of swift-heavy-ion irradiated polyethylene

    International Nuclear Information System (INIS)

    Melot, M.; Ngono-Ravache, Y.; Balanzat, E.

    2003-01-01

    The damage processes triggered by swift heavy ions, SHI, can be very different to those induced by classical low ionising particles. This is due to the very high electronic stopping power, (dE/dx) e , of SHI. This paper concerns the effects of SHI on polyethylene, PE. In PE, low (dE/dx) e irradiations induce crosslinking and in-chain double bond formation. At high (dE/dx) e , the creation yield of vinyl groups becomes significant. Above a (dE/dx) e threshold, alkyne and allene groups appear. We present results on low temperature irradiations that bring new enlightenment on the damage process by preventing the migration of radiation-induced radicals and molecules. Two SHI specific modifications are studied: vinyl groups and alkyne end groups. We have irradiated PE films with oxygen and sulphur beams at 13.6 and 11.2 MeV/amu, respectively. The modifications were followed by in situ infrared spectroscopy (FTIR). We have performed irradiations at 8 and 290 K. The samples irradiated at 8 K have been annealed up to 290 K for investigating the effect of radical migration. Lowering the irradiation temperature to 8 K increases the creation yield of vinyl groups and alkyne end groups. The enhancement factor between 290 and 8 K is around three. Consequently the formation of defects specific to SHI irradiations is sensitive to radical migration and hence requires some time. During annealing, the alkyne concentration remains stable indicating that the creation of this group cannot be induced by radical recombination. The annealing spectra of vinyl groups are more complex

  16. Pharmacologic pearls for end-of-life care.

    Science.gov (United States)

    Clary, Patrick L; Lawson, Phil

    2009-06-15

    As death approaches, a gradual shift in emphasis from curative and life prolonging therapies toward palliative therapies can relieve significant medical burdens and maintain a patient's dignity and comfort. Pain and dyspnea are treated based on severity, with stepped interventions, primarily opioids. Common adverse effects of opioids, such as constipation, must be treated proactively; other adverse effects, such as nausea and mental status changes, usually dissipate with time. Parenteral methylnaltrexone can be considered for intractable cases of opioid bowel dysfunction. Tumor-related bowel obstruction can be managed with corticosteroids and octreotide. Therapy for nausea and vomiting should be targeted to the underlying cause; low-dose haloperidol is often effective. Delirium should be prevented with normalization of environment or managed medically. Excessive respiratory secretions can be treated with reassurance and, if necessary, drying of secretions to prevent the phenomenon called the "death rattle." There is always something more that can be done for comfort, no matter how dire a situation appears to be. Good management of physical symptoms allows patients and loved ones the space to work out unfinished emotional, psychological, and spiritual issues, and, thereby, the opportunity to find affirmation at life's end.

  17. Advanced disassembling technique of irradiated driver fuel assembly for continuous irradiation of fuel pins

    International Nuclear Information System (INIS)

    Ichikawa, Shoichi; Haga, Hiroyuki; Katsuyama, Kozo; Maeda, Koji; Nishinoiri, Kenji

    2012-01-01

    It was necessary to carry out continuous irradiation tests in order to obtain the irradiation data of high burn-up fuel and high neutron dose material for FaCT (Fast Reactor Cycle Technology Development) project. There, the disassembling technique of an irradiated fuel assembly was advanced in order to realize further continuous irradiation tests. Although the conventional disassembling technique had been cutting a lower end-plug of a fuel pin needed to fix fuel pins to an irradiation vehicle, the advanced disassembling technique did not need cutting a lower end-plug. As a result, it was possible to supply many irradiated fuel pins to various continuous irradiation tests for FaCT project. (author)

  18. Distancing sedation in end-of-life care from physician-assisted suicide and euthanasia

    Science.gov (United States)

    Soh, Tze Ling Gwendoline Beatrice; Krishna, Lalit Kumar Radha; Sim, Shin Wei; Yee, Alethea Chung Peng

    2016-01-01

    Lipuma equates continuous sedation until death (CSD) to physician-assisted suicide/euthanasia (PAS/E) based on the premise that iatrogenic unconsciousness negates social function and, thus, personhood, leaving a patient effectively ‘dead’. Others have extrapolated upon this position further, to suggest that any use of sedation and/or opioids at the end of life would be analogous to CSD and thus tantamount to PAS/E. These posits sit diametrically opposite to standard end-of-life care practices. This paper will refute Lipuma’s position and the posits borne from it. We first show that prevailing end-of-life care guidelines require proportional and monitored use of sedatives and/or opioids to attenuate fears that the use of such treatment could hasten death. These guidelines also classify CSD as a last resort treatment, employed only when symptoms prove intractable, and not amenable to all standard treatment options. Furthermore, CSD is applied only when deemed appropriate by a multidisciplinary palliative medicine team. We also show that empirical data based on local views of personhood will discount concerns that iatrogenic unconsciousness is tantamount to a loss of personhood and death. PMID:27211055

  19. Distancing sedation in end-of-life care from physician-assisted suicide and euthanasia.

    Science.gov (United States)

    Soh, Tze Ling Gwendoline Beatrice; Krishna, Lalit Kumar Radha; Sim, Shin Wei; Yee, Alethea Chung Peng

    2016-05-01

    Lipuma equates continuous sedation until death (CSD) to physician-assisted suicide/euthanasia (PAS/E) based on the premise that iatrogenic unconsciousness negates social function and, thus, personhood, leaving a patient effectively 'dead'. Others have extrapolated upon this position further, to suggest that any use of sedation and/or opioids at the end of life would be analogous to CSD and thus tantamount to PAS/E. These posits sit diametrically opposite to standard end-of-life care practices. This paper will refute Lipuma's position and the posits borne from it. We first show that prevailing end-of-life care guidelines require proportional and monitored use of sedatives and/or opioids to attenuate fears that the use of such treatment could hasten death. These guidelines also classify CSD as a last resort treatment, employed only when symptoms prove intractable, and not amenable to all standard treatment options. Furthermore, CSD is applied only when deemed appropriate by a multidisciplinary palliative medicine team. We also show that empirical data based on local views of personhood will discount concerns that iatrogenic unconsciousness is tantamount to a loss of personhood and death. Copyright: © Singapore Medical Association.

  20. Effect of irradiation on the tensile properties of niobium-base alloys

    International Nuclear Information System (INIS)

    Grossbeck, M.L.; Heestand, R.L.; Atkin, S.D.

    1986-11-01

    The alloys Nb-1Zr and PWC-11 (Nb-1Zr-0.1C) were selected as prime candidate alloys for the SP-100 reactor. Since the mechanical properties of niobium alloys irradiated to end-of-life exposure levels of about 2 x 10 26 neutrons/m 2 (E > 0.1 MeV) at temperatures above 1300 K were not available, an irradiation experiment (B-350) in EBR-II was conducted. Irradiation creep, impact properties, bending fatigue, and tensile properties were investigated; however, only tensile properties will be reported in this paper. The tensile properties were studied since they easily reveal the common irradiation phenomena of hardening and embrittlement. Most attention was directed to testing at the irradiation temperature. Further testing was conducted at lower temperatures in order to scope the behavior of the alloys in cooldown conditions

  1. Combination of potassium sorbate and irradiation treatments to extend the shelf life of cured fish products

    International Nuclear Information System (INIS)

    Maha, M.; Sudarman, H.; Chosdu, R.; Siagian, E.G.

    1989-01-01

    Studies on shelf life extension of three kinds of cured fish products, i.e. salted chub mackeral (Rastrelliger neglectus), boiled chub mackerel (Rastrelliger neglectus) and smoked milkfish (Chanos chanos) have been made using a combined potassium sorbate and irradiation treatment. An integrated process for the preparation of each cured product provided with the combination treatment is described. Total bacterial count, total volatile base nitrogen, volatile reducing substances, and mould growth were used as objective indices of quality in comparison with sensory evaluation to determine the shelf life of the products held at ambient conditions. It was found that 0.1% potassium sorbate followed by irradiation up to 4 kGy retards mould growth on the products and extends the shelf life to a considerable length of time in comparison with the commercially prepared products. (author). 14 refs, 3 figs, 5 tabs

  2. Parental perspectives on suffering and quality of life at end-of-life in children with advanced heart disease: an exploratory study*.

    Science.gov (United States)

    Blume, Elizabeth D; Balkin, Emily Morell; Aiyagari, Ranjit; Ziniel, Sonja; Beke, Dorothy M; Thiagarajan, Ravi; Taylor, Laura; Kulik, Thomas; Pituch, Kenneth; Wolfe, Joanne

    2014-05-01

    To describe parent perspectives regarding the end-of-life experience of children with advanced heart disease. Cross-sectional multicenter survey study of bereaved parents. Two tertiary care pediatric hospitals. Parents of children younger than 21 years with primary cardiac diagnoses who died in the hospital 9 months to 4 years before the survey date. Parents were excluded if they were non-English speakers or had previously denied permission to contact. The Survey for Caring for Children with Advanced Heart Disease was developed, piloted, and then sent to parents of all children who died at two sites. Fifty bereaved parents responded (39% response rate) a mean of 2.7 years after their child's death. Median age at death was 6 months (3.6 d to 20.4 yr). At end-of-life, 86% of children were intubated and 46% were receiving mechanical circulatory support. Seventy-eight percent died during withdrawal of life-sustaining interventions and 16% during resuscitative efforts. Parents realized that their child had no realistic chance of survival a median of 2 days prior to death (0-30 d). According to parents, 47% of children suffered "a great deal," "a lot," or "somewhat" during the end-of-life period. The symptoms parents perceived to be causing the most suffering were breathing and feeding difficulties in children under 2 years and fatigue and sleeping difficulties in older children. Seventy-one percent of parents described the quality of life of their child during the last month of life as "poor" or "fair." Most parents (84%) described the quality of care delivered as "very good" or "excellent." According to their parents, many children with advanced heart disease experience suffering in the end-of-life care period. For most, realization that their child has no realistic chance of survival does not occur until late, some not until death is imminent. Once this realization occurs, however, parents perceive peacefulness, a "good death," and excellent quality of care

  3. Cost accounting for end-of-life care: recommendations to the field by the Cost Accounting Workgroup.

    Science.gov (United States)

    Seninger, Stephen; Smith, Dean G

    2004-01-01

    Accurate measurement of economic costs is prerequisite to progress in improving the care delivered to Americans during the last stage of life. The Robert Wood Johnson Excellence in End-of-Life Care national program assembled a Cost Accounting Workgroup to identify accurate and meaningful methods to measure palliative and end-of-life health care use and costs. Eight key issues were identified: (1) planning the cost analysis; (2) identifying the perspective for cost analysis; (3) describing the end-of-life care program; (4) identifying the appropriate comparison group; (5) defining the period of care to be studied; (6) identifying the units of health care services; (7) assigning monetary values to health care service units; and (8) calculating costs. Economic principles of cost measurement and cost measurement issues encountered by practitioners were reviewed and incorporated into a set of recommendations.

  4. Shelf-life and quality evaluation of clementine following a combined treatment with γ-irradiation

    International Nuclear Information System (INIS)

    Mahrouz, M.; Lacroix, M.; D'Aprano, G.; Oufedjikh, H.; Boubekri, C.

    2004-01-01

    In order to enhance the shelf-life of a late variety of Moroccan Citrus clementina (Nour), ionizing treatments were applied at 0.3 kGy, as well as washing (cold water) and waxing treatments. It has been found that, despite the irradiation treatment, the washing and waxing treatment do not improve the quality of C. clementina, but rather result in peel injury. Finally, sensory evaluation confirmed that irradiation had no detrimental effect on the quality of clementines

  5. FMIT - the fusion materials irradiation test facility

    International Nuclear Information System (INIS)

    Liska, D.J.

    1980-01-01

    A joint effort by the Hanford Engineering Development Laboratory (HEDL) and Los Alamos Scientific Laboratory (LASL) has produced a preliminary design for a Fusion Materials Irradiation Test Facility (FMIT) that uses a high-power linear accelerator to fire a deuteron beam into a high-speed jet of molten lithium. The result is a continuous energy spectrum of neutrons with a 14-MeV average energy which can irradiate material samples to projected end-of-life levels in about 3 years, with a total accumulated fluence of 10 21 to 10 22 n/cm 2

  6. [State policy at the end of life. The transformation of medical deontology].

    Science.gov (United States)

    Serrano Ruiz-Calderón, José Miguel

    2012-01-01

    The contemporary state invades privacy in ways that affect even the end of life process. It develops public policies that can affect medical ethics. This limitation of power leaves the doctor's attention to the profession and may become a convenient code.

  7. Irradiation Performance of HTGR Fuel in WWR-K Research Reactor

    International Nuclear Information System (INIS)

    Ueta, Shohei; Sakaba, Nariaki; Shaimerdenov, Asset; Gizatulin, Shamil; Chekushina, Lyudmila; Chakrov, Petr; Honda, Masaki; Takahashi, Masashi; Kitagawa, Kenichi

    2014-01-01

    A capsule irradiation test with the high temperature gas-cooled reactor (HTGR) fuel is being carried out using WWR-K research reactor in the Institute of Nuclear Physics of the Republic of Kazakhstan (INP) to attain 100 GWd/t-U of burnup under normal operating condition of a practical small-sized HTGR. This is the first HTGR fuel irradiation test for INP in Kazakhstan collaborated with Japan Atomic Energy Agency (JAEA) in frame of International Science and Technology Center (ISTC) project. In the test, TRISO coated fuel particle with low-enriched UO_2 (less than 10 % of "2"3"5U) is used, which was newly designed by JAEA to extend burnup up to 100 GWd/t-U comparing with that of the HTTR (33 GWd/t-U). Both TRISO and fuel compact as the irradiation test specimen were fabricated in basis of the HTTR fuel technology by Nuclear Fuel Industries, Ltd. in Japan. A helium-gas-swept capsule and a swept-gas sampling device installed in WWR-K were designed and constructed by INP. The irradiation test has been started in October 2012 and will be completed up to the end of February 2015. The irradiation test is in the progress up to 69 GWd/t of burnup, and integrity of new TRISO fuel has been confirmed. In addition, as predicted by the fuel design, fission gas release was observed due to additional failure of as-fabricated SiC-defective fuel. (author)

  8. Continuous induction of unscheduled DNA synthesis by gamma irradiation

    International Nuclear Information System (INIS)

    Weniger, P.; Klein, W.; Ott, E.; Kocsis, F.; Altmann, H.

    1988-08-01

    The induction of DNA-synthesis in non-S-phase cells is a very sensitive measure of a preceding damage of the DNA. Usually, in an in vivo -in vitro test (treatment of an animal, incorporation of H3-thymidine in a cell suspension) the damaging of DNA takes place hours to days before the evaluation. In this case, the time course of the UDS-induction after a single dose of 1 Gy gamma irradiation should be observed for a long time (21 months). C57 black mice served as test animals. In an age of about 80 days they were irradiated and the induction of unscheduled DNA synthesis was measured at ten points of time during the whole life-span of the animals. Although the repair in this gamma radiation damage in DNA is a very quick process - with centrifugation in alkaline sucrose you find a half time of some minutes - an induction of unscheduled DNA synthesis could be seen at the irradiated animals until the end of their life (640 days). The reason for this could be permanent disorders in cellular regulation caused by the gamma irradiation. 4 figs. (Author)

  9. Shell-life and microbiological quality of lamb meat as effected by high pressure, irradiation and combination treatments

    International Nuclear Information System (INIS)

    Paul, Pushpa; Chawla, S.P.; Thomas, Paul; Kesavan, P.C.; Arya, R.N.; Fotedar, R.

    1997-01-01

    The effect of gamma irradiation (1.0 kGy) and high hydrostatic pressure (220 MPa for 30 min), either alone or in combination on the shelf-life of minced lamb meat stored at 0-3 deg C have been investigated. Untreated control samples initially have total microbial counts of 10 5 CFU/g, 10 2 CFU/g of coliforms and 10 4 CFU/g of Staphylococcus spp. Coliforms are eliminated by all the treatments. Staphylococcus spp. however, are reduced only by 1 log cycle when treated with either irradiation alone or high pressure alone and this flora is a mixture of mannitol fermenting and mannitol non-fermenting species. In samples subjected to the combination treatment Staphylococcus spp. appears only after 3 weeks of storage and all are mannitol non-fermenting. On the basis of microbiological and sensory quality the shelf life of control sample is less than 1 week. All treated meat samples have shelf life of 3 weeks but only combination treated samples are free from potentially pathogenic Staphylococcus spp. The results demonstrate the potential application of low dose irradiation combined with high pressure treatment for shelf-life enhancement and microbial safety of meat and meat products. (author)

  10. The microbiological quality and shelf-life of the irradiated chicken meat

    International Nuclear Information System (INIS)

    Basbayraktar, V.; Kozat, P.; Halkman, H.B.D.; Cetinkaya, N.

    2002-01-01

    Chicken breast and leg meats were packaged. Immediately after packaging, both sets of breast and legs meat were irradiated at 0, 1, 2, 3, 4 kGy. All the samples were stored at +8 deg. C and were analyzed for populations of mesophilic, total molds and yeasts, Coliform Bacteria, E. coli, Salmonella every 5 days for 20 days. By using a mesophilic populations of 10 7 cells/g as a criteria for spoilage, fresh breast and leg meats receiving a dose of 0 kGy had shelf a live of 5 days with packaging-Both breast and leg meats that received a dose of 3 kGy had shelf lives that were greater than 10 days at + 8 deg. C using packaging. This study showed that 1.0 kGy irradiation can inactivate 10 4 g /Coliform Bacteria and 10 3 g/E. coli. The shelf life of meat is largely dependent upon the level of microbiological contamination that occurs during processing especially in the slaughterhouse in Turkey. Irradiation has the potential to emerge as one of today's most significant food-preservation technologies

  11. Plan and reports of coupled irradiation (JRR-3 and JOYO of research reactors) and hot facilities work (WASTEF, JMTR-HL, MMF and FMF). R and D project on irradiation damage management technology for structural materials of long-life nuclear plant

    International Nuclear Information System (INIS)

    Matsui, Yoshinori; Yamamoto, Masaya; Yoshitake, Tsunemitsu; Yoshikawa, Katsunori; Iwamatsu, Shigemi; Ichikawa, Shoichi; Yamagata, Ichiro; Soga, Tomonori; Yonekawa, Minoru; Kitamura, Ryoichi; Miyake, Osamu; Takahashi, Hiroyuki; Ishikawa, Kazuyoshi; Kikuchi, Taiji; Usami, Koji; Endo, Shinya; Ichise, Kenichi; Numata, Masami; Onozawa, Atsushi; Aizawa, Masao; Kusunoki, Tsuyoshi; Nakata, Masahito; Abe, Kazuyuki; Ito, Kazuhiro; Takaya, Shigeru; Nagae, Yuji; Wakai, Eiichi; Aoto, Kazumi

    2010-03-01

    'R and D Project on Irradiation Damage Management Technology for Structural Materials of Long-life Nuclear Plant' was carried out from FY2006 in a fund of a trust enterprise of the Ministry of Education, Culture, Sports, Science and Technology. The coupled irradiations or single irradiation by JOYO fast reactor and JRR-3 thermal reactor were performed for about two years. The irradiation specimens are very important materials to establish of 'Evaluation of Irradiation Damage Indicator' in this research. For the acquisition of the examination specimens irradiated by the JOYO and JRR-3, we summarized about the overall plan, the work process and the results for the study to utilize these reactors and some facilities of hot laboratory (WASTEF, JMTR-HL, MMF and FMF) of the Oarai Research and Development Center and the Nuclear Science Research Institute in the Japan Atomic Energy Agency. (author)

  12. Cross-current leaching of indium from end-of-life LCD panels.

    Science.gov (United States)

    Rocchetti, Laura; Amato, Alessia; Fonti, Viviana; Ubaldini, Stefano; De Michelis, Ida; Kopacek, Bernd; Vegliò, Francesco; Beolchini, Francesca

    2015-08-01

    Indium is a critical element mainly produced as a by-product of zinc mining, and it is largely used in the production process of liquid crystal display (LCD) panels. End-of-life LCDs represent a possible source of indium in the field of urban mining. In the present paper, we apply, for the first time, cross-current leaching to mobilize indium from end-of-life LCD panels. We carried out a series of treatments to leach indium. The best leaching conditions for indium were 2M sulfuric acid at 80°C for 10min, which allowed us to completely mobilize indium. Taking into account the low content of indium in end-of-life LCDs, of about 100ppm, a single step of leaching is not cost-effective. We tested 6 steps of cross-current leaching: in the first step indium leaching was complete, whereas in the second step it was in the range of 85-90%, and with 6 steps it was about 50-55%. Indium concentration in the leachate was about 35mg/L after the first step of leaching, almost 2-fold at the second step and about 3-fold at the fifth step. Then, we hypothesized to scale up the process of cross-current leaching up to 10 steps, followed by cementation with zinc to recover indium. In this simulation, the process of indium recovery was advantageous from an economic and environmental point of view. Indeed, cross-current leaching allowed to concentrate indium, save reagents, and reduce the emission of CO2 (with 10 steps we assessed that the emission of about 90kg CO2-Eq. could be avoided) thanks to the recovery of indium. This new strategy represents a useful approach for secondary production of indium from waste LCD panels. Copyright © 2015 Elsevier Ltd. All rights reserved.

  13. Irradiation of mushrooms (Agaricus campestris L) to extend their shelf-life

    International Nuclear Information System (INIS)

    Lescano, G.

    1990-01-01

    Mushrooms (Agaricus campestris L) were irradiated with 1.0; 2.0 and 3.0 kGy, being then stored either at 10 deg C ± 1 deg C or at room temperature (20 deg C ± 2 deg C), with the purpose of determining the most convenient condition to extend their shelf-life. It is concluded that 3.0 kGy and 10 deg C are the most suitable for that, leading to the inhibition of cap opening and stem elongation, less darkening and no evidence of fungal development until 17th day. Subsequentely almost a duplication of their shelf-life was obtained. (Author) [es

  14. End-of-life experiences and expectations of Africans in Australia: cultural implications for palliative and hospice care.

    Science.gov (United States)

    Hiruy, Kiros; Mwanri, Lillian

    2014-03-01

    The ageing and frail migrants who are at the end of life are an increasing share of migrants living in Australia. However, within such populations, information about end-of-life experiences is limited, particularly among Africans. This article provides some insights into the sociocultural end-of-life experiences of Africans in Australia and their interaction with the health services in general and end-of-life care in particular. It provides points for discussion to consider an ethical framework that include Afro-communitarian ethical principles to enhance the capacity of current health services to provide culturally appropriate and ethical care. This article contributes to our knowledge regarding the provision of culturally appropriate and ethical care to African patients and their families by enabling the learning of health service providers to improve the competence of palliative care systems and professionals in Australia. Additionally, it initiates the discussion to highlight the importance of paying sufficient attention to a diverse range of factors including the migration history when providing palliative and hospice care for patients from African migrant populations.

  15. Effect of parathyroidectomy and cinacalcet on quality of life in patients with end-stage renal disease-related hyperparathyroidism : A systematic review

    NARCIS (Netherlands)

    van der Plas, Willemijn Y.; Dulfer, Roderick R.; Engelsman, Anton F.; Vogt, Liffert; de Borst, Martin H.; van Ginhoven, Tessa M.; Kruijff, Schelto

    2017-01-01

    Background. Patients with end-stage renal disease (ESRD) have a decreased quality of life (QoL), which is attributable in part to ESRD-related hyperparathyroidism (HPT). Both cinacalcet and parathyroidectomy (PTx) are treatments for advanced HPT, but their effects on QoL are unclear. We performed a

  16. Effect of parathyroidectomy and cinacalcet on quality of life in patients with end-stage renal disease-related hyperparathyroidism: a systematic review

    NARCIS (Netherlands)

    van der Plas, Willemijn Y.; Dulfer, Roderick R.; Engelsman, Anton F.; Vogt, Liffert; de Borst, Martin H.; van Ginhoven, Tessa M.; Kruijff, Schelto

    2017-01-01

    Background. Patients with end-stage renal disease (ESRD) have a decreased quality of life (QoL), which is attributable in part to ESRD-related hyperparathyroidism (HPT). Both cinacalcet and parathyroidectomy (PTx) are treatments for advanced HPT, but their effects on QoL are unclear. We performed a

  17. End-of-life palliative chemotherapy: Where do we stand?

    International Nuclear Information System (INIS)

    Mohammed, A.A.; Al-Zahrani, A.S.; Ghanem, H.M.; El Saify, A.M.; EL-Khatib, H.M.; Mohammed, A.A.; Farooq, M.U.

    2015-01-01

    Background: This study evaluates the use of palliative chemotherapy (PCT) and possible associated factors at the end of life. Method: The study includes all advanced non hematological cancer patients who died in the King Abdullah Medical City during the period from January 2011 to April 2014. Demographic and disease features were registered. Results: 420 patients were included in the study, median age 62 years (range 17-108); 52% female and 48% male. 87.4% of patients were Saudis and 12.6% non Saudis. 124 (29.5%) patients received PCT at the last month before death (LM-PCT): 21.8%, 22.6% and 55.6% within one, two and four weeks of death, respectively. Place of death (critical care vs. regular ward) and mode of admission (ER vs. OPD vs. Transferred) had a strong association with LM-PCT (p< 0.0001, / = 0.35) and (p< 0.0001, V = 0.43), respectively. There was a gradual increase in the number of patients receiving LM-PCT from January 2011 to April 2014; 15.3%, 28.2%, 37.1% and 19.4%, respectively. Conclusion: In our center; at the end of life, there is a gradual increase in the number of patients receiving chemotherapy which significantly increased cancer patients’ odds without clear predictive factors associated with its use, which calls into question the benefits of PCT in terminally ill cancer patients.

  18. 76 FR 47596 - Notice of Scientific Summit; The Science of Compassion-Future Directions in End-of-Life and...

    Science.gov (United States)

    2011-08-05

    ...; The Science of Compassion--Future Directions in End-of-Life and Palliative Care SUMMARY: Notice is... science at the end-of-life. On August 11-12, the summit will feature keynote presentations, three plenary...), Department of Health and Human Services, will convene a scientific summit titled ``The Science of Compassion...

  19. Improving Gas Furnace Performance: A Field and Laboratory Study at End of Life

    Energy Technology Data Exchange (ETDEWEB)

    Brand, L. [Partnership for Advanced Residential Retrofit (PARR), Des Plaines, IL (United States); Yee, S. [Partnership for Advanced Residential Retrofit (PARR), Des Plaines, IL (United States); Baker, J. [Partnership for Advanced Residential Retrofit (PARR), Des Plaines, IL (United States)

    2015-02-01

    In 2010, natural gas provided 54% of total residential space heating energy the U.S. on a source basis, or 3.5 Quadrillion Btu. Natural gas burned in furnaces accounted for 92% of that total, and boilers and other equipment made up the remainder. A better understanding of installed furnace performance is a key to energy savings for this significant energy usage. In this project, the U.S. Department of Energy Building America team Partnership for Advanced Residential Retrofit examined the impact that common installation practices and age-induced equipment degradation may have on the installed performance of natural gas furnaces over the life of the product, as measured by steady-state efficiency and annual efficiency. The team identified 12 furnaces of various ages and efficiencies that were operating in residential homes in the Des Moines, Iowa, metropolitan area and worked with a local heating, ventilation, and air conditioning contractor to retrieve furnaces and test them at the Gas Technology Institute laboratory for steady-state efficiency and annual efficiency. Prior to removal, system airflow, static pressure, equipment temperature rise, and flue loss measurements were recorded for each furnace as installed in the house.

  20. Life shortening and carcinogenesis in mice irradiated at the perinatal period with gamma rays

    International Nuclear Information System (INIS)

    Sasaki, S.; Kasuga, T.

    1986-01-01

    This study elucidates the life-span radiation effects in mice irradiated at the perinatal period in comparison to mice irradiated at the young adult period. B6C3F 1 female mice were irradiated at 17 days of prenatal age, at 0 days of postnatal age, or as young adults at 15 weeks of age with 190, 380, or 570 rads of 137 Cs gamma rays. Mice irradiated at the late fetal period showed dose-dependent life shortening of somewhat lesser magnitude than that seen after neonatal or young adult irradiation. Mice exposed at the late fetal period were highly susceptible to induction of pituitary tumors for which the latent period was the longest of all induced neoplasms. Incidence of lung tumors in mice irradiated at the late fetal period with 190 and 380 rads was higher than in controls. Malignant lymphomas of the lymphocytic type developed in excess, after a short latent period, in mice irradiated fetally with the highest dose; susceptibility of prenatally exposed mice was lower than that of early postnatally exposed mice. Liver tumors developed more frequently in mice irradiated in utero than in controls; susceptibility to induction of this type of neoplasm was highest at the neonatal period. In general, carcinogenic response of mice exposed at the late fetal period resembled that of neonatally exposed mice but was quite different from that of young adult mice. Mice exposed as young adults have no, or low, susceptibility to induction of pituitary, lung, and liver tumors; and a higher susceptibility to induction of myeloid leukemias and Harderian gland tumors. 19 refs., 4 figs., 3 tabs

  1. The use of theory in qualitative approaches to research: application in end-of-life studies.

    Science.gov (United States)

    Wu, Hung-Lan; Volker, Deborah L

    2009-12-01

    This paper is a report of an analysis of the use of theory in qualitative approaches to research as exemplified in qualitative end-of-life studies. Nurses researchers turn to theory to conceptualize research problems and guide investigations. However, researchers using qualitative approaches do not consistently articulate how theory has been applied, and no clear consensus exists regarding the appropriate application of theory in qualitative studies. A review of qualitative, end-of-life studies is used to illustrate application of theory to study design and findings. A review of theoretical literature was carried out, focusing on definitions and use of theory in qualitative end-of-life studies published in English between 1990 and 2008. The term 'theory' continues to be used in a variety of ways by theorists and researchers. Within the reviewed end-of-life studies, the use of theory included theory creation or provision of a comparative framework for data analysis and interpretation. Implications for nursing. Nurses who conduct qualitative studies should examine the philosophical and theoretical bases of their selected methodological approach, articulate a theoretical framework that fits the phenomenon being studied, and adopt a critical, flexible and creative attitude when applying theory to a study. Theory can be put to several uses in qualitative inquiry and should guide nurse researchers as they develop and implement their studies. Nurse educators who teach qualitative approaches to research should emphasize a variety of ways to incorporate theory in qualitative designs.

  2. Export, metal recovery and the mobile phone end-of-life ecosystem

    NARCIS (Netherlands)

    Bollinger, L.A.; Blass, V.

    2012-01-01

    Against a background of rapidly growing mobile phone consumption in developing and emerging economies, falling use times and looming metal scarcity, finding better ways to deal with end-of-life (EoL) phones is imperative. The current dynamic in which large numbers of EoL phones are exported from

  3. Experiences and attitudes towards end-of-life decisions amongst Danish physicians

    DEFF Research Database (Denmark)

    Folker, Anna Paldam; Holtug, Nils; Jensen, Annette B

    1996-01-01

    In this survey we have investigated the experiences and attitudes of Danish physicians regarding end-of-life decisions. Most respondents have made decisions that involve hastening the death of a patient, and almost all find it acceptable to do so. Such decisions are made more often, and considered...

  4. Managing Bias in Palliative Care: Professional Hazards in Goals of Care Discussions at the End of Life.

    Science.gov (United States)

    Callaghan, Katharine A; Fanning, Joseph B

    2018-02-01

    In the setting of end-of-life care, biases can interfere with patient articulation of goals and hinder provision of patient-centered care. No studies have addressed clinician bias or bias management specific to goals of care discussions at the end of life. To identify and determine the prevalence of palliative care clinician biases and bias management strategies in end-of-life goals of care discussions. A semistructured interview guide with relevant domains was developed to facilitate data collection. Participants were asked directly to identify biases and bias management strategies applicable to this setting. Two researchers developed a codebook to identify themes using a 25% transcript sample through an iterative process based on grounded theory. Inter-rater reliability was evaluated using Cohen κ. It was 0.83, indicating near perfect agreement between coders. The data approach saturation. A purposive sampling of 20 palliative care clinicians in Middle Tennessee participated in interviews. The 20 clinicians interviewed identified 16 biases and 11 bias management strategies. The most frequently mentioned bias was a bias against aggressive treatment (n = 9), described as a clinician's assumption that most interventions at the end of life are not beneficial. The most frequently mentioned bias management strategy was self-recognition of bias (n = 17), described as acknowledging that bias is present. This is the first study identifying palliative care clinicians' biases and bias management strategies in end-of-life goals of care discussions.

  5. [The nursing role and ethical dimension of end of life care].

    Science.gov (United States)

    Daydé, Marie-Claude

    2016-02-01

    Supporting people in situations of precarity at the end of life is often fraught with complex problems, where one form of vulnerability amplifies another. This complexity requires interdisciplinary support, around the nursing care, to reflect together on the meaning of the action taken in an ethical approach. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  6. Medical futility and end-of-life care | Sidler | South African Medical ...

    African Journals Online (AJOL)

    treating physician is responsible for guiding this process by demonstrating sensitivity and compassion, respecting the values of patients, their families and the medical staff. The need for training to equip medical staff to take responsibility as empathetic participants in end-of-life decision-making is underscored. South African ...

  7. Use of irradiation in combination with preservation techniques to extend the shelf-life of tropical fruits and their products

    International Nuclear Information System (INIS)

    Noomhorm, A.; Ilangantileke, S.G.; Upadhyay, I.P.; Karki, D.B.; Apintanapong, M.

    1998-01-01

    Gamma irradiation in combination with other treatment processes was investigated with a view to extending the shelf-life of some tropical fruits in fresh and processed conditions. A low dose of irradiation (0.6 kGy) combined with hot water treatment (at 55 deg. C for 20 min) extended the shelf-life of fresh mangoes from 15 to 32 days at 20 deg. C storage. The shelf-life of fresh lychees was extended to 16 days by irradiation (1 kGy) and storage at 5 deg. C through reducing the rotting and preserving the fruit colour. A shelf-life of up to 30 days was obtained by a combination of hot benomyl dipping of the lychess (at 55 deg. C for 2 min) and polyethylene packaging, whereas modified atmosphere storage in CO 2 did not control pericarp browning. Irradiation as a means of preservation was investigated in processed fruits such as semi-dried mangoes and longans, and mango puree. A minimum dose of 2 kGy extended the shelf-life of the semi-dried mangoes and longans for up to 75 days when stored at 14 deg. C, without mould growth, whereas these fruits deteriorated at 30 deg. C storage, as indicated by discoloration and a deterioration in the flavour. On the other hand, doses of up to 4 kGy and storage at a low temperature (5 deg. C) were necessary to maintain microorganism growth (as determined by the aerobic plate count) at the lowest level; no microorganisms were observed at 6 kGy and higher. The chemical attributes of the puree tended to remain unaffected by the irradiation treatment but were more sensitive to the storage duration and conditions. The puree was preserved for as long as 60 days at 5 deg. C, without compromising the keeping quality. (author)

  8. End-of-Discharge and End-of-Life Prediction in Lithium-Ion Batteries with Electrochemistry-Based Aging Models

    Science.gov (United States)

    Daigle, Matthew; Kulkarni, Chetan S.

    2016-01-01

    As batteries become increasingly prevalent in complex systems such as aircraft and electric cars, monitoring and predicting battery state of charge and state of health becomes critical. In order to accurately predict the remaining battery power to support system operations for informed operational decision-making, age-dependent changes in dynamics must be accounted for. Using an electrochemistry-based model, we investigate how key parameters of the battery change as aging occurs, and develop models to describe aging through these key parameters. Using these models, we demonstrate how we can (i) accurately predict end-of-discharge for aged batteries, and (ii) predict the end-of-life of a battery as a function of anticipated usage. The approach is validated through an experimental set of randomized discharge profiles.

  9. Suitability of Dukat strawberries for studying effects on shelf life of irradiation combined with cold storage

    International Nuclear Information System (INIS)

    Zegota, H.

    1988-01-01

    A new Dukat variety of strawberries was used to study the effect of irradiation combined with cold storage on their shelf life and chemical composition. Strawberries, with or without stems, were irradiated with a dose of 2.5 or 3.0 kGy within 6-10 or 20-24 h after harvesting. Results of the sensory evaluation showed that the minimum storage time for the fruits could be extended by a minimum of 9 days. If the time between harvest and irradiation was shorter, better results for storage experiments were obtained. Fruits with stems were more suitable for cold storage after irradiation than those without stems. Irradiation of strawberries did not change the titratable acidity and content of the reducing sugars. Colour intensity and ascorbic acid levels decreased in proportion to the absorbed dose and storage time. (orig.)

  10. R and D for back-end options for irradiated research reactor fuel in Germany

    International Nuclear Information System (INIS)

    Bruecher, H.; Curtius, H.; Fachinger, J.

    2001-01-01

    Out of 11.5 t of irradiated fuel arising from German research reactors until the end of this decade, 3.9 t are intended to be returned to the USA, and 2.3 t are expected to be recycled for reuse of uranium. The remaining 5.3 t, as well as the fuel irradiated after the year 2010, will have to follow the domestic back-end option of extended dry interim storage in Castor-type casks, followed by disposal in a deep geological repository. R and D is going on in the Research Centre Juelich to investigate the long-term behaviour of U-Al based fuel in a salt repository. First results from leaching experiments show I) a fast dissolution of the fuel with mobilization of its radionuclide inventory, and 2) the following formation of amorphous Al-Mg-hydroxide phases. Long-lived actinides from the fuel were shown to be fixed in these phases and hence immobilized. Future R and D will be to investigate the nature and stability of these phases for long-term safety assessments. Investigations will have to be extended to cover alternative disposal sites (granite clay) as well as different (e.g. silicon based) fuels. (author)

  11. Comparative Effectiveness of Usual Source of Care Approaches to Improve End-of-Life Outcomes for Children With Intellectual Disability.

    Science.gov (United States)

    Lindley, Lisa C; Cozad, Melanie J

    2017-09-01

    Children with intellectual disability (ID) are at risk for adverse end-of-life outcomes including high emergency room utilization and hospital readmissions, along with low hospice enrollment. The objective of this study was to compare the effectiveness of usual source of care approaches to improve end-of-life outcomes for children with ID. We used longitudinal California Medicaid claims data. Children were included who were 21 years with fee-for-service Medicaid claims, died between January 1, 2007, and December 31, 2010, and had a moderate-to-profound ID diagnosis. End-of-life outcomes (i.e., hospice enrollment, emergency room utilization, hospital readmissions) were measured via claims data. Our treatments were usual source of care (USC) only vs. usual source of care plus targeted case management (USC plus TCM). Using instrumental variable analysis, we compared the effectiveness of treatments on end-of-life outcomes. Ten percent of children with ID enrolled in hospice, 73% used the emergency room, and 20% had three or more hospital admissions in their last year of life. USC plus TCM relative to USC only had no effect on hospice enrollment; however, it significantly reduced the probability of emergency room utilization (B = -1.29, P life outcomes for children with ID. Further study of the extent of UCS and TCM involvement in reducing emergency room utilization and hospital readmissions at end of life is needed. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  12. Caring to learn, learning to care: Inmate Hospice Volunteers and the Delivery of Prison End-of-Life Care

    Science.gov (United States)

    Cloyes, Kristin G.; Rosenkranz, Susan J.; Supiano, Katherine P.; Berry, Patricia H.; Routt, Meghan; Llanque, Sarah M.; Shannon-Dorcy, Kathleen

    2017-01-01

    The increasing numbers of aging and chronically ill prisoners incarcerated in Western nations is well documented, as is the growing need for prison-based palliative and end-of-life care. Less often discussed is specifically how end-of-life care can and should be provided, by whom, and with what resources. One strategy incorporates prisoner volunteers into end-of-life services within a peer care program. This article reports on one such program based on focused ethnographic study including in-depth interviews with inmate hospice volunteers, nursing staff, and corrections officers working in the hospice program. We describe how inmate volunteers learn hospice care through formal education and training, supervised practice, guidance from more experienced inmates, and support from correctional staff. We discuss how emergent values of mentorship and stewardship are seen by volunteers and staff as integral to prison hospice sustainability and discuss implications of this volunteer-centric model for response-ability for the end-of-life care of prisoners. PMID:28100141

  13. End-of-life care of women with gynecologic malignancies: a pilot study.

    Science.gov (United States)

    Nevadunsky, Nicole S; Spoozak, Lori; Gordon, Sharon; Rivera, Enid; Harris, Kimala; Goldberg, Gary L

    2013-03-01

    There are limited data regarding the end-of-life care for women with gynecologic malignancies. We set out to generate pilot data describing the care that women with gynecologic malignancies received in the last 6 months of life. Patient demographics, patterns of care, and utilization of palliative medicine consultation services were evaluated. One hundred patients who died of gynecologic malignancies were identified in our institutional database. Only patients who had received treatment with a gynecologic oncologist within 1 year of death were included. Medical records were reviewed for relevant information. Data were abstracted from the electronic medical record, and analyses were made using Student t test and Mann-Whitney U test with SPSS software. The mean age of patients was 60 years (range, 30-94 years). Racial/ethnic distribution was as follows: 38%, white; 34%, black; and 15%, Hispanic. Seventy-five percent of patients received chemotherapy within the last 6 months of life, and 30% received chemotherapy within the last 6 weeks of life. The median number of days hospitalized during the last 6 months of life was 24 (range, 0-183 days). During the last 6 months of life, 19% were admitted to the intensive care unit, 17% were intubated, 5% had terminal extubation, and 13% had cardiopulmonary resuscitative efforts. Sixty-four percent had a family meeting, 50% utilized hospice care, and 49% had palliative medicine consultations. There was a significant difference in hospice utilization when comparison was made between patients who had 14 days or more from consultation until death versus patients who had 14 days or less or no consultation, 21 (72%) versus 29 (41%), P = 0.004. Patients who were single were less likely to have a palliative medicine consultation, P = 0.005. End-of-life care for patients with gynecologic malignancies often includes futile, aggressive treatments and invasive procedures. It is unknown whether these measures contribute to longevity or

  14. Educational interventions to train healthcare professionals in end-of-life communication: a systematic review and meta-analysis.

    Science.gov (United States)

    Chung, Han-Oh; Oczkowski, Simon J W; Hanvey, Louise; Mbuagbaw, Lawrence; You, John J

    2016-04-29

    Practicing healthcare professionals and graduates exiting training programs are often ill-equipped to facilitate important discussions about end-of-life care with patients and their families. We conducted a systematic review to evaluate the effectiveness of educational interventions aimed at providing healthcare professionals with training in end-of-life communication skills, compared to usual curriculum. We searched MEDLINE, Embase, CINAHL, ERIC and the Cochrane Central Register of Controlled Trials from the date of inception to July 2014 for randomized control trials (RCT) and prospective observational studies of educational training interventions to train healthcare professionals in end-of-life communication skills. To be eligible, interventions had to provide communication skills training related to end-of-life decision making; other interventions (e.g. breaking bad news, providing palliation) were excluded. Our primary outcomes were self-efficacy, knowledge and end-of-life communication scores with standardized patient encounters. Sufficiently similar studies were pooled in a meta-analysis. The quality of evidence was assessed using GRADE. Of 5727 candidate articles, 20 studies (6 RCTs, 14 Observational) were included in this review. Compared to usual teaching, educational interventions to train healthcare professionals in end-of-life communication skills were associated with greater self-efficacy (8 studies, standardized mean difference [SMD] 0.57;95% confidence interval [CI] 0.40-0.75; P communication scores (8 studies, SMD 0.69; 95% CI 0.41-0.96; p communication training may improve healthcare professionals' self-efficacy, knowledge, and EoL communication scores compared to usual teaching. Further studies comparing two active educational interventions are recommended with a continued focus on contextually relevant high-level outcomes. PROSPERO CRD42014012913.

  15. ["Dignity" at the end of life: ethical and deontologic reflections].

    Science.gov (United States)

    Mazzon, Davide

    2015-12-01

    Bioethical reflection is often raised to qualify medical treatment in relation to the concept of "dignity" of the human being. In philosophy, the concept of human dignity is used to refer to the intrinsic value of every human being but it has been framed in many different ways depending on the theoretical matrix we refer to. According to Christian principles, the dignity of human beings resides on their being created in the image and likeness of God: hence, the holiness of life for the believer and the condemnation of all means of action intended to anticipate death from suicide to euthanasia. On the contrary, according to the liberal tradition, human dignity is especially expressed in the autonomy of every human being. The Italian and the German Constitutions recall the value of human dignity. In the article 32 of the Italian Constitution, the concept of dignity is taken into account when stating the autonomy of the individual decision-making about health treatment. This is confirmed by the Code of Medical Ethics (2014): the right to self-determination and the right of patients to decide for themselves in accordance with their own life plans, are at the core of the concept of "human dignity". For this reason, doctors should support and encourage the full right of every patient to be considered as an autonomous person until the end of life, affirming his dignity. The acronym ABCD (airway, breathing, circulation, drugs) synthetises the essentials of intensive care procedures in life-threatening events. The same acronym should guide our behavior in promoting dignity in clinical settings. Attitude: moving away from our certainties, to better understand the real nature of the sick person we are approaching. Behavior: always be inspired by kindness and respect. Compassion, that is, deep awareness of the suffering, coupled with the desire to bring relief. Dialogue, being open to know the human being "behind" disease. This approach, developed by Chochinov and called

  16. The Life Span of the BD-PND Bubble Detector

    International Nuclear Information System (INIS)

    Vanhavere, F.; Loos, M.; Thierens, H.

    1999-01-01

    BD-PND bubble detectors from Bubble Technology Industries (BTI) were used to conduct a study of the life span of these detectors. The manufacturer guarantees an optimum detector performance for three months after receipt. Nevertheless, it is important to know the evolution of their characteristics with time, also after those three months. On a standard set-up with a 252 Cf source the bubble detectors were irradiated until they reached the end of their life span. During this period, the evolution in sensitivity was monitored. The temperature compensating system seems to be the limiting factor with time for the use of the BTI bubble detectors. The change in temperature dependence with age was determined. The same parameters were also checked with several batches of detectors that were used in practice. (author)

  17. Advanced Cancer and End-of-Life Preferences: Curative Intent Surgery Versus Noncurative Intent Treatment.

    Science.gov (United States)

    Schubart, Jane R; Green, Michael J; Van Scoy, Lauren J; Lehman, Erik; Farace, Elana; Gusani, Niraj J; Levi, Benjamin H

    2015-12-01

    People with cancer face complex medical decisions, including whether to receive life-sustaining treatments at the end of life. It is not unusual for clinicians to make assumptions about patients' wishes based on whether they had previously chosen to pursue curative treatment. We hypothesized that cancer patients who initially underwent curative intent surgery (CIS) would prefer more aggressive end-of-life treatments compared to patients whose treatment was noncurative intent (non-CIT). This study was a retrospective review of data from a large, randomized controlled trial examining the use of an online decision aid for advance care planning, "Making Your Wishes Known" (MYWK), with patients who had advanced cancer. We reviewed patients' medical records to determine which patients underwent CIS versus non-CIT. In the parent trial, conducted at an academic medical center (2007-2012), 200 patients were enrolled with stage IV malignancy or other poor prognosis cancer. Patients' preferences for aggressive treatment were measured in two ways: using patient-selected General Wishes statements generated by the decision aid and patient-selected wishes for specific treatments under various hypothetical clinical scenarios (Specific Wishes). We evaluated 79 patients. Of these, 48 had undergone initial CIS and 31 had non-CIT. Cancer patients who initially underwent CIS did not prefer more aggressive end-of-life treatments compared to patients whose treatment was non-CIT. Clinicians should avoid assumptions about patients' preferences for life-sustaining treatment based on their prior choices for aggressive treatment.

  18. International Space Station End-of-Life Probabilistic Risk Assessment

    Science.gov (United States)

    Duncan, Gary W.

    2014-01-01

    The International Space Station (ISS) end-of-life (EOL) cycle is currently scheduled for 2020, although there are ongoing efforts to extend ISS life cycle through 2028. The EOL for the ISS will require deorbiting the ISS. This will be the largest manmade object ever to be de-orbited therefore safely deorbiting the station will be a very complex problem. This process is being planned by NASA and its international partners. Numerous factors will need to be considered to accomplish this such as target corridors, orbits, altitude, drag, maneuvering capabilities etc. The ISS EOL Probabilistic Risk Assessment (PRA) will play a part in this process by estimating the reliability of the hardware supplying the maneuvering capabilities. The PRA will model the probability of failure of the systems supplying and controlling the thrust needed to aid in the de-orbit maneuvering.

  19. Factors influencing the development of end-of-life communication skills: A focus group study of nursing and medical students.

    Science.gov (United States)

    Gillett, Karen; O'Neill, Bernadette; Bloomfield, Jacqueline G

    2016-01-01

    Poor communication between health care professionals and dying patients and their families results in complaints about end-of-life care. End-of-life communication skills should be a core part of nursing and medical education but research suggests that qualified doctors and nurses find this a challenging area of practice. The aim of this study was to explore factors influencing the development of end-of-life communication skills by nursing and medical students. A qualitative study comprising five focus groups. Second year undergraduate nursing (n=9 across 2 focus groups) and fourth year undergraduate medical students (n=10 across 3 focus groups) from a London University. Barriers and facilitators influenced nursing and medical students' experience of communication with dying patients and their families in clinical practice. Extrinsic barriers included gatekeeping by qualified staff and lack of opportunity to make sense of experiences through discussion. Intrinsic barriers included not knowing what to say, dealing with emotional responses, wasting patients' time, and concerns about their own ability to cope with distressing experiences. Facilitating factors included good role models, previous experience, and classroom input. In addition to clinical placements, formal opportunities for reflective discussion are necessary to facilitate the development of students' confidence and skills in end-of-life communication. For students and mentors to view end-of-life communication as a legitimate part of their learning it needs to be specified written practice-learning outcome. Mentors and supervisors may require training to enable them to facilitate students to develop end-of-life communication skills. Copyright © 2015 Elsevier Ltd. All rights reserved.

  20. Involvement of nurses in end-of-life discussions for severely disabled children

    NARCIS (Netherlands)

    Zaal-Schuller, I. H.; Willems, D. I.; Ewals, F.; van Goudoever, J. B.; de Vos, M. A.

    2018-01-01

    In children with profound intellectual and multiple disabilities (PIMD), discussions about end-of-life decisions (EoLDs) are comparatively common. Nurses play a crucial role in the care for these children, yet their involvement in EoLD discussions is largely unknown. The objective of this research

  1. [Ethical issues in the practice of advance directives, living wills, and self-determination in end of life care].

    Science.gov (United States)

    Fang, Hui-Feng; Jhing, Huei-Yu; Lin, Chia-Chin

    2009-02-01

    The Hospice-Palliative Care Act, enacted in Taiwan in 2000, was designed to respect the end of life medical wishes of patients with incurable illnesses, safeguard the rights of these patients, and provide clinical guidelines for healthcare workers responsible to provide end of life care. Self-determination is a core element of human dignity. Advance directive documents include a living will, and durable power of attorney for healthcare. This article reviews current issues and ethical dilemmas with regard to advance directives. Patients, family members, and clinicians may require better education on the Hospice-Palliative Care Act in order to respect more appropriately patient end of life medical care wishes.

  2. Medical end-of-life decisions: Does its use differ in vulnerable patient groups? A systematic review and meta-analysis

    NARCIS (Netherlands)

    Rietjens, J.A.C.; Deschepper, R.; Pasman, R.; Deliens, L.

    2012-01-01

    Medical end-of-life decisions, defined as end-of-life practices with a potential or certain life-shortening effect, precede almost 50% of deaths in Western countries, and receive ample medical-ethical attention. This systematic review aims to detect whether there are differences in the prevalence of

  3. The irradiation performance of austenitic stainless steel clade PWR fuel rods

    International Nuclear Information System (INIS)

    Teixeira e Silva, A.; Esteves, A.M.

    1988-01-01

    The steady state irradiation performance of austenitic stainless steel clad pressurized water reactor fuel rods is modeled with fuel performance codes of the FRAP series. These codes, originally developed to model the thermal-mechanical behavior of zircaloy clad fuel rods, are modified to model stainless steel clad fuel rods. The irradiation thermal-mechanical behavior of type 348 stainless steel and zircaloy fuel rods is compared. (author) [pt

  4. Negotiating end-of-life decision making: a comparison of Japanese and U.S. residents' approaches.

    Science.gov (United States)

    Gabbay, Baback B; Matsumura, Shinji; Etzioni, Shiri; Asch, Steven M; Rosenfeld, Kenneth E; Shiojiri, Toshiaki; Balingit, Peter P; Lorenz, Karl A

    2005-07-01

    To compare Japanese and U.S. resident physicians' attitudes, clinical experiences, and emotional responses regarding making disclosures to patients facing incurable illnesses. From September 2003 to June 2004, the authors used a ten-item self-administered anonymous questionnaire in a cross-sectional survey of 103 internal medicine residents at two U.S. sites in Los Angeles, California, and 244 general medical practice residents at five Japanese sites in Central Honshu, Kyushu, Okinawa, Japan. The Japanese residents were more likely to favor including the family in disclosing diagnosis (95% versus 45%, pguilt about these behaviors. The residents' approaches to end-of-life decision making reflect known cultural preferences related to the role of patients and their families. Although Japanese trainees were more likely to endorse the role of the family, they expressed greater uncertainty about their approach. Difficulty and uncertainty in end-of-life decision making were common among both the Japanese and U.S. residents. Both groups would benefit from ethical training to negotiate diverse, changing norms regarding end-of-life decision making.

  5. Negative effects of UVB-irradiated phytoplankton on life history traits and fitness of Daphnia magna

    NARCIS (Netherlands)

    Lange, de H.J.; Reeuwijk, van P.L.

    2003-01-01

    1. We tested the effect of ultraviolet-B (UVB)-irradiated phytoplankton on life history characteristics of Daphnia magna . Two phytoplankton species were used, Chlamydomonas reinhardtii and Cryptomonas pyrenoidifera . The phytoplankton species were cultured under photosynthetically active radiation

  6. Performance Evaluation of Open-Ended ELSS Mutual Fund ...

    African Journals Online (AJOL)

    This study examined the performance of the open-ended equity linked saving mutual fund schemes (ELSS) in India during the financial distress in 2008-2009. In this study, the month end net asset values of selected equity linked saving mutual fund schemes were considered and the data was obtained from the website of ...

  7. The family physician's perceived role in preventing and guiding hospital admissions at the end of life: a focus group study.

    Science.gov (United States)

    Reyniers, Thijs; Houttekier, Dirk; Pasman, H Roeline; Stichele, Robert Vander; Cohen, Joachim; Deliens, Luc

    2014-01-01

    Family physicians play a pivotal role in providing end-of-life care and in enabling terminally ill patients to die in familiar surroundings. The purpose of this study was to explore the family physicians' perceptions of their role and the difficulties they have in preventing and guiding hospital admissions at the end of life. Five focus groups were held with family physicians (N= 39) in Belgium. Discussions were transcribed verbatim and analyzed using a constant comparative approach. Five key roles in preventing and guiding hospital admissions at the end of life were identified: as a care planner, anticipating future scenarios; as an initiator of decisions in acute situations, mostly in an advisory manner; as a provider of end-of-life care, in which competency and attitude is considered important; as a provider of support, particularly by being available during acute situations; and as a decision maker, taking overall responsibility. Family physicians face many different and complex roles and difficulties in preventing and guiding hospital admissions at the end of life. Enhancing the family physician's role as a gatekeeper to hospital services, offering the physicians more end-of-life care training, and developing or expanding initiatives to support them could contribute to a lower proportion of hospital admissions at the end of life. © 2014 Annals of Family Medicine, Inc.

  8. Irradiation of full size UMo plates

    International Nuclear Information System (INIS)

    Vacelet, H.; Lavastre, Y.; Grasse, M.; Sacristan, P.; Languille, A.

    1999-01-01

    An important development program for a UMo MTR fuel has been launched in France. The goal of the French working group is to develop a high performing and reprocessable fuel before the end of the US return policy. This paper is focussed on the fabrication of full-sized UMo plates with LEU (Low Enriched Enrichment) and their irradiation in OSIRIS reactor which was started on the 22nd of September. The results of the plates inspection are presented here as well as the irradiation conditions. (author)

  9. Effect of Enzyme Supplementation and Irradiation of Barley on Broiler Chicks Performance

    International Nuclear Information System (INIS)

    Farag, D.H.M.; Abd El-Hakeim, N.F.

    1999-01-01

    The experiments were conducted to study the influence of irradiation treatment at dose levels of 0.20 and 60 kGy on barley beta-glucan and the effect of enzyme supplementation and irradiation of barley on broiler chicks performance. The amount of total and water-soluble beta-glucan in raw barley was 36 kg -1 , respectively. The effect of irradiation treatment on total beta-glucan was insignificant while the level of soluble beta-glucan was increased with increasing the dose levels of irradiation. The effect of irradiation treatment and enzyme supplementation of barley diets on growth and conversion performance of broiler chicks indicated that birds fed raw barley diet had lower body weight, body weight gain and feed conversion than those fed control diet throughout the experimental period. Irradiation of barley at dose of 20 kGy did not affect the chick performance (feed consumption, weight gain feed-gain ratio) that received the B 20 diet from 7 to 21 days of age, but when bird maintained on B 20 diet from 7 28 days of age, only feed-gain ratio was improved by 14.4%. The results indicate that there was a significant effect of irradiation of barley at 60 kGy (B 60) on feed -gain ratio of chicks when were fed B 60 diet from 7 to 21 days of age. The corresponding improvement in feed-gain ratio was 16.4%. When birds were fed B 60 diet from 7-28 days of age, the improvement in body weight and feed-gain ratio was 25.5 and 19.6%, respectively

  10. Mapping hospice patients' perception and verbal communication of end-of-life needs: an exploratory mixed methods inquiry

    Directory of Open Access Journals (Sweden)

    Arnold Bruce L

    2011-01-01

    Full Text Available Abstract Background Comprehensive "Total Pain" assessments of patients' end-of-life needs are critical for providing improved patient-clinician communication, assessing needs, and offering high quality palliative care. However, patients' needs-based research methodologies and findings remain highly diverse with their lack of consensus preventing optimum needs assessments and care planning. Mixed-methods is an underused yet robust "patient-based" approach for reported lived experiences to map both the incidence and prevalence of what patients perceive as important end of life needs. Methods Findings often include methodological artifacts and their own selection bias. Moving beyond diverse findings therefore requires revisiting methodological choices. A mixed methods research cross-sectional design is therefore used to reduce limitations inherent in both qualitative and quantitative methodologies. Audio-taped phenomenological "thinking aloud" interviews of a purposive sample of 30 hospice patients are used to identify their vocabulary for communicating perceptions of end-of-life needs. Grounded theory procedures assisted by QSR-NVivo software is then used for discovering domains of needs embedded in the interview narratives. Summary findings are translated into quantified format for presentation and analytical purposes. Results Findings from this mixed-methods feasibility study indicate patients' narratives represent 7 core domains of end-of-life needs. These are (1 time, (2 social, (3 physiological, (4 death and dying, (5 safety, (6 spirituality, (7 change & adaptation. The prevalence, rather than just the occurrence, of patients' reported needs provides further insight into their relative importance. Conclusion Patients' perceptions of end-of-life needs are multidimensional, often ambiguous and uncertain. Mixed methodology appears to hold considerable promise for unpacking both the occurrence and prevalence of cognitive structures represented by

  11. Inert medium (helium) irradiation testing of pressure tube samples

    International Nuclear Information System (INIS)

    Ancuta, M.; Radu, V.; Stefan, V.; Preda, M.

    2001-01-01

    Irradiation tests currently performed in C-5 capsule aim at obtaining data and information concerning behavior to irradiation of pressure tubes of CANDU type fuel channel, to evidence the factors limiting operation life span. A calculation code for analysis and prediction of pressure tube behavior should be based upon periodical inspection results, post irradiation examination of the removed from reactor pressure tubes as well as on the experimental results obtained with materials subjected to irradiation conditions identical with the operational ones. Mechanical behavior analysis should focus both complex thermal-mechanical type stresses and mechanical properties alteration under irradiation. The experimental results should be applied: - to evaluate the irradiation effects upon mechanical properties of Zr-2.5% Nb exposed to fluences up to 10 21 n·cm -2 ; - to gather data concerning the real stress / real deformation characteristic from which characteristic quantities can be deduced as, for instance, elasticity modulus, plasticity modulus, exponent of stress term in the Tsu-Berteles relation, to be used within the CANTUP simulation code describing pressure tube behavior, currently developed at INR Pitesti; - to develop prediction methods of pressure tube behavior and merging with in-service inspection procedure in order to forecast the life span and the proper timing for replacement before major failures occur. The samples irradiated in C-5 capsule were extracted from the ends of Zr-2.5% Nb pressure tubes resulting from Cernavoda NPP Unit 1. The samples for tensile tests were extracted on longitudinal and transversal directions of the pressure tube. The tests were carried out under following conditions: - test environment temperature, 260 - 280 deg.C; - testing medium, helium at 1 - 6 b pressure; - neutron flux (E n > 1 MeV), 1 - 2 · 10 13 ncm -2 s -1 ; - neutron fluence (E n > 1 MeV), 4 · 10 20 ncm -2 . The following characteristics were obtained from tensile

  12. Roman concept of mental capacity to make end-of-life decisions.

    Science.gov (United States)

    Mendelson, Danuta

    2007-01-01

    When assessing decisional competence of patients, psychiatrists have to balance the patients' right to personal autonomy, their condition and wishes against principles of medical ethics and professional discretion. This article explores the age-old legal and ethical dilemmas posed by refusal of vital medical treatment by patients and their mental capacity to make end-of-life decisions against the background of philosophical, legal and medical approaches to these issues in the time of the Younger Pliny (c62-c113 CE). Classical Roman discourse regarding mental competency and "voluntary death" formed an important theme of the vast corpus of Greco-Roman writings, which was moulded not only by legal permissibility of suicide but also by philosophical (in modern terms, moral or ethical) considerations. Indeed, the legal and ethical issues of evaluating the acceptability of end of life decisions discussed in the Letters are as pertinent today as they were 2000 years ago. We may gain valuable insights about our own methodologies and frames of reference in this area of the law and psychiatry by examining Classical Roman approaches to evaluating acceptability of death-choices as described in Pliny's Letters and the writings of some of his peers.

  13. Advancing palliative and end-of-life science in cardiorespiratory populations: The contributions of nursing science.

    Science.gov (United States)

    Grady, Patricia A

    Nursing science has a critical role to inform practice, promote health, and improve the lives of individuals across the lifespan who face the challenges of advanced cardiorespiratory disease. Since 1997, the National Institute of Nursing Research (NINR) has focused attention on the importance of palliative and end-of-life care for advanced heart failure and advanced pulmonary disease through the publication of multiple funding opportunity announcements and by supporting a cadre of nurse scientists that will continue to address new priorities and future directions for advancing palliative and end-of-life science in cardiorespiratory populations. Published by Elsevier Inc.

  14. Experience with an end-of-life practice at a university hospital.

    Science.gov (United States)

    Campbell, M L; Frank, R R

    1997-01-01

    To describe a 10-yr experience with an end-of-life practice in a hospital. A nonexperimental, prospective, descriptive design was used to record variables from a convenience sample of patients transferred to the Comprehensive Supportive Care Team. Detroit Receiving Hospital is an urban, university-affiliated, Level I trauma/emergency hospital. Patients who are not expected to survive hospitalization, and for whom a decision has been made to focus care on palliative interventions, are candidates for care by this practice. None. Patient demographics, including the following information: age, gender; diagnoses; illness severity; mortality rate; and disposition. Measures of resource utilization included: referral sources; Therapeutic intervention Scoring System values; bed costs; and length of hospital stay. Satisfactory patient/family care with a measurable reeducation in the use of resources can be achieved in the hospital setting. A hands-on approach to the care of dying patients by this specialty, palliative care service has provided patients, families, and clinicians with the type of support needed for satisfactory end-of-life care. A summary of our experience may be useful to others.

  15. End-of-Life Care Interventions: An Economic Analysis.

    Science.gov (United States)

    Pham, B; Krahn, M

    2014-01-01

    The annual cost of providing care for patients in their last year of life is estimated to account for approximately 9% of the Ontario health care budget. Access to integrated, comprehensive support and pain/symptom management appears to be inadequate and inequitable. To evaluate the cost-effectiveness of end-of-life (EoL) care interventions included in the EoL care mega-analysis. Multiple sources were used, including systematic reviews, linked health administration databases, survey data, planning documents, expert input, and additional literature searches. We conducted a literature review of cost-effectiveness studies to inform the primary economic analysis. We conducted the primary economic analysis and budget impact analysis for an Ontario cohort of decedents and their families and included interventions pertaining to team-based models of care, patient care planning discussions, educational interventions for patients and caregivers, and supportive interventions for informal caregivers. The time horizon was the last year of life. Costs were in 2013 Canadian dollars. Effectiveness measures included days at home, percentage dying at home, and quality-adjusted life-days. We developed a Markov model; model inputs were obtained from a cohort of Ontario decedents assembled from Institute for Clinical Evaluative Sciences databases and published literature. In-home palliative team care was cost-effective; it increased the chance of dying at home by 10%, increased the average number of days at home (6 days) and quality-adjusted life-days (0.5 days), and it reduced costs by approximately $4,400 per patient. Expanding in-home palliative team care to those currently not receiving such services (approximately 45,000 per year, at an annual cost of $76-108 million) is likely to improve quality of life, reduce the use of acute care resources, and save $191-$385 million in health care costs. Results for the other interventions were uncertain. The cost-effectiveness analysis was

  16. SP-100 Fuel Pin Performance: Results from Irradiation Testing

    Science.gov (United States)

    Makenas, Bruce J.; Paxton, Dean M.; Vaidyanathan, Swaminathan; Marietta, Martin; Hoth, Carl W.

    1994-07-01

    A total of 86 experimental fuel pins with various fuel, liner, and cladding candidate materials have been irradiated in the Experimental Breeder Reactor-II (EBR-II) and the Fast Flux Test Facility (FFTF) reactor as part of the SP-100 fuel pin irradiation testing program. Postirradiation examination results from these fuel pins are key in establishing performance correlations and demonstrating the lifetime and safety of the reactor fuel system. This paper provides a brief description of the in-reactor fuel pin tests and presents the most recent irradiation data on the performance of wrought rhenium (Re) liner material and high density UN fuel at goal burnup of 6 atom percent (at. %). It also provides an overview of the significant variety of other fuel/liner/cladding combinations which were irradiated as part of this program and which may be of interest to more advanced efforts.

  17. GPs and end of life decisions : views and experiences

    OpenAIRE

    Abela, Jurgen

    2015-01-01

    The views and experiences of GPs with respect to end of life (EoL) care are seldom addressed. The aim of this article is to better understand this aspect of care. A cross-sectional survey of all doctors in the country was designed and set up. The overall response was 396 (39.7%), 160 of which were GPs. 28.7% of GPs received no formal training in palliative medicine. 89.8% of respondents declared that their religion was important in EoL care. 45.3% agreed with the right of a patient to decide ...

  18. Nurses' care practices at the end of life in intensive care units in Bahrain.

    Science.gov (United States)

    O'Neill, Catherine S; Yaqoob, Maryam; Faraj, Sumaya; O'Neill, Carla L

    2017-12-01

    The process of dying in intensive care units is complex as the technological environment shapes clinical decisions. Decisions at the end of life require the involvement of patient, families and healthcare professionals. The degree of involvement can vary depending on the professional and social culture of the unit. Nurses have an important role to play in caring for dying patients and their families; however, their knowledge is not always sought. This study explored nurses' care practices at the end of life, with the objective of describing and identifying end of life care practices that nurses contribute to, with an emphasis on culture, religious experiences and professional identity. Research Design and context: Grounded theory was used. In all, 10 nurses from intensive care unit in two large hospitals in Bahrain were participated. Ethical Considerations: Approval to carry out the research was given by the Research Ethics Committee of the host institution, and the two hospitals. A core category, Death Avoidance Talk, was emerged. This was supported by two major categories: (1) order-oriented care and (2) signalling death and care shifting. Death talk was avoided by the nurses, doctors and family members. When a decision was made by the medical team that a patient was not to be resuscitated, the nurses took this as a sign that death was imminent. This led to a process of signalling death to family and of shifting care to family members. Despite the avoidance of death talk and nurses' lack of professional autonomy, they created awareness that death was imminent to family members and ensured that end of life care was given in a culturally sensitive manner and aligned to Islamic values.

  19. Recent irradiation tests for future nuclear system at HANARO

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Man Soon; Choo, Kee Nam; Yang, Seong Woo; Park, Sang Jun [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

    2016-05-15

    The capsule at HANARO is a device that evaluates the irradiation effects of nuclear materials and fuels, which can reproduce the environment of nuclear power plants and accelerate to reach to the end of life condition. As the integrity assessment and the extension of lifetime of nuclear power plants are recently considered as important issues in Korea, the requirements for irradiation test are gradually being increased. The capacity and capability irradiation tests at HANARO are becoming important because Korea strives to develop SFR (Sodium-cooled Fast Reactor) and VHTR (Very High Temperature Reactor) among the future nuclear system and to export the research reactors and to develop the fusion reactor technology.

  20. Alloy development for irradiation performance. Quarterly progress report for period ending December 31, 1980

    International Nuclear Information System (INIS)

    1981-04-01

    Progress is reported in eight sections: analysis and evaluation studies, test matrices and test methods development, Path A Alloy Development (austenitic stainless steels), Path C Alloy Development (Ti and V alloys), Path D Alloy Development (Fe alloys), Path E Alloy Development (ferritic steels), irradiation experiments and materials inventory, and materials compatibility and hydrogen permeation studies