Sample records for patients eventually died

  1. The Angry Dying Patient. (United States)

    Houston, Robert E.


    Over 25 years ago, Kubler-Ross identified anger as a predictable part of the dying process. When the dying patient becomes angry in the clinical setting, all types of communication become strained. Physicians can help the angry dying patient through this difficult time by using 10 rules of engagement. When physicians engage and empathize with these patients, they improve the patient's response to pain and they reduce patient suffering. When physicians educate patients on their normal responses to dying and enlist them in the process of family reconciliation, they can impact the end-of-life experience in a positive way.

  2. The eventual outcome of patients who had lower limb amputations ...

    African Journals Online (AJOL)

    C De Klerk

    Background: Peripheral vascular disease (PVD) presenting with irreversible lower limb pathology has a high morbidity and mortality rate. This study aimed to determine the outcome of patients who underwent lower limb amputations (LLAs) because of PVD at Pelonomi Hospital, Bloemfontein, 2008–2011. Methods: ...

  3. Patient and family physician preferences for care and communication in the eventuality of anthrax terrorism. (United States)

    Kahan, Ernesto; Fogelman, Yacov; Kitai, Eliezer; Vinker, Shlomo


    The threat of bioterrorism consequent to the September 11, 2001 attack in the USA generated suggestions for improved medical response mainly through hospital preparedness. The aim of the present study was to investigate the impact of this period of tension on patients' first choice for care and for receiving relevant information, and on primary care doctors' feelings of responsibility in the eventuality of an anthrax attack. During October 11-31, 2001, 500 patients from 30 clinics throughout Israel were asked to complete a questionnaire on their awareness of the anthrax threat, measures taken to prepare for it, and preferred sources of care and information. Their 30 physicians, and an additional 20, completed a questionnaire on knowledge about anthrax and anthrax-related patient behaviours and clinic visits. The outstanding finding was the low rate (30%) of patients who chose the hospital emergency department as their first choice for care or information if they were worried about an anthrax attack or the media communicated that an attack was in progress. The other two-thirds preferred their family doctor or the health authorities. Most of the physicians (89%) felt it was their responsibility to treat anthrax-infected patients and that they should therefore be supplied with appropriate guidelines. This study suggests that in Israel, a country with a high degree of awareness of civil defence aspects, both patients and primary care doctors believe that family physicians should have a major role in the case of bioterrorist attacks. This must be seriously considered during formulation of relevant health services programmes.

  4. Ab initio vel ex eventu (United States)

    Thiessen, P. A.; Treder, H.-J.

    Der gegenwärtige Stand der physikalischen Erkenntnis, in Sonderheit die Atomistik und die Quantentheorie, ermöglicht (in wohldefinierten Energie-Bereichen) eine ab initio-Berechnung aller physikalischen und chemischen Prozesse und Strukturen. Die Schrödinger-Gleichung erlaubt zusammen mit den Prinzipien der Quantenstatistik (Pauli-Prinzip) aus dem Planckschen Wirkungsquantum h und den atomischen Konstanten die Berechnung aller Energieumsätze, Zeitabläufe etc., die insbesondere die chemische Physik bestimmen. Die Rechenresultate gelten auch quantitativ bis auf die unvermeidliche Stochastik.Die ab initio-Berechnungen korrespondieren einerseits und sind andererseits komplementär zu den auf den Methoden der theoretischen Chemie und der klassischen Thermodynamik beruhenden Ergebnissen ex eventu. Die theoretische Behandlung ab initio führt zu mathematischen Experimenten, die die Laboratoriums-Experimente ergänzen oder auch substituieren.Translated AbstractAb initio vel ex eventuThe present state of physical knowledge, in peculiar atomistic and quantum theory, makes an ab initio calculation of all physical and chemical processes and structures possible (in well defined reaches of energy). The Schrödinger equation together with the principles of quantum statistics (Pauli principle) permits from the Planck and atomistic constants to calculate all exchanges of energy, courses of time, etc. which govern chemical physics. The calculated results are valid even quantitatively apart from the unavoidable stochastics.These ab initio calculations on the one hand correspond and are on the other complimentary to results ex eventu based on the methods of theoretical chemistry and classical thermodynamics. Theoretical treatment ab initio leads to mathematical experiments which add to or even substitute experiments in the laboratory.

  5. Enabling ICU patients to die at home. (United States)

    Battle, Emma; Bates, Lucy; Liderth, Emma; Jones, Samantha; Sheen, Sheryl; Ginty, Andrew; Northmore, Melanie


    There is often an overlap between intensive care medicine and palliative medicine. When all curative treatment options have been explored, keeping the patient comfortable and free from pain is the main concern for healthcare practitioners. Patient autonomy in end of life decisions has not been encouraged in the intensive care unit (ICU), until now, because of its specialised and technical nature. Staff at the Royal Bolton Hospital have broken down the barriers to enabling ICU patients to die in their own homes, and have developed a system of collaborative working that can help to fulfil a patient's final wish to go home. This article describes how ICU staff developed a process that enabled two ventilated patients to be transferred home for end of life care.

  6. Health care practitioners and dying patients

    Directory of Open Access Journals (Sweden)

    Panagiotis Pentaris


    Full Text Available A full understanding of and a competent approach to dying patients may lead to a more qualitative service delivery, an enhanced quality of life paradigms, and the patients’ wellbeing, all of which remain the ultimate goal of health care practice. The modern world has developed in parallel with secularism and religious diversity. This paper aims to illustrate the secularization process in Britain (with indications of generalized meanings and juxtaposes it with a description of the needs of dying patients regarding the meanings of religion and nonreligion. Although this paper draws on and provides a review of selected theoretical literature, it also addresses a significant challenge: the lack of scientifi c research on the subject. Hence, this paper aims to give an overview of the issues, but not synthesise them. The arguments that are elaborated in the paper are also supported by the author’s current research project in the city of London. The approach here is client oriented, and concerns social and health care. Practitioners ought to become competent, and maintain their competence throughout their professional career. Religious competence seems to have not been at the centre of discussions, regardless of the historical pathway that religious discourse has drawn since the beginnings of humanity. The paper concludes with certain suggestions for future research and inclusive approaches regarding religious matters.

  7. Patients who die during palliative radiotherapy. Status survey

    Energy Technology Data Exchange (ETDEWEB)

    Berger, B.; Ankele, H.; Bamberg, M.; Zips, D. [University of Tuebingen, Department of Radiation Oncology, Tuebingen (Germany)


    Palliative radiotherapy (RT) is routinely used in end of life care of patients with advanced malignancies; however, unnecessarily burdensome treatment shortly before death should be avoided. There is little knowledge on incidence and causes of intercurrent deaths during palliative RT. In this study death events among inpatients receiving palliative RT between January 2009 and December 2011 at this department were retrospectively analyzed. Among epidemiological factors, treatment schedule and chronology, latency and duration of treatment in relation to the actual survival were identified. In this study 52 patients died during or shortly after palliative RT. Symptomatic bone metastases and brain metastases represented the most common RT indications. The general health status was poor with a median Karnofsky performance score of 50 %, RT was realized with a median single dose of 2.5 Gy to a median total dose of 30.5 Gy and was stopped prematurely in 73 % of patients. On average 53 % of the remaining lifetime was occupied by latency to starting RT. Once RT was begun the treatment duration required a median 64 % of the still remaining lifetime. The majority of patients who died had explicitly adverse pre-existing factors and rarely completed RT as scheduled. Latency to RT and RT duration occupied more than half of the remaining lifetime. (orig.) [German] Die palliative Radiotherapie (RT) hat einen hohen Stellenwert in der Symptomenkontrolle terminal erkrankter Tumorpatienten. Unnoetig belastende Therapien kurz vor Lebensende sollten jedoch vermieden werden. Bislang gibt es kaum strukturierte Daten ueber Sterbefaelle unter palliativer RT. Im Rahmen der vorgestellten Studie wurden die Sterbefaelle unter stationaer palliativ bestrahlten Patienten der eigenen Abteilung zwischen Januar 2009 und Dezember 2011 analysiert. Ausgewertet wurden epidemiologische Faktoren, Behandlungskonzept und -verlauf. Zeit bis zum RT-Beginn und RT-Dauer wurden ins Verhaeltnis zur tatsaechlichen

  8. Dying with dignity: the good patient versus the good death. (United States)

    Proulx, Kathryn; Jacelon, Cynthia


    Death is a unique experience for each human being, yet there is tremendous societal pressure on a dying person to be a "goodpatient " while trying to experience the "good death. " These pressures shape patient, caregiver, and family choices in end-of-life situations. The purpose of this literature review was twofold: first, to develop an understanding of "dying with dignity" to enhance the end-of-life care received by dying patients, and second, to contribute to a concept analysis of dignity to improve the clarity and consistency of future research related to dignity in aging individuals. Articles pertaining to dying with dignity from the disciplines of nursing, medicine, ethics, psychology, and sociology were reviewed using a matrix method. A dichotomy surrounding dying with dignity emerged from this review. The definition of dignity in dying identifies not only an intrinsic, unconditional quality of human worth, but also the external qualities of physical comfort, autonomy, meaningfulness, usefulness, preparedness, and interpersonal connection. For many elderly individuals, death is a process, rather than a moment in time, resting on a need for balance between the technology of science and the transcendence of spirituality.

  9. When LVAD Patients Die: The Caregiver's Mourning. (United States)

    Rossi Ferrario, Silvia; Omarini, Pierangela; Cerutti, Paola; Balestroni, Giangluigi; Omarini, Giovanna; Pistono, Massimo


    Left ventricular assist devices (LVADs) have progressively evolved, particularly in the last 10 years, to serve patients affected by severe heart failure as a bridge to transplant or destination therapy. The survival rate and quality of life of pre- and postimplant patients, as well as caregivers' perceptions and distress, are under investigation by the scientific community. But what caregivers think and feel after the loss of their loved one has not so far been examined. We contacted 16 principal caregivers of deceased LVAD patients by telephone. They were asked to evaluate their experience with LVADs and were administered a specific questionnaire about their mourning, the Caregiver Mourning Questionnaire (CMQ), to evaluate their perceptions of the physical, emotional, and social support-related problems that they had experienced during the previous 3 months. Positive aspects reported by the caregivers were the patient's overall subjective well-being and increased survival. Negative aspects were the difficulty to manage infections and the driveline, and the incomplete autonomy of the patient. Half of the caregivers reported not being preadvised about many of the problems they would face. The CMQ revealed that numerous caregivers had health problems, difficulty in sleeping, eating disorders, lack of energy, and loneliness. Use of psychotropic drugs and regrets about how they assisted their loved one also emerged. In conclusion, caregivers of LVAD patients may experience complicated mourning. Our data support in particular the need for an early intervention of palliative care which could prevent or reduce complicated mourning. Copyright © 2015 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  10. Barriers to Quality Care for Dying Patients in Rural Communities (United States)

    Van Vorst, Rebecca F.; Crane, Lori A.; Barton, Phoebe Lindsey; Kutner, Jean S.; Kallail, K. James; Westfall, John M.


    Context: Barriers to providing optimal palliative care in rural communities are not well understood. Purpose: To identify health care personnel's perceptions of the care provided to dying patients in rural Kansas and Colorado and to identify barriers to providing optimal care. Methods: An anonymous self-administered survey was sent to health care…

  11. Patients who die during palliative radiotherapy. Status survey

    International Nuclear Information System (INIS)

    Berger, B.; Ankele, H.; Bamberg, M.; Zips, D.


    Palliative radiotherapy (RT) is routinely used in end of life care of patients with advanced malignancies; however, unnecessarily burdensome treatment shortly before death should be avoided. There is little knowledge on incidence and causes of intercurrent deaths during palliative RT. In this study death events among inpatients receiving palliative RT between January 2009 and December 2011 at this department were retrospectively analyzed. Among epidemiological factors, treatment schedule and chronology, latency and duration of treatment in relation to the actual survival were identified. In this study 52 patients died during or shortly after palliative RT. Symptomatic bone metastases and brain metastases represented the most common RT indications. The general health status was poor with a median Karnofsky performance score of 50 %, RT was realized with a median single dose of 2.5 Gy to a median total dose of 30.5 Gy and was stopped prematurely in 73 % of patients. On average 53 % of the remaining lifetime was occupied by latency to starting RT. Once RT was begun the treatment duration required a median 64 % of the still remaining lifetime. The majority of patients who died had explicitly adverse pre-existing factors and rarely completed RT as scheduled. Latency to RT and RT duration occupied more than half of the remaining lifetime. (orig.) [de

  12. The Lived Experiences of Nurses Caring For Dying Pediatric Patients. (United States)

    Curcio, Danna L


    Nurses and healthcare professionals may have difficulty adjusting to and comprehending their experiences when a patient’s life ends. This has the potential to interfere with patient care. Reflection on past events and actions enables critical discovery of strategies to benefit both nurses and patients. This qualitative phenomenological study explores the lived experiences of nurses caring for dying pediatric patients. The philosophical underpinning of Merleau-Ponty (2008), in combination with the research method of van Manen (1990), was used for this study. The Roy Adaptation Model (RAM) (Roy, 2009; Roy & Andrews, 1991) was the nursing model that guided the study to help understand that nurses are an adaptive system, using censoring as a compensatory adaptive process to help function for a purposeful cause. Nine female nurse participants with one to four years of experience were interviewed. The context of the experiences told by nurses caring for dying pediatric patents uncovered seven essential themes of empathy, feelings of ambivalence, inevitability, inspiration, relationship, self-preservation, and sorrow, and these themes demonstrated a connection formed between the nurse and the patient.

  13. Experiences of Family Members of Dying Patients Receiving Palliative Sedation. (United States)

    Tursunov, Olga; Cherny, Nathan I; Ganz, Freda DeKeyser


    To describe the experience of family members of patients receiving palliative sedation at the initiation of treatment and after the patient has died and to compare these experiences over time.
. Descriptive comparative study.
. Oncology ward at Shaare Zedek Medical Center in Jerusalem, Israel.
. A convenience sample of 34 family members of dying patients receiving palliative sedation. 
. A modified version of a questionnaire describing experiences of family members with palliative sedation was administered during palliative sedation and one to four months after the patient died. Descriptive statistics were used to describe the results of the questionnaire, and appropriate statistical analyses were conducted for comparisons over time.
. Experiences of family members and time.
. Most relatives were satisfied with the sedation and staff support. Palliative sedation was experienced as an ethical way to relieve suffering. However, one-third felt that it shortened the patient's life. An explanation of the treatment was given less than half of the time and was usually given on the same day treatment was started. This explanation was given by physicians and nurses. Many felt that they were not ready for changes in the patient's condition and wanted increased opportunities to discuss the treatment with oncology care providers. No statistically significant differences in experiences were found over time. 
. Relatives' experiences of palliative sedation were generally positive and stable over time. Important experiences included timing of the initiation of sedation, timing and quality of explanations, and communication.
. Nurses should attempt to initiate discussions of the possible role of sedation in the event of refractory symptoms and follow through with continued discussions. The management of refractory symptoms at the end of life, the role of sedation, and communication skills associated with decision making related to palliative sedation should be a

  14. Comparing quality of dying and death perceived by family members and nurses for patients dying in US and Dutch ICUs

    DEFF Research Database (Denmark)

    Gerritsen, Rik T; Koopmans, Matty; Hofhuis, José G M


    with 8 higher in the US and 2 higher in NL. CONCLUSION: The QODD was rated similarly by family members in the US and the Netherlands but varied when assessed by nurses. These differences may be due to organizational or cultural differences between the two countries or to expectations of respondents.......BACKGROUND: The Quality of Dying and Death (QODD) questionnaire is used as a self-reported measure to allow families and clinicians to assess patients' quality of dying and death. We evaluated end-of-life (EOL) experiences as measured by the QODD completed by families and nurses in the United...... States (US) and the Netherlands (NL) to explore similarities and differences in these experiences and identify opportunities for improving EOL care. METHODS: Questionnaire data were gathered from family members of patients dying in the ICU and nurses caring for these patients. In NL, data were gathered...

  15. The Transformation Process in Nurses Caring for Dying Patients. (United States)

    Huang, Ching-Chi; Chen, Jih-Yuan; Chiang, Hsien-Hsien


    Despite the recent increase in attention to end-of-life hospice care, little empirical evidence regarding the process of emotional or mental transformation in caregivers is available. This study explores the transformative process that occurs in nurses because of the spiritual suffering and conflict associated with after caring for dying patients. A phenomenological approach was used to investigate eight nurses (27-40 years old) working in the hospice ward of a medical center in Taipei. Data were collected through open-ended questions using semistructured interviews and were analyzed reflectively. A three-stage transformation in the emotional processes of participants was observed. In the first stage, the participants experienced acute emotional suffering because of facing the death of their patients, potentially exacerbated by their own memories of losing family members. In the second stage, the participants adopted coping strategies to improve self-care. These strategies included attempting to soothe patients, helping patients face or deal with unfulfilled business, and participating in funeral or memorial services. In the third stage, the participants learned to provide better care through emancipatory reflection and a reassertion of responsibilities toward the self, patients, and patient families. After the third stage, the initial emotional impact morphed into a medium for self-strengthening, and participants became more adept at detecting patient needs and at providing care to complete the transformational process fully. Emotional suffering was the primary factor that induced participants to transform their personal and professional selves. Adequate emotional self-management, dialogue with other nurses, and personal reflection are crucial actions that nurses may use to cultivate personal growth, implement ethical practice, interact with other nurses, and engage in personal reflection. Strategies such as caring for patients, implementing reflective nursing

  16. Cause and place of death in patients dying with colorectal cancer. (United States)

    Jones, O M; John, S K P; Horseman, N; Lawrance, R J; Fozard, J B J


    Few studies on colorectal cancer look at the one-third of patients for whom treatment fails and who need a management strategy for death. This paper has examined the mode and place of death in patients with colorectal cancer. This study was a review of 209 deaths, analysed between January 2001 and September 2004 by retrospective review of a prospectively collected database. A total of 118 patients (group 1) had undergone resection of their primary colorectal cancer, 20 (group 2) had had a defunctioning stoma or bypass surgery and the remaining 71 patients (group 3) had either had no surgery, an open and close laparotomy or had a colonic stent. One hundred and fifty-six (75%) patients died of colorectal cancer with the remainder dying of other causes. The number of admissions to hospital and the number of days spent in hospital from diagnosis to death were greatest in group 1. Overall, only 34 patients (22%) dying from colorectal cancer died at home. Forty (26%) died in hospital and 70 (45%) died in a palliative care unit. Patients dying from colorectal cancer who undergo surgical resection of their primary tumour spend more time between diagnosis and death in hospital. They are also more likely to die in hospital than patients treated by surgical palliation or nonsurgically. Patients who are treated palliatively from the outset (group 3) are most likely to die at home. If hospital is accepted as an appropriate place for death from colorectal cancer, then greater provision for this should be made.

  17. Euthanasia – Help to die : a literature review from patients' perspective


    Nilsson, Kim; Jonas, Andersson


      Background: Euthanasia means help to die. Some terminally ill patients wish for euthanasia. Purpose: Illuminating terminally ill patients' desire for voluntary euthanasia. Method: A general literature study. Seven articles were reviewed and analyzed. Results: Patients do not want to live a painful life or die a painful death, patients want control over their lives and feel involved in decisions affecting their lives and the patients want to feel quality of life despite their illness or trea...

  18. Caring for dying patients: Attitude of nursing students and effects of education

    Directory of Open Access Journals (Sweden)

    Mojtaba Jafari


    Full Text Available Background: Education about caring for dying patients could be effective in changing nursing students′ attitude toward caring for dying patients. Aim: The aim of the present study was to examine the nursing students′ attitude toward caring for dying patients and effects of education on their attitude. Materials and Methods: The present study enjoys a quasi-experimental method with using one-group pre-test/post-test design conducted in Bam in southeast of Iran. The attitude of nursing students was measured using Frommelt Attitude Toward Care of the Dying (FATCOD scale before and after an educational intervention. Data were analyzed using non-parametric tests in Statistical Package for the Social Sciences (SPSS 18 software. Results: Of 32 students, 30 participated in this study (response rate of 94%. Only 20% of the students reported previous experience of dying patients in their clinical courses. Students showed moderately negative to neutral attitudes toward caring for dying patients. Education has improved students′ attitude significantly (mean score of FATCOD before study were 3.5 ± 0.43 and after intervention were 4.7 ± 0.33 ( P < 0.001. Conclusion: Educational programs about death and caring for dying patients should be added to undergraduate nursing curricula. Further research recommended examining nursing students′ knowledge about caring for dying patients and the effect of education on their knowledge.

  19. The end-of-life phase of high-grade glioma patients: dying with dignity? (United States)

    Sizoo, Eefje M; Taphoorn, Martin J B; Uitdehaag, Bernard; Heimans, Jan J; Deliens, Luc; Reijneveld, Jaap C; Pasman, H Roeline W


    In the end-of-life (EOL) phase, high-grade glioma (HGG) patients have a high symptom burden and often lose independence because of physical and cognitive dysfunction. This might affect the patient's personal dignity. We aimed to (a) assess the proportion of HGG patients dying with dignity as perceived by their relatives and (b) identify disease and care factors correlated with dying with dignity in HGG patients. We approached relatives of a cohort of 155 deceased HGG patients for the study. Participants completed a questionnaire concerning the EOL phase of the patient, covering several subthemes: (a) symptoms and signs, (b) health-related quality of life, (c) decision making, (d) place and quality of EOL care, and (e) dying with dignity. Relatives of 81 patients participated and 75% indicated that the patient died with dignity. These patients had fewer communication deficits, experienced fewer transitions between health care settings in the EOL phase, and more frequently died at their preferred place of death. Relatives were more satisfied with the physician providing EOL care and reported that the physician adequately explained treatment options. Multivariate analysis identified satisfaction with the physician, the ability to communicate, and the absence of transitions between settings as most predictive of a dignified death. Physicians caring for HGG patients in the EOL phase should timely focus on explaining possible treatment options, because patients experience communication deficits toward death. Physicians should strive to allow patients to die at their preferred place and avoid transitions during the last month of life.

  20. Clinical nurses' attitudes towards death and caring for dying patients in China. (United States)

    Wang, Liping; Li, Chaxiang; Zhang, Qiongling; Li, YaJie


    To examine Chinese clinical nurses' attitudes towards death and caring for dying patients, and to examine the relationships between clinical nurses' attitudes towards death and caring for dying patients. A convenience sample of 770 clinical nurses from 15 hospitals in China. All participants completed the Chinese version of the Frommelt Attitude Toward Care of the Dying Scale, Form B (FATCOD-B-C), the Chinese version of the Death Attitude Profile-Revised (DAP-R-C), and a demographic questionnaire. The mean score of the FATCOD-B-C items was 95.62 (SD = 7.45). The majority of Chinese clinical nurses were likely to provide care for the dying person's family (mean = 3.77), but did not have a positive attitude towards communication with the dying person(mean = 2.62). The majority of Chinese clinical nurses showed low scores on death avoidance (mean=1.96) and natural acceptance (mean = 1.61), and most of them viewed death as a passageway to a happy afterlife (mean = 4.33). Attitudes towards caring for dying patients were significantly negatively correlated with fear of death (r = -0.120) and positively correlated with approach acceptance (r = 0.127) and natural acceptance (r = 0.117). Factors that predicted clinical nurses' attitudes towards the care of dying patients included education level, fear of death, approach acceptance, religious beliefs, previous education on death and dying, natural acceptance, professional title, and experience with death or dying patients, which accounted for 18.7% of the variance. Nurses' personal attitudes towards death were associated with their attitudes towards the care of dying patients. Training and educational programmes for clinical nurses should take into consideration nurses' personal attitudes towards death as well as their cultural backgrounds and religious beliefs.

  1. On the Moral Acceptability of Physician-Assisted Dying for Non-Autonomous Psychiatric Patients. (United States)

    Varelius, Jukka


    Several authors have recently suggested that the suffering caused by mental illness could provide moral grounds for physician-assisted dying. Yet they typically require that psychiatric-assisted dying could come to question in the cases of autonomous, or rational, psychiatric patients only. Given that also non-autonomous psychiatric patients can sometimes suffer unbearably, this limitation appears questionable. In this article, I maintain that restricting psychiatric-assisted dying to autonomous, or rational, psychiatric patients would not be compatible with endorsing certain end-of-life practices commonly accepted in current medical ethics and law, practices often referred to as 'passive euthanasia'. © 2015 John Wiley & Sons Ltd.

  2. Communicating With Dying Patients and Their Families: Multimedia Training in End-of-Life Care. (United States)

    Chappell, Phylliss M; Healy, Jennifer; Lee, Shuko; Medellin, Glen; Sanchez-Reilly, Sandra


    The need for end-of-life (EOL), high-impact education initiatives to prepare medical students to communicate with dying patients and their families and to cope with issues of death and dying, is well recognized. Third-year medical students (n = 224), during their ambulatory rotation, completed a multimedia EOL curriculum, which included pre-/posttests, an online case-based module, didactic presentation, and a tablet computer application designed to demonstrate the signs and symptoms seen in the last hours of life for families of dying patients. Pre- and posttests were compared using Pearson χ 2 or Fisher exact test, and improvement was measured by weighted κ coefficient. On preintervention surveys, the majority of students demonstrated positive attitudes toward the care of dying patients and their families. Despite this high pretest positive attitude, there was a statistically significant overall positive attitude change after the intervention. The lowest pretest positive attitudes and lowest posttest positive attitude shifts, although all statistically improved, involved addressing the thoughts and feelings of dying patients and in coping with their own emotional response. Medical students exposure to this multimedia EOL curriculum increases positive attitudes in caring for dying patients and their families.

  3. Nurses attitudes towards death, dying patients and euthanasia: A descriptive study. (United States)

    Ay, Melike Ayça; Öz, Fatma


    Attitudes of nurses towards death and related concepts influence end-of-life care. Determining nurses' views and attitudes towards these concepts and the factors that affect them are necessary to ensure quality end-of-life care. The purpose of this study was to determine nurses' views and attitudes about death, dying patient, euthanasia and the relationships between nurses' characteristics. Participants consist of the nurses who volunteered to take part in this descriptive study from 25 hospitals (n = 340) which has a paediatric or adult intensive care unit and located within the boundaries of Ankara, Turkey. 'Nurse Information Form' and 'Attitude Scale about Euthanasia, Death and Dying Patients (DAS)' were used as data collection tool. Ethical consideration: Written permissions were received from the 'Noninterventional Clinical Researches Ethics Board' of authors' university and education councils of each hospital. Informed consent was obtained from participants. It is found that there are statistically significant difference among the factors of marital status, having a child, years of experience, bereavement experience, affected by working with dying patient, definition of euthanasia, views about patients who are appropriate for euthanasia, views about patients who desire to die and feeling need for counselling on these concepts according to the mean total score of nurses' attitudes about euthanasia, death and dying patient (p euthanasia and work with dying patient. This is reflected in their attitude. In order to gain positive attitude towards death, dying patient and euthanasia, the implementation of training and consulting services to nurses at appropriate intervals during both education and professional life are required.

  4. The End-of-Life Phase of High-Grade Glioma Patients: Dying With Dignity?

    NARCIS (Netherlands)

    Sizoo, E.M.; Taphoorn, M.J.B.; Uitdehaag, B.M.J.; Heimans, J.J.; Deliens, L.; Reijneveld, J.C.; Pasman, H.R.W.


    Background. In the end-of-life (EOL) phase, high-grade glioma (HGG) patients have a high symptom burden and often lose independence because of physical and cognitive dysfunction. This might affect the patient's personal dignity. We aimed to (a) assess the proportion of HGG patients dying with

  5. The end-of-life phase of high-grade glioma patients: dying with dignity?

    NARCIS (Netherlands)

    Sizoo, Eefje M.; Taphoorn, Martin J. B.; Uitdehaag, Bernard; Heimans, Jan J.; Deliens, Luc; Reijneveld, Jaap C.; Pasman, H. Roeline W.


    In the end-of-life (EOL) phase, high-grade glioma (HGG) patients have a high symptom burden and often lose independence because of physical and cognitive dysfunction. This might affect the patient's personal dignity. We aimed to (a) assess the proportion of HGG patients dying with dignity as

  6. Determinants of care outcomes for patients who die in hospital in Ireland: a retrospective study.

    LENUS (Irish Health Repository)

    McKeown, Kieran


    More people die in hospital than in any other setting which is why it is important to study the outcomes of hospital care at end of life. This study analyses what influenced outcomes in a sample of patients who died in hospital in Ireland in 2008\\/9. The study was undertaken as part of the Irish Hospice Foundation\\'s Hospice Friendly Hospitals Programme (2007-2012).

  7. Use of sedation to relieve refractory symptoms in dying patients ...

    African Journals Online (AJOL)

    Indications. Agitated delirium was the most common reason (45%) for using sedation, followed by intractable vomiting due to inoperable malignant intestinal obstruction in 25% of patients. Three patients with persistent convulsions or myoclonic jerking and 2 patients with severe refractory dyspnoea required some sedation.

  8. Factors associated with preference for dying at home among terminally ill patients with cancer

    DEFF Research Database (Denmark)

    Schou-Andersen, Marianne; Ullersted, Maria P; Jensen, Anders Bonde


    relatives of deceased patients who died of cancer in Denmark in 2006. Bereaved relatives were asked to state patient's preference concerning place of death at the beginning and end of the palliative period. These data were recently combined with updated, extensive demographic and socio-economic data from...

  9. Will black holes eventually engulf the Universe?

    International Nuclear Information System (INIS)

    Martin-Moruno, Prado; Jimenez Madrid, Jose A.; Gonzalez-Diaz, Pedro F.


    The Babichev-Dokuchaev-Eroshenko model for the accretion of dark energy onto black holes has been extended to deal with black holes with non-static metrics. The possibility that for an asymptotic observer a black hole with large mass will rapidly increase and eventually engulf the Universe at a finite time in the future has been studied by using reasonable values for astronomical parameters. It is concluded that such a phenomenon is forbidden for all black holes in quintessential cosmological models

  10. Review of Ordering Don't Resuscitate in Iranian Dying Patients. (United States)

    Cheraghi, Mohammad Ali; Bahramnezhad, Fatemeh; Mehrdad, Neda


    Making decision on not to resuscitate is a confusing, conflicting and complex issue and depends on each country's culture and customs. Therefore, each country needs to take action in accordance with its cultural, ethical, religious and legal contexts to develop guidelines in this regard. Since the majority of Iran's people are Muslims, and in Islam, the human life is considered sacred, based on the values of the community, an Iranian Islamic agenda needs to be developed not taking measures about resuscitation of dying patients. It is necessary to develop an Iranian Islamic guidelines package in order to don't resuscitate in dying patients.

  11. Doing one's utmost: nurses' descriptions of caring for dying patients in an intensive care environment. (United States)

    Fridh, Isabell; Forsberg, Anna; Bergbom, Ingegerd


    The aim of this study was to explore nurses' experiences and perceptions of caring for dying patients in an intensive care unit (ICU) with focus on unaccompanied patients, the proximity of family members and environmental aspects. Interviews were conducted with nine experienced ICU nurses. A qualitative descriptive approach was employed. The analysis was performed by means of conventional content analysis [Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res 2005;15:1277-88] following the steps described by e.g. Elo and Kyngas [Elo S, Kyngas H. The qualitative content analysis process. J Adv Nurs 2008;62:107-15]. The analysis resulted in a main category; Doing one's utmost, described by four generic categories and 15 sub-categories, comprising a common vision of the patients' last hours and dying process. This description was dominated by the nurses' endeavour to provide dignified end-of-life care (EOLC) and, when relatives were present, to give them an enduring memory of their loved one's death as a calm and dignified event despite his/her previous suffering and death in a high-technological environment. This study contributes new knowledge about what ICU nurses focus on when providing EOLC to unaccompanied patients but also to those whose relatives were present. Nurses' EOLC was mainly described as their relationship and interaction with the dying patient's relatives, while patients who died alone were considered tragic but left a lesser impression in the nurses' memory.

  12. Dying cancer patients talk about physician and patient roles in DNR decision making. (United States)

    Eliott, Jaklin A; Olver, Ian


    Within medical and bioethical discourse, there are many models depicting the relationships between, and roles of, physician and patient in medical decision making. Contestation similarly exists over the roles of physician and patient with regard to the decision not to provide cardiopulmonary resuscitation (CPR) following cardiac arrest [the do-not-resuscitate or do-not-resuscitate (DNR) decision], but there is little analysis of patient perspectives. Analyse what patients with cancer within weeks before dying say about the decision to forego CPR and the roles of patient and physician in this decision. Discursive analysis of qualitative data gathered during semi-structured interviews with 28 adult cancer patients close to death and attending palliative or oncology clinics of an Australian teaching hospital. Participants' descriptions of appropriate patient or physician roles in decisions about CPR appeared related to how they conceptualized the decision: as a personal or a medical issue, with patient and doctor respectively identified as appropriate decision makers; or alternatively, both medical and personal, with various roles assigned embodying different versions of a shared decision-making process. Participants' endorsement of physicians as decision makers rested upon physicians' enactment of the rational, knowledgeable and compassionate expert, which legitimized entrusting them to make the DNR decision. Where this was called into question, physicians were positioned as inappropriate decision makers. When patients' and physicians' understandings of the best decision, or of the preferred role of either party, diverge, conflict may ensue. In order to elicit and negotiate with patient preferences, flexibility is required during clinical interactions about decision making. © 2010 Blackwell Publishing Ltd.

  13. Oh death, where is thy sting? Reflections on dealing with dying patients. (United States)

    Loewy, Erich H


    This paper examines the reactions of physicians and other health professionals when they become involved in decisions about the death of their patients... Four traditional views of death are explored. The problem that physicians have in helping patients die (be it by hastening death through pain control, assisting patients in suicide or by more active means) is analyzed. Physicians, in dealing with such patients, must be mindful of their own, and their patients beliefs as well as mindful of the community in which such dying takes place. They must try to reconcile these often divergent views but can neither paternalistically deny patients their rational will, hide themselves behind an appeal to the law or go against their own deeply held moral views. When such views cannot be reconciled, compassionate transfer to a more compatible physician may be necessary.

  14. The best interests of persistently vegetative patients: to die rather that to live? (United States)

    Chan, Tak Kwong; Tipoe, George Lim


    Adults without the capacity to make their own medical decisions have their rights protected under the Mental Capacity Act (2005) in the UK. The underlying principle of the court's decisions is the best interests test, and the evaluation of best interests is a welfare appraisal. Although the House of Lords in the well-known case of Bland held that the decision to withhold treatment for patients in a persistent vegetative state should not be based on their best interests, judges in recent cases have still held that the best interests of persistently vegetative patients demand that the right to die with dignity prevails over society's interest to preserve life. The basis of suggesting that it is in the best interests for one who is alive (although vegetative) in peace to die in peace is weak. Even if it may not be in their best interests to live on, it may not be so to die either. The phrase 'the right to dignity/to die with dignity' has been misused as a trump card to justify the speculation that a vegetative patient would necessarily refuse to live on machines. Without disrespect to the court's decision, we argue that the use of the best interests test to authorise withdrawing/withholding treatment from persistently vegetative patients without an advance directive is problematic. We propose that the court could have reached the same decision by considering only the futility of treatment without working through the controversial best interests of the patient.

  15. Attitudes of elderly Korean patients toward death and dying: an application of Q-methodology. (United States)

    Yeun, Eunja


    The aim of this study was to identify the attitudes of elderly Korean patients toward death and dying using Q-methodology to aid in the development of basic strategies for nursing care of elderly Koreans. Thirty participants at a university hospital sorted 40 selected Q-statements on a nine-point scale. Data analysis identified three types of attitudes toward death and dying in elderly patients in Korea: religion-dependent, science-adherent, and sardonic. Religion-dependent elders are highly dependent upon religion as evidenced by their reply that they would like to rely on God and a minister the most. Science-adherent elders have great affection for life and believe in modern medical advancements. The sardonic elders regard death as the dispensation of nature so there is no need to be afraid of death and dying. This study will contribute to the understanding that nurses and other health professionals have of the perceptions of elderly Koreans about death and dying. Also, the findings may provide the basis for the development of more appropriate strategies to improve death and dying education programs of health professionals.

  16. Case study: an ethical dilemma involving a dying patient. (United States)

    Pacsi, Alsacia L


    Nursing often deals with ethical dilemmas in the clinical arena. A case study demonstrates an ethical dilemma faced by healthcare providers who care for and treat Jehovah's Witnesses who are placed in a critical situation due to medical life-threatening situations. A 20-year-old, pregnant, Black Hispanic female presented to the Emergency Department (ED) in critical condition following a single-vehicle car accident. She exhibited signs and symptoms of internal bleeding and was advised to have a blood transfusion and emergency surgery in an attempt to save her and the fetus. She refused to accept blood or blood products and rejected the surgery as well. Her refusal was based on a fear of blood transfusion due to her belief in Bible scripture. The ethical dilemma presented is whether to respect the patient's autonomy and compromise standards of care or ignore the patient's wishes in an attempt to save her life. This paper presents the clinical case, identifies the ethical dilemma, and discusses virtue ethical theory and principles that apply to this situation.

  17. Consensus guidelines on analgesia and sedation in dying intensive care unit patients

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    Lemieux-Charles Louise


    Full Text Available Abstract Background Intensivists must provide enough analgesia and sedation to ensure dying patients receive good palliative care. However, if it is perceived that too much is given, they risk prosecution for committing euthanasia. The goal of this study is to develop consensus guidelines on analgesia and sedation in dying intensive care unit patients that help distinguish palliative care from euthanasia. Methods Using the Delphi technique, panelists rated levels of agreement with statements describing how analgesics and sedatives should be given to dying ICU patients and how palliative care should be distinguished from euthanasia. Participants were drawn from 3 panels: 1 Canadian Academic Adult Intensive Care Fellowship program directors and Intensive Care division chiefs (N = 9; 2 Deputy chief provincial coroners (N = 5; 3 Validation panel of Intensivists attending the Canadian Critical Care Trials Group meeting (N = 12. Results After three Delphi rounds, consensus was achieved on 16 statements encompassing the role of palliative care in the intensive care unit, the management of pain and suffering, current areas of controversy, and ways of improving palliative care in the ICU. Conclusion Consensus guidelines were developed to guide the administration of analgesics and sedatives to dying ICU patients and to help distinguish palliative care from euthanasia.

  18. Gestalt Therapy with the Dying Patient: Integrative Work Using Clay, Poetry Therapy, and Creative Media. (United States)

    Petzold, Hilarion G.


    Reports the use of death therapy with a cancer patient. Gestalt therapy and creative media were used to facilitate an integration of life and a sense of balance with life. Suggests that counseling the dying means walking along a stretch of the path together. (Author)

  19. [How Can We Cuddle Up to Dying Patients? Attempts of Cancer Philosophy Clinic and Education]. (United States)

    Yamada, Keisuke


    What is needed to treat problems about how can we cuddle up to dying patients is not scientific thinking but philosophical thinking. Cancer philosophy clinic is a place where both patients and medical staffs think about death and how to live until death. The author tries to manage cancer philosophy clinic with the idea of logotherapy and terminal art. The author also tries to educate medical students and other medical staffs in cancer philosophy.

  20. Cultural beliefs about a patient's right time to die: an exploratory study. (United States)

    Perkins, Henry S; Cortez, Josie D; Hazuda, Helen P


    Generalist physicians must often counsel patients or their families about the right time to die, but feel ill-prepared to do so. Patient beliefs may help guide the discussions. Because little prior research addresses such beliefs, we investigated them in this exploratory, hypothesis-generating study. Anticipating culture as a key influence, we interviewed 26 Mexican Americans (MAs), 18 Euro-Americans (EAs), and 14 African Americans (AAs) and content-analyzed their responses. Nearly all subjects regardless of ethnic group or gender said God determines (at least partially) a patient's right time to die, and serious disease signals it. Yet subjects differed by ethnic group over other signals for that time. Patient suffering and dependence on "artificial" life support signaled it for the MAs; patient acceptance of death signaled it for the EAs; and patient suffering and family presence at or before the death signaled it for the AAs. Subjects also differed by gender over other beliefs. In all ethnic groups more men than women said the time of death is unpredictable; but more women than men said the time of death is preset, and family suffering signals it. Furthermore, most MA women--but few others--explicitly declared that family have an important say in determining a patient's right time to die. No confounding occurred by religion. Americans may share some beliefs about the right time to die but differ by ethnic group or gender over other beliefs about that time. Quality end-of-life care requires accommodating such differences whenever reasonable.

  1. Nursing care of patients during the dying process: a painful professional and human function

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    Martha Adiela Lopera Betancur


    Full Text Available Objective. This work sought to describe the care functions of nurses with patients during the dying process. Methodology. This was a qualitative study with ethnographic approach stemming from the analysis of the culture of nurses; it was conducted in the city of Medellín, Colombia. Theoretical saturation was obtained with 23 interviews. Results. Nurses feel the duty to care for patients throughout the vital cycle through functions defined as: serving, helping, accompanying, offering support, advocating, educating, and representing, which they identify as indispensable. They also perceive as their own the social responsibility for some issues related to death and due to this they get involved at the personal level, appropriate care and are affected as persons. Conclusion. Patient care during dying processes transcends the limits of the nurse' professional functions to become a human obligation.

  2. Nursing care of patients during the dying process: a painful professional and human function. (United States)

    Lopera Betancur, Martha Adiela


    This work sought to describe the care functions of nurses with patients during the dying process. This was a qualitative study with ethnographic approach stemming from the analysis of the culture of nurses; it was conducted in the city of Medellín, Colombia. Theoretical saturation was obtained with 23 interviews. Nurses feel the duty to care for patients throughout the vital cycle through functions defined as: serving, helping, accompanying, offering support, advocating, educating, and representing, which they identify as indispensable. They also perceive as their own the social responsibility for some issues related to death and due to this they get involved at the personal level, appropriate care and are affected as persons. Patient care during dying processes transcends the limits of the nurse' professional functions to become a human obligation.

  3. Beyond Pain: Nurses' Assessment of Patient Suffering, Dignity, and Dying in the Intensive Care Unit. (United States)

    Su, Amanda; Lief, Lindsay; Berlin, David; Cooper, Zara; Ouyang, Daniel; Holmes, John; Maciejewski, Renee; Maciejewski, Paul K; Prigerson, Holly G


    Deaths in the intensive care unit (ICU) are increasingly common in the U.S., yet little is known about patients' experiences at the end of life in the ICU. The objective of this study was to determine nurse assessment of symptoms experienced, and care received by ICU patients in their final week, and their associations with nurse-perceived suffering and dignity. From September 2015 to March 2017, nurses who cared for 200 ICU patients who died were interviewed about physical and psychosocial dimensions of patients' experiences. Medical chart abstraction was used to document baseline patient characteristics and care. The patient sample was 61% males, 70.2% whites, and on average 66.9 (SD 15.1) years old. Nurses reported that 40.9% of patients suffered severely and 33.1% experienced severe loss of dignity. The most common symptoms perceived to contribute to suffering and loss of dignity included trouble breathing (44.0%), edema (41.9%), and loss of control of limbs (36.1%). Most (n = 9) remained significantly (P dignity (AOR 3.15). Use of feeding tube was associated with severe loss of dignity (AOR 3.12). Dying ICU patients are perceived by nurses to experience extreme indignities and suffer beyond physical pain. Attention to symptoms such as dyspnea and edema may improve the quality of death in the ICU. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

  4. Death and caring for dying patients: exploring first-year nursing students' descriptive experiences. (United States)

    Ek, Kristina; Westin, Lars; Prahl, Charlotte; Osterlind, Jane; Strang, Susann; Bergh, Ingrid; Hammarlund, Kina


    To describe first-year nursing students' experiences of witnessing death and providing end-of-life care. This study is part of a larger longitudinal project. Interviews (n=17) were conducted with nursing students at the end of their first year of education. To analyse the interviews (lived-experience descriptions), a thematic analysis, 'a search for meaning' ( Van Manen, 1997 ) was applied. The results are presented within the framework of four separate themes: (1) The thought of death is more frightening than the actual experience, (2) Daring to approach the dying patient and offering something of oneself, (3) The experience of not sufficing in the face of death and (4) Being confronted with one's own feelings. Nursing students require continuous support and opportunity to reflect and discuss their experiences about caring for dying patients and confronting death throughout the entirety of their education. In addition, teachers and clinical supervisors need to give support using reflective practice to help students to develop confidence in their capacity for caring for dying patients.

  5. die rol van die unieverdedigingsmag in die onderdrukking van die

    African Journals Online (AJOL)

    agv regeringsoptrede nie.39. Siotsom. In die geskiedenis van die Unieverdedigings- mag word die gebeure random die 1914-staking oorskadu deur die Rebellie en Suid-Afrika se deelname aan die Eerste Wereldoorlog. Tog was dit 'n belangrike mylpaal in die geskiedenis van die organisasie, omdat dit sy eerste optrede ...

  6. Suffering and euthanasia: a qualitative study of dying cancer patients' perspectives. (United States)

    Karlsson, Marit; Milberg, Anna; Strang, Peter


    Although intolerable suffering is a core concept used to justify euthanasia, little is known about dying cancer patients' own interpretations and conclusions of suffering in relation to euthanasia. Sixty-six patients with cancer in a palliative phase were selected through maximum-variation sampling, and in-depth interviews were conducted on suffering and euthanasia. The interviews were analyzed using qualitative content analysis with no predetermined categories. The analysis demonstrated patients' different perspectives on suffering in connection to their attitude to euthanasia. Those advocating euthanasia, though not for themselves at the time of the study, did so due to (1) perceptions of suffering as meaningless, (2) anticipatory fears of losses and multi-dimensional suffering, or (3) doubts over the possibility of receiving help to alleviate suffering. Those opposing euthanasia did so due to (1) perceptions of life, despite suffering, as being meaningful, (2) trust in bodily or psychological adaptation to reduce suffering, a phenomenon personally experienced by informants, and (3) by placing trust in the provision of help and support by healthcare services to reduce future suffering. Dying cancer patients draw varying conclusions from suffering: suffering can, but does not necessarily, lead to advocations of euthanasia. Patients experiencing meaning and trust, and who find strategies to handle suffering, oppose euthanasia. In contrast, patients with anticipatory fears of multi-dimensional meaningless suffering and with lack of belief in the continuing availability of help, advocate euthanasia. This indicates a need for healthcare staff to address issues of trust, meaning, and anticipatory fears.

  7. Music thanatology: prescriptive harp music as palliative care for the dying patient. (United States)

    Freeman, Lindsay; Caserta, Michael; Lund, Dale; Rossa, Shirley; Dowdy, Ann; Partenheimer, Andrea


    Music thanatology represents an emerging area in which the raw materials of music, usually harp and/or voice, assist and comfort the dying patient. During prescriptive "music vigils, " the clinician-musician carefully observes physiological changes, cues, and breathing patterns, thereby synchronizing the music to reflect or support the patient's physiology and overall condition. Using data collected from 65 patients, this study was designed to assess the effectiveness of prescriptive harp music on selected palliative care outcomes using a sample of de-identified data forms from past music vigils. Patients were administered a 25- to 95-minute intervention of prescriptive harp music. Data collected included vital signs and observational indicators before (Ti) and after (T2) the vigil. Patients were more likely to experience decreased levels of agitation and wakefulness while also breathing more slowly and deeply with less effort at the conclusion of the music vigil. Results from this study suggest that a prescriptive vigil conducted by a trained music thanatologist could provide an effective form of palliative care for dying patients.

  8. Transcultural comparison of hospital and hospice as caring environments for dying patients. (United States)

    Gates, M F


    Leininger's nursing Theory of Cultural Care Diversity and Universality provided the framework for this comparative study of two environments for persons who are dying; namely a hospital oncology unit and a free-standing hospice unit. Analysis of data from ethnographic and ethnonursing research methods including unstructured interviews, observation-participation, and field journal materials yielded contrasts with two settings. The presence of a caring atmosphere/ambience was apparent in both the hospital and hospice. Universal patterns common to both were: caring beliefs and practices of staff; identification of each setting as "community" or "home"; and multiple symbolic uses of humor and food. Diversities included hierarchical organizational structure and cure orientation in the hospital; interdisciplinary collaboration and care orientation in hospice; more pronounced use of touch as a caring modality; and greater evidence of symbolism and ritual related to death and dying in hospice. Adoption of the cultural care modes of accommodation, repatterning, and maintenance are suggested in promoting a caring atmosphere wherever dying patients are served.

  9. Uncovering the decision-making work of transferring dying patients home from critical care units: An integrative review. (United States)

    Lin, Yanxia; Myall, Michelle; Jarrett, Nikki


    To understand how decisions are made to transfer dying patients home from critical care units. Many people prefer a home death, but a high proportion die in critical care units. Transferring dying patients home is recognized to be complex but transfer decision-making itself remains unclear. Integrative review. Seven bibliographic databases (origin-2015), grey literature and reference lists were searched. An integrative review method was used to synthesize data from diverse sources. Papers were selected through title and abstract screening and full-text reviewing, using inclusion and exclusion criteria derived from review questions. Following quality appraisal, data were extracted and synthesized using normalization process theory as a framework. The number of patients transferred home ranged from 1-346, with most papers reporting on the transfer of one or two patients. Four themes regarding transfer decision-making work were generated: divergent views and practice, multiple stakeholders' involvement in decision-making, collective work and limited understanding of individuals' experiences. The practice of transferring patients home to die and its decision-making varies internationally and is usually influenced by the care system, culture or religion. It is less common to transfer patients home to die from critical care units in western societies. A better understanding of the decision-making work was obtained but mainly from the perspective of hospital-based healthcare professionals. Further research is needed to develop decision-making practice guidance to facilitate patients' wishes to die at home. © 2017 John Wiley & Sons Ltd.

  10. Physicians' current practices and opportunities for DNA banking of dying patients with cancer. (United States)

    Quillin, John M; Bodurtha, Joann N; Siminoff, Laura A; Smith, Thomas J


    The availability of genetic tests for cancer susceptibility is increasing. Current tests, however, have limited clinical sensitivity. Even when clinically valid tests are available, the genetic counseling and informed consent process might not be feasible for dying patients with cancer. DNA banking preserves the opportunity for future research or clinical testing and may provide critical opportunities for surviving relatives. This study explored the current practices and potential for DNA banking for cancer susceptibility among oncologists specializing in palliative care. Palliative care oncologists actively providing clinical care for dying patients with cancer were recruited for an online survey. Descriptive statistics for DNA banking practices, perceived qualification to recommend banking, and potential predictors were assessed. Data were collected from 49 physicians (37% recruitment rate). Eighty percent reported assessing at least some patients for genetic cancer susceptibility in the past 12 months. No participants reported banking DNA for patients in the past 12 months. Only 5% reported feeling at least somewhat qualified to order DNA banking. A Web-based risk assessment tool and genetic counselor on staff were perceived as the most helpful potential resources. Despite its potential, DNA banking is not being used by palliative care oncologists.


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    A. Y. Mikhaylov


    Full Text Available We report a case of acute baclofen poisoning in a 23-year-old female patient, who committed suicide, which led to the development of a deep coma. The electroencephalogram on the first day recorded the phenomenon of “burst suppression”, which was seen as a sign of a dying brain. Subsequent studies have shown positive changes of the electroencephalogram and regression of neurological symptoms. Thus, the phenomenon of “burst suppression” in the depression of consciousness to deep coma and given adequate treatment, can be reversible.

  12. Die binding van die konfessie

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    P. J. Coetzee


    Full Text Available Ons moet waak teen twee uiterstes. Aan die een kant het die dogma as onversoenlike vyand die dogmatisme en aan die ander kant die antidogmatisme — dit hou enersyds die gevaar in van verabsolutering (oorskatting, en ander- syds die gevaar van relativisme (onderskatting.

  13. Attitude of Palestinian Nursing Students Toward Caring for Dying Patients: A Call for Change in Health Education Policy. (United States)

    Abu-El-Noor, Nasser Ibrahim; Abu-El-Noor, Mysoon Khalikl


    Death is a natural process that occurs each day. Some nursing students may encounter the experience of taking care of a dying patient while others do not. Therefore, their attitude toward death and caring for dying patients may vary. The purpose of this study was to assess Palestinian student nurses' attitudes toward death and caring for dying patients and their families. In a cross-sectional, descriptive study, all fourth-year students at the College of Nursing, Islamic University of Gaza, Palestine, were invited to participate in this study. A total of 141 students completed the Frommelt Attitude Toward Care of the Dying Scale Form B (FATCOD-B). Results revealed that the mean score on the FATCOD-B was (96.96 ± 8.30). Overall, nursing students in the sample demonstrated a relatively low attitude toward caring for dying patients and their families. No statistically significant differences of students' attitudes toward caring for dying patients were found between male and female students nor between students who attended death cases and those who did not. The results suggest that theoretical nursing education should place more emphasis on palliative care to improve the quality of care at the end of life. © The Author(s) 2015.

  14. Die Region braucht die Kultur - die Kultur braucht die Region


    Klemm, Ulrich


    Die Region braucht die Kultur - die Kultur braucht die Region. - In: Region in Aktion - oder: Region im Abseits? - Boxberg-Wölchingen : Eigenständige Regionalentwicklung Baden-Württemberg, 1995. - S. 25 f.

  15. Male ICU nurses' experiences of taking care of dying patients and their families: a gender analysis. (United States)

    Wu, Tammy W; Oliffe, John L; Bungay, Vicky; Johnson, Joy L


    Male intensive care unit (ICU) nurses bring energy and expertise along with an array of beliefs and practices to their workplace. This article investigates the experiences of male ICU nurses in the context of caring for dying patients and their families. Applying a gender analysis, distilled are insights to how masculinities inform and influence the participants' practices and coping strategies. The findings reveal participants draw on masculine ideals of being a protector and rational in their decisive actions toward meeting the comfort needs of dying patients and their families. Somewhat paradoxically, most participants also transgressed masculine norms by outwardly expressing their feelings and talking about emotions related to these experiences. Participants also reported renewed appreciation of their life and their families and many men chronicled recreational activities and social connectedness as strategies for coping with workplace induced stresses. The findings drawn from this study can guide both formal and informal support services for men who are ICU nurses, which in turn might aid retention of this subgroup of workers. © The Author(s) 2014.

  16. Symptoms, unbearability and the nature of suffering in terminal cancer patients dying at home: a prospective primary care study

    NARCIS (Netherlands)

    Ruijs, C.D.M.; Kerkhof, A.J.F.M.; van der Wal, G.; Onwuteaka-Philipsen, B.D.


    Background: Primary care physicians provide palliative home care. In cancer patients dying at home in the Netherlands (45% of all cancer patients) euthanasia in about one out of every seven patients indicates unbearable suffering. Symptom prevalence, relationship between intensity of symptoms and

  17. Dying cancer patients' own opinions on euthanasia: an expression of autonomy? A qualitative study. (United States)

    Karlsson, Marit; Milberg, Anna; Strang, Peter


    Deliberations on euthanasia are mostly theoretical, and often lack first-hand perspectives of the affected persons. Sixty-six patients suffering from cancer in a palliative phase were interviewed about their perspectives of euthanasia in relation to autonomy. The interviews were transcribed verbatim and analysed using qualitative content analysis with no predetermined categories. The informants expressed different positions on euthanasia, ranging from support to opposition, but the majority were undecided due to the complexity of the problem. The informants' perspectives on euthanasia in relation to autonomy focused on decision making, being affected by (1) power and (2) trust. Legalization of euthanasia was perceived as either (a) increasing patient autonomy by patient empowerment, or (b) decreasing patient autonomy by increasing the medical power of the health care staff, which could be frightening. The informants experienced dependence on others, and expressed various levels of trust in others' intentions, ranging from full trust to complete mistrust. Dying cancer patients perceive that they cannot feel completely independent, which affects true autonomous decision making. Further, when considering legalization of euthanasia, the perspectives of patients fearing the effects of legalization should also be taken into account, not only those of patients opting for it.

  18. Level of consciousness in dying patients. The role of palliative sedation: a longitudinal prospective study. (United States)

    Claessens, Patricia; Menten, Johan; Schotsmans, Paul; Broeckaert, Bert


    Patients suffering from a terminal illness often are confronted with severe symptoms during the last phase of their lives. Palliative sedation, although one of the options of last resort, remains a much debated and controversial issue and is often referred to as a form of slow euthanasia or euthanasia in disguise. A prospective longitudinal and descriptive design was used. Each patient admitted in one of the 8 participating units was included if they met the inclusion criteria and gave written informed consent. 266 patients were included. The incidence of palliative sedation was 7;5%. For the group of sedated patients results show that 90% entered the palliative care unit being fully conscious. Two patients were comatose upon arrival. 90% of the patients remained fully conscious up to the day palliative sedation was started. When looking at the effect of palliative sedation on the level of consciousness the analysis strongly suggest that the palliative sedation - as expected- has an impact on the GCS score. Irrespective of the dichotomization of the score the probability of having a lower GCS increases substantially once sedation is initiated. Additionally, results show that once palliative sedation is administered, the level of consciousness gradually goes down up until the day of death. Palliative sedation is nor slow euthanasia nor an ambivalent practice. It is an intentional medical treatment which is administered in a proportional way when refractory suffering occurs. It occurs in extraordinary situations and at the very end of the dying process.

  19. Music therapy with imminently dying hospice patients and their families: facilitating release near the time of death. (United States)

    Krout, Robert E


    Hospice care seeks to address the diverse needs of terminally ill patients in a number of physical, psychosocial, and spiritual areas. Family members of the patient often are included in the care and services provided by the hospice team, and hospice clinicians face a special challenge when working with families of patients who are imminently dying. When loved ones are anticipating the patient's impending death, they may find it difficult to express feelings, thoughts, and last wishes. Music therapy is a service modality that can help to facilitate such communication between the family and the patient who is actively dying, while also providing a comforting presence. Music therapy as a way to ease communication and sharing between dying patients and their loved ones is discussed in this article. The ways in which music therapy can facilitate a means of release for both patients and family members in an acute care unit of a large US hospice organization are specifically described. Case descriptions illustrate how music therapy functioned to allow five patients and their families to both come together and let go near the time of death. Elements to consider when providing such services to imminently dying patients and their families are discussed.

  20. Die nabyheid van die Koninkryk

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    W.J. Snyman


    Full Text Available Vanweë die belangrikheid daarvan volg hier ’n breër bespreking van die proefskrif van dr. Tjaart van der Walt oor die nabyheid van die Koninkryk as wat in ’n gewone resensie kan geskied. Die vraagstuk wat onder oë gesien word is so oud as die kerk en die teologie, soms minder en soms meer op die voorgrond. Tans kan gesê word, staan dit in die middelpunt. Daarby is dit nie maar ’n akademiese vraagstuk nie, maar ’n vraagstuk waarvoor elke nadenkende leser van die Skrif te staan kom.

  1. [Can cancer patient in terminal stage of cancer die with dignity at home? And under what conditions?]. (United States)

    Slovácek, L; Simková, M; Petera, J; Filip, S


    In their brief communication, the authors are discussing the issue of palliative care for cancer patients in terminal stage of cancer. The authors are also contributing their own experience with the provision of such care to patients who wish to die at home.

  2. Dying in Palliative Care Units and in Hospital: A Comparison of the Quality of Life of Terminal Cancer Patients. (United States)

    Viney, Linda L.; And Others


    Compared quality of life of terminal cancer patients (n=182) in two palliative care units with that of those in general hospital. Patients in specialized palliative care units were found to differ from those dying in hospital, showing less indirectly expressed anger but more positive feelings. They also reported more anxiety about death but less…

  3. A mixed method thematic review: the importance of hope to the dying patient. (United States)

    Broadhurst, Kathleen; Harrington, Ann


    To review the literature and investigate the meaning of hope to patients receiving palliative care and to examine the themes that foster hope in those patients. Hope is often linked to the future and is a significant factor for patients dealing with adversity, such as a terminal illness. The concept of hope is underreported in the literature. Mixed method thematic review. CINAHL, Scopus, PsychINFO, Informit, PubMed, Science Direct, ProQuest, Web of Science and Google Scholar online databases were searched using keywords and inclusion and exclusion criteria published between 2003-2013. Twelve qualitative articles were thematically analysed using Braun and Clarke's (2006) steps to ascertain major themes and sub-themes. On analysis, the remaining three mixed method studies were found to reflect the themes generated by the qualitative studies. Seven key themes that increased hope were found: disease status; positive personal relationships; positive character traits; quality of life; setting and achieving goals; spirituality/religion; and hope after death. The importance of hope to dying patients was established. Hope is a very complex and personal phenomena requiring hope-enhancing strategies to be individualized. More research is needed with groups whose culture, youth or type of illness may affect their ability to foster and maintain hope. © 2015 John Wiley & Sons Ltd.

  4. The attitudes of brain cancer patients and their caregivers towards death and dying: a qualitative study

    Directory of Open Access Journals (Sweden)

    Kimmelman Jonathan


    Full Text Available Abstract Background Much money and energy has been spent on the study of the molecular biology of malignant brain tumours. However, little attention has been paid to the wishes of patients afflicted with these incurable tumours, and how this might influence treatment considerations. Methods We interviewed 29 individuals – 7 patients dying of a malignant brain tumor and 22 loved ones. One-on-one interviews were conducted according to a pre-designed interview guide. A combination of open-ended questions, as well as clinical scenarios was presented to participants in order to understand what is meaningful and valuable to them when determining treatment options and management approaches. The results were analyzed, coded, and interpreted using qualitative analytic techniques in order to arrive at several common overarching themes. Results Seven major themes were identified. In general, respondents were united in viewing brain cancer as unique amongst malignancies, due in large part to the premium placed on mental competence and cognitive functioning. Importantly, participants found their experiences, however difficult, led to the discovery of inner strength and resilience. Responses were usually framed within an interpersonal context, and participants were generally grateful for the opportunity to speak about their experiences. Attitudes towards religion, spirituality, and euthanasia were also probed. Conclusion Several important themes underlie the experiences of brain cancer patients and their caregivers. It is important to consider these when managing these patients and to respect not only their autonomy but also the complex interpersonal toll that a malignant diagnosis can have.

  5. Die topkwark

    Directory of Open Access Journals (Sweden)

    R. Tegen


    Full Text Available ’n Oorsig van die belangrikheid van die onlangs ontdekte topkwark by Fermilab in Chicago word gegee. Daar word aangetnon dat die topkwark belangrik is in fisika van die Oerknal, oftewel "Big Bang", en in die Standaard Model van Elementêredeeltjie-fisika. Toepaslike literatuur vir verdere studie kan van die lys van verwysings in hierdie kort, nietegniese artikel, nagegaan word.

  6. Attitudes and views of physicians and nurses towards cancer patients dying at home. (United States)

    Porta, M; Busquet, X; Jariod, M


    The objective was to study attitudes and views of primary care professionals towards terminally ill cancer patients who die at home, using a cross-sectional study based in the health district of Manresa (province of Barcelona, Catalonia, Spain) of the Catalan Health Service, involving 151 primary health care professionals (87 physicians and 64 nurses). By using a self-responded anonymous questionnaire (response rate 89%) it was found that despite excellent motivation, primary care professionals reported widespread frustration and a poor opinion of the quality of care provided to terminally ill cancer patients. Attitudes and views clearly differ by age, sex and geographic setting. In the study area, most professional are reluctant to disclose the diagnosis of cancer, and this attitude is associated with a more favourable assessment of the support provided to the family. The idea that the most appropriate place of death is at home is strongly linked to the belief that patients ought to be informed of their illness, to feelings of frustration and to youth. These findings further substantiate the need and the potential for ample changes in terminal cancer care in Spain.

  7. Why is the Liverpool care pathway used for some dying cancer patients and not others? Healthcare professionals’ perspectives

    Directory of Open Access Journals (Sweden)

    Freemantle Alison


    Full Text Available Abstract Background Despite evidence suggesting that the Liverpool Care Pathway for the Dying Patient is a structured and proficient means of supporting care delivery in the last hours or days of life, discrepancies in uptake are widespread. This exploratory study sought to understand why patients dying of cancer in oncology wards of one hospital trust were, or were not, supported by the LCP. A purposive qualitative case study design was used; each case represented a patient who had died and their most involved nurse and doctor. In-depth interviews explored both recollections of the ‘case’ and wider experiences of using the Pathway in end-of-life care. Eleven healthcare professionals were interviewed about their involvement in the end-of-life care of six patients. For four of these patients care was supported by the LCP. Findings Although doctors and nurses reported they preferred to use the Pathway to ensure comfortable death, an important factor influencing their decisions was time of death. Access to timely senior review was regarded as an essential preliminary to placing patients on the Pathway but delayed access ‘out of hours’ was commonly experienced and tensions arose from balancing conflicting priorities. Consequently, the needs of dying patients sometimes failed to compete with those receiving curative treatment. Conclusions This study suggests that greater attention should be focused on ‘out of hours’ care in hospitals to ensure regular senior review of all patients at risk of dying and to support front line staff to communicate effectively and make contingency plans focused on patients’ best interests.

  8. Euthanasia in patients dying at home in Belgium: interview study on adherence to legal safeguards (United States)

    Smets, Tinne; Bilsen, Johan; Van den Block, Lieve; Cohen, Joachim; Van Casteren, Viviane; Deliens, Luc


    Background Euthanasia became legal in Belgium in 2002. Physicians must adhere to legal due care requirements when performing euthanasia; for example, consulting a second physician and reporting each euthanasia case to the Federal Review Committee. Aim To study the adherence and non-adherence of GPs to legal due care requirements for euthanasia among patients dying at home in Belgium and to explore possible reasons for non-adherence. Design of study Large scale, retrospective study. Setting General practice in Belgium. Method A retrospective mortality study was performed in 2005–2006 using the nationwide Belgian Sentinel Network of General Practitioners. Each week GPs reported medical end-of-life decisions taken in all non-sudden deaths of patients in their practice. GP interviews were conducted for each euthanasia case occurring at home. Results Interviews were conducted for nine of the 11 identified euthanasia cases. Requirements concerning the patient's medical condition were met in all cases. Procedural requirements such as consultation of a second physician were sometimes ignored. Euthanasia cases were least often reported (n = 4) when the physician did not regard the decision as euthanasia, when only opioids were used to perform euthanasia, or when no second physician was consulted. Factors that may contribute to explaining non-adherence to the euthanasia law included: being unaware of which practices are considered to be euthanasia; insufficient knowledge of the euthanasia law; and the fact that certain procedures are deemed burdensome. Conclusion Substantive legal due care requirements for euthanasia concerning the patient's request for euthanasia and medical situation were almost always met by GPs in euthanasia cases. Procedural consultation and reporting requirements were not always met. PMID:20353662

  9. Towards a Perron--Frobenius Theory for Eventually Positive Operators


    Glück, Jochen


    This article is a contribution to the spectral theory of so-called eventually positive operators, i.e.\\ operators $T$ which may not be positive but whose powers $T^n$ become positive for large enough $n$. While the spectral theory of such operators is well understood in finite dimensions, the infinite dimensional case has received much less attention in the literature. We show that several sensible notions of "eventual positivity" can be defined in the infinite dimensional setting, and in con...

  10. Different utilization of intensive care services (ICSs) for patients dying of hemorrhagic and ischemic stroke, a hospital-based survey. (United States)

    Wang, Vinchi; Hsieh, Chieh-Chao; Huang, Yen-Ling; Chen, Chia-Ping; Hsieh, Yi-Ting; Chao, Tzu-Hao


    The intensive care service (ICS) saves lives and rescues the neurological function of stroke patients. We wondered the different utilization of ICS for patients with ischemic and hemorrhagic stroke, especially those who died within 30 days after stroke.Sixty-seven patients died during 2011 to 2015 due to acute stroke (42 due to intracranial hemorrhage [ICH]; 25 due to cerebral infarct [CI]). The durations of hospital stay (hospital staying days [HSDs]) and ICS staying days (ISDs) and codes of the do-not-resuscitate (DNR) were surveyed among these medical records. Statistics included chi-square and descriptive analyses.In this study, CI patients had a longer HSD (mean 14.3 days), as compared with ICH patients (mean 8.3 days); however, the ICH patients had a higher percentage of early entry within the first 24 hours of admission into ICS than CI group (95.1% vs 60.0%, P = .003). A higher rate of CI patients died in holidays or weekends than those with ICH (44.0% vs 21.4%, P = .051). DNR, requested mainly from direct descendants (children or grandchildren), was coded in all 25 CI patients (100.0%) and 38 ICH patients (90.5%). More cases with early DNR coded within 24 hours after admission occurred in ICH group (47%, 12% in CI patients, P = .003). None of the stroke patient had living wills. Withhold of endotracheal intubation (ETI) occurred among CI patients, more than for ICH patients (76.0% vs 18.4%, P mortality within holidays or weekends, and higher ETI withhold; but less percentage of ICS utilization expressed by a lower ISD/HSD ratio. This ICS utilization is a key issue of medical quality for stroke care.

  11. Standardized evaluation of lung congestion during COPD exacerbation better identifies patients at risk of dying

    Directory of Open Access Journals (Sweden)

    Høiseth AD


    concentration 1.8, CI 1.2–2.6 (P=0.003.Conclusion: By applying a standardized approach when evaluating pulmonary congestion on chest radiographs during AECOPD, a group of patients with increased risk of dying, possibly due to heart failure, is identified.Keywords: heart failure, radiograph, NT-proBNP, mortality, X-ray, cephalization

  12. Work engagement and attitudes toward caring for dying patients and families among home-visiting nurses in Japan. (United States)

    Mahiro, Sakai; Takashi, Naruse; Satoko, Nagata


    Nurses with higher levels of work engagement tend to be highly efficient in their work and more willing to keep working and to provide patient-centred care. However, whether more engaged nurses provide end-of-life care more proactively has not been examined in the home-care setting. This study aimed to examine work engagement among home-visiting nurses in Japan and its relationship with their attitudes toward caring for dying patients and their families. A total of 343 nurses working in 62 agencies across Chiba prefecture, eastern Japan, received an anonymous self-administered questionnaire from July to August 2012. The authors performed multiple regression analysis to explore the relationships between home-visiting nurses' work engagement and attitudes. Data from 184 nurses (53.6%) was analysed. Work engagement was significantly positively related to the nurses' attitudes toward caring for dying patients and their families. As more engaged nurses tend to have more positive attitudes toward caring for dying patients and their families, further research is needed to identify the factors that might help nursing managers to enhance their staff's engagement and perhaps thereby improve their attitudes, with the ultimate aim of achieving better outcomes for patients and families.

  13. The timing of death in patients with tuberculosis who die during anti-tuberculosis treatment in Andhra Pradesh, South India

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    Jonnalagada Subbanna


    Full Text Available Abstract Background India has 2.0 million estimated tuberculosis (TB cases per annum with an estimated 280,000 TB-related deaths per year. Understanding when in the course of TB treatment patients die is important for determining the type of intervention to be offered and crucially when this intervention should be given. The objectives of the current study were to determine in a large cohort of TB patients in India:- i treatment outcomes including the number who died while on treatment, ii the month of death and iii characteristics associated with "early" death, occurring in the initial 8 weeks of treatment. Methods This was a retrospective study in 16 selected Designated Microscopy Centres (DMCs in Hyderabad, Krishna and Adilabad districts of Andhra Pradesh, South India. A review was performed of treatment cards and medical records of all TB patients (adults and children registered and placed on standardized anti-tuberculosis treatment from January 2005 to September 2009. Results There were 8,240 TB patients (5183 males of whom 492 (6% were known to have died during treatment. Case-fatality was higher in those previously treated (12% and lower in those with extra-pulmonary TB (2%. There was an even distribution of deaths during anti-tuberculosis treatment, with 28% of all patients dying in the first 8 weeks of treatment. Increasing age and new as compared to recurrent TB disease were significantly associated with "early death". Conclusion In this large cohort of TB patients, deaths occurred with an even frequency throughout anti-TB treatment. Reasons may relate to i the treatment of the disease itself, raising concerns about drug adherence, quality of anti-tuberculosis drugs or the presence of undetected drug resistance and ii co-morbidities, such as HIV/AIDS and diabetes mellitus, which are known to influence mortality. More research in this area from prospective and retrospective studies is needed.

  14. Die funksie van die belydenis in die struktuur van die kerk en die ...

    African Journals Online (AJOL)

    Ter wille van die argument wat in hierdie voordrag na vore gebring word, word vier sodanige konstituerende elemente van die kerklike struktuur onderskei, te wete die belydenis, die teologie, die verkondi- ging (meer bepaald die prediking) en die kerkorde (kerkwet volgens ons terminologie). Ons gaan nou elkeen hiervan ...

  15. How to Deal With Relatives of Patients Dying in the Hospital? Qualitative Content Analysis of Relatives' Experiences. (United States)

    Witkamp, Erica; Droger, Mirjam; Janssens, Rien; van Zuylen, Lia; van der Heide, Agnes


    Hospital care and communication tend to be focused on the individual patient, and decision making is typically based on the principle of individual autonomy. It can be questioned whether this approach is adequate when a patient is terminally ill. Our aim was to explore the involvement and experiences of relatives in the hospital during the patient's last phase of life. This study was embedded in a retrospective questionnaire study on the quality of dying of a consecutive sample of patients who died in a general university hospital in The Netherlands. We performed a secondary qualitative analysis of relatives' comments and answers to open questions. Relatives of 951 deceased adult patients were asked to complete a questionnaire; 451 questionnaires were returned and analyzed for this study. Relatives expressed a need for 1) comprehensible, timely, and sensitive information and communication, 2) involvement in decision making, 3) acknowledgment of their position, 4) being able to trust health care staff, and 5) rest and privacy. When relatives felt that their role had sufficiently been acknowledged by health care professionals (HCPs), their experiences were more positive. Relatives emphasized their relation with the patient and their involvement in care of the patient dying in the hospital. An approach of HCPs to care based on the concept of individual autonomy seems inadequate. The role of relatives might be better addressed by the concept of relational autonomy, which provides HCPs with opportunities to create a relationship with relatives in care that optimally addresses the needs of patients. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  16. Why are some patients with Duchenne muscular dystrophy dying young: An analysis of causes of death in North East England. (United States)

    Van Ruiten, H J A; Marini Bettolo, C; Cheetham, T; Eagle, M; Lochmuller, H; Straub, V; Bushby, K; Guglieri, M


    Duchenne muscular dystrophy (DMD) is the most common inherited muscle disease in children. Recent years have seen an increase in age of survival into adulthood following the introduction of proactive standards of care. We reviewed mortality in DMD in our population in order to identify potential underlying risk factors for premature death and improve clinical care. A retrospective case note review of all deaths in the DMD population over the last 10 years in North East England. We identified 2 groups of patients: patients who died from underlying cardiac and/or respiratory failure (group 1) and patients who died unexpectedly in the absence of underlying cardio-respiratory failure (group 2). Detailed information was available on 21 patients. Mean age of death in group 1 (17 patients) was 23.9 (14.4-39.5) years, in group 2 (4 patients) 14 (12.7-14.9) years. Causes of death in group 2 were acute pneumonia, cardiac arrest, acute respiratory distress and multi-organ failure. Across both groups we identified concerns regarding respiratory failure, inadequate nutrition, non-attendance at appointments, suboptimal coordination of care and decreased psychological wellbeing. In group 2, fat embolism, cardiac arrhythmia and adrenal insufficiency were also potential contributing factors. The main cause of death in DMD in our population remains cardio-respiratory failure. Four patients (19%) died in their teenage years in the absence of severe cardiorespiratory failure. A more thorough understanding of the impact of DMD and its treatment on all organs systems is required to minimise the risk of an untimely death. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

  17. The Contribution of Death-Related Experiences to Health Care Providers' Attitudes toward Dying Patients: II. Medical and Nursing Students with No Professional Experience. (United States)

    Brent, Sandor B.; And Others


    Compared attitudes toward care of dying patients of beginning medical and nursing students with no professional death-related experience. On five of six attitude measures, female nursing students expressed more positive attitude than either male or female medical students. Hours of death-and-dying coursework and general life experience exerted…

  18. Die posisie van die Helper in die sending

    Directory of Open Access Journals (Sweden)

    I. J. van der Walt


    Full Text Available Gedurende die aanvangsjare van die sending het die helper ’n onmisbare funksie vervul. Hulle het die onherbergsame binnelande geken, waardevolle kontakpunte vir die sendelinge geopen en hulle mense geestelik help voorlig en voorberei.

  19. Why do we want the right to die? A systematic review of the international literature on the views of patients, carers and the public on assisted dying. (United States)

    Hendry, Maggie; Pasterfield, Diana; Lewis, Ruth; Carter, Ben; Hodgson, Daniel; Wilkinson, Clare


    Assisted dying is legal in four European countries and three American states. Elsewhere, particularly in more affluent or mainly Protestant countries, it remains controversial. Dominant headlines feature professional (medical, legal, religious) arguments versus celebrity campaigners; ordinary people are less clearly represented. To synthesise the international evidence of people's views and attitudes towards assisted dying in order to inform current debate about this controversial issue. Systematic review and mixed method synthesis of qualitative and survey data. Eleven electronic databases from inception to October 2011; bibliographies of included studies. Two reviewers independently screened papers and appraised quality. Qualitative results were extracted verbatim; survey results were summarised in a table. Qualitative data were synthesised using framework methods and survey results integrated where they supported, contrasted or added to the themes identified. Sixteen qualitative studies and 94 surveys were included; many participants considered the immediate relevance of assisted dying for them. Themes related to poor quality of life, a good quality of death, potential abuse of assisted dying and the importance of individual stance. People valued autonomy in death as much as in life. Attitudes were diverse, complex and related to definitions of unbearable suffering including physical, psycho-social and existential factors and were consistent regardless of social, economic, legal and health-care contexts. Our review sheds light on ordinary people's perspectives about assisted dying, when they are ill or disabled. Unbearable suffering is a key construct, and common factors are revealed that lead people to ask for help to die. The consistency of international views indicates a mandate for legislative and medical systems worldwide to listen and understand this.

  20. Legal physician-assisted dying in Oregon and the Netherlands: evidence concerning the impact on patients in "vulnerable" groups. (United States)

    Battin, Margaret P; van der Heide, Agnes; Ganzini, Linda; van der Wal, Gerrit; Onwuteaka-Philipsen, Bregje D


    Debates over legalisation of physician-assisted suicide (PAS) or euthanasia often warn of a "slippery slope", predicting abuse of people in vulnerable groups. To assess this concern, the authors examined data from Oregon and the Netherlands, the two principal jurisdictions in which physician-assisted dying is legal and data have been collected over a substantial period. The data from Oregon (where PAS, now called death under the Oregon Death with Dignity Act, is legal) comprised all annual and cumulative Department of Human Services reports 1998-2006 and three independent studies; the data from the Netherlands (where both PAS and euthanasia are now legal) comprised all four government-commissioned nationwide studies of end-of-life decision making (1990, 1995, 2001 and 2005) and specialised studies. Evidence of any disproportionate impact on 10 groups of potentially vulnerable patients was sought. Rates of assisted dying in Oregon and in the Netherlands showed no evidence of heightened risk for the elderly, women, the uninsured (inapplicable in the Netherlands, where all are insured), people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations. The only group with a heightened risk was people with AIDS. While extralegal cases were not the focus of this study, none have been uncovered in Oregon; among extralegal cases in the Netherlands, there was no evidence of higher rates in vulnerable groups. Where assisted dying is already legal, there is no current evidence for the claim that legalised PAS or euthanasia will have disproportionate impact on patients in vulnerable groups. Those who received physician-assisted dying in the jurisdictions studied appeared to enjoy comparative social, economic, educational, professional and other privileges.

  1. Length of home hospice care, family-perceived timing of referrals, perceived quality of care, and quality of death and dying in terminally ill cancer patients who died at home. (United States)

    Yamagishi, Akemi; Morita, Tatsuya; Kawagoe, Shohei; Shimizu, Megumi; Ozawa, Taketoshi; An, Emi; Kobayakawa, Makoto; Tsuneto, Satoru; Shima, Yasuo; Miyashita, Mitsunori


    This study aims to clarify the length of home hospice care, family-perceived timing of referrals, and their effects on the family-perceived quality of care and quality of death and dying of terminally ill cancer patients who died at home and identify the determinants of perceived late referrals. A multicenter questionnaire survey was conducted involving 1,052 family members of cancer patients who died at home supported by 15 home-based hospice services throughout Japan. A total of 693 responses were analyzed (effective response rate, 66 %). Patients received home-based hospice care for a median of 35.0 days, and 8.0 % received home hospice care for less than 1 week. While 1.5 % of the families reported the timing of referrals as early, 42 % reported the timing as late or too late. The families of patients with a length of care of less than 4 weeks were more likely to regard the timing of referrals as late or too late. The patients of family members who regarded the timing of referrals as late or too late had a significantly lower perceived quality of care (effect size, 0.18; P = 0.039) and lower quality of death and dying (effect size, 0.15, P = 0.063). Independent determinants of higher likelihoods of perceived late referrals included: frequent visits to emergency departments, patient being unprepared for worsening condition, and patient having concerns about relationship with new doctor. Discharge nurse availability was independently associated with lower likelihoods of perceived late referrals. A significant number of bereaved families regarded the timing of referrals to home hospices as late, and the perceived timing was associated with the family-perceived quality of care and quality of death and dying. Systematic strategies to overcome the barriers related to perceived late referrals are necessary.

  2. What do Japanese residents learn from treating dying patients? The implications for training in end-of-life care

    Directory of Open Access Journals (Sweden)

    Kazuko Arai


    Full Text Available Abstract Background How medical residents’ experiences with care for dying patients affect their emotional well-being, their learning outcomes, and the formation of their professional identities is not fully understood. We examine residents’ emotional states and learning occurring during the provision of care to dying patients and specifically discuss the impact of providing end-of-life (EOL care on professional identity formation. Methods Semi-structured interviews were conducted with 13 residents who had graduated in the last 3 to 5 years. Thematic theoretical analysis was applied, and key themes were developed based on Kolb’s experiential learning cycle. Results Eight key themes emerged from the analysis. The residents experienced dilemmas in confronting the reality of medical uncertainty as well as a disruption of emotional state and self-efficacy. Although the residents felt a sense of helplessness and guilt, they were able to reflect on strategies for handling medical care that focused on patients and that required a truly sincere attitude. They also contemplated the importance of palliative care and communication with patients, patients’ family members and medical staff. Building on these experiences, the residents rebuilt a sense of awareness that allowed them to directly engage with the type of medical care that they are likely to be called upon to perform in the future as the population continues to age. Conclusions This study revealed Japanese residents’ perceptions, emotions and learning processes in caring for dying patients by applying Kolb’s experiential learning theory. The findings of this study may illuminate valuable pieces of knowledge for future education in EOL care.

  3. From will to live to will to die: oncologists, nurses, and social workers identification of suicidality in cancer patients. (United States)

    Granek, Leeat; Nakash, Ora; Ariad, Samuel; Chen, Wendy; Birenstock-Cohen, Shira; Shapira, Shahar; Ben-David, Merav


    The purpose of this research was to examine how oncologists, nurses, and social workers identify suicidality in cancer patients. Sixty-one healthcare professionals (23 oncologists, 18 social workers, and 20 nurses) at two academic cancer centers were interviewed using an in-depth interview guide. This was a qualitative study based on grounded theory methodology. Analysis involved line-by-line coding, with categories and themes emerging from participants' narratives. Suicidality in cancer patients exists on a wide spectrum that ranges from an active will to live to an active will to die. Four phases were identified that included: (A) a strong will to live expressed in themes of active treatments, seeking second opinions, overtreatment, and alternative treatments; (B) a decreasing will to live indicated in themes of mental health distress and physical pain and suffering; (C) a readiness to die expressed in themes of mental health distress, previous mental health diagnoses, physical pain, avoiding more suffering, preserving quality of life in old age, nearing end of life, lack of social support, and maintaining a sense of control; and (D) a will to die indicated in themes of euthanasia and active suicidality. Suicidality in cancer patients exists on a continuum. Cancer patients fluctuate on this spectrum depending on circumstances such as degree of suffering, their personalities and life circumstances, and whether they are nearing the end of life. Results of the study emphasize the need to collect more context specific data on suicidality among cancer patients and the importance of early integration of psychosocial and palliative care in the cancer treatment trajectory.

  4. Eventual Suicide in Interrupted and Uninterrupted Attempters: A Challenge to the Cry-for-Help Hypothesis. (United States)

    Steer, Robert A.; And Others


    Followed patients (N=499) hospitalized for suicide attempts (attempters) between 1970 and 1975 until 1982. Found under six percent eventually committed suicide. Found the interrupted attempters were approximately three times more likely to commit suicide than were the uninterrupted attempters. (Author/ABL)


    African Journals Online (AJOL)

    stel (kortdiensstelsel). Met die uitbreek van die oorlog in 1939 het die. Unieverdedigingsmag uit 40% Staandemag en. 60% aktiewe Burgermag bestaan. Op 22 Sept. 1939 is magtiging aan die Aktiewe Burgermag- eenhede verleen om vrywilligers vir die duur van die oorlog te aanvaar. Agv beswaar dat die Verdedigingswet.

  6. Die Formatestadt


    Günter Trojan


    Zu Zeiten von DV oder VHS (wer kennt das eigentlich noch?) war die Welt noch in Ordnung: Da hatte man eine Kassette in der Hand und wenn das passende Gerät gefunden wurde konnte man das Video auch abspielen. Günter Trojan diskutiert die Geschichte und Gegenwart unterschiedlicher Videoformate ...

  7. Die Formatestadt

    Directory of Open Access Journals (Sweden)

    Günter Trojan


    Full Text Available Zu Zeiten von DV oder VHS (wer kennt das eigentlich noch? war die Welt noch in Ordnung: Da hatte man eine Kassette in der Hand und wenn das passende Gerät gefunden wurde konnte man das Video auch abspielen. Günter Trojan diskutiert die Geschichte und Gegenwart unterschiedlicher Videoformate ...

  8. Would you be surprised if this patient died?: Preliminary exploration of first and second year residents' approach to care decisions in critically ill patients

    Directory of Open Access Journals (Sweden)

    Armstrong John D


    Full Text Available Abstract Background How physicians approach decision-making when caring for critically ill patients is poorly understood. This study aims to explore how residents think about prognosis and approach care decisions when caring for seriously ill, hospitalized patients. Methods Qualitative study where we conducted structured discussions with first and second year internal medicine residents (n = 8 caring for critically ill patients during Medical Intensive Care Unit Ethics and Discharge Planning Rounds. Residents were asked to respond to questions beginning with "Would you be surprised if this patient died?" Results An equal number of residents responded that they would (n = 4 or would not (n = 4 be surprised if their patient died. Reasons for being surprised included the rapid onset of an acute illness, reversible disease, improving clinical course and the patient's prior survival under similar circumstances. Residents reported no surprise with worsening clinical course. Based on the realization that their patient might die, residents cited potential changes in management that included clarifying treatment goals, improving communication with families, spending more time with patients and ordering fewer laboratory tests. Perceived or implied barriers to changes in management included limited time, competing clinical priorities, "not knowing" a patient, limited knowledge and experience, presence of diagnostic or prognostic uncertainty and unclear treatment goals. Conclusions These junior-level residents appear to rely on clinical course, among other factors, when assessing prognosis and the possibility for death in severely ill patients. Further investigation is needed to understand how these factors impact decision-making and whether perceived barriers to changes in patient management influence approaches to care.

  9. Clinical characteristics and course of dying in patients with amyotrophic lateral sclerosis withdrawing from long-term ventilation. (United States)

    Kettemann, Dagmar; Funke, Andreas; Maier, André; Rosseau, Simone; Meyer, Robert; Spittel, Susanne; Münch, Christoph; Meyer, Thomas


    Non-invasive ventilation (NIV) or tracheotomy with invasive ventilation (TIV) are treatment options in ALS. However, a proportion of patients receiving long-term ventilation decide to have it withdrawn. The objective of this study was to analyse the clinical characteristics and palliative approaches in ALS patients withdrawing from long-term ventilation (WLTV). In a cohort study, two different palliative concepts in WLTV were studied: (1) augmented symptom control (ASC; sedation not intended) in patients with ventilator-free tolerance; (2) continuous deep sedation (CDS; sedation intended) in patients without ventilator-free tolerance. Results showed that WLTV was realised in 49 ALS patients (NIV = 13; TIV = 36). Mean daily ventilation was 23.4 h. The ALS Functional Rating Scale (ALSFRS-R) was low (5.6 of 48). Forty-one per cent of patients (n = 20) presented with ophthalmoplegia. ASC was performed in 20 patients, CDS in 29 patients. The mean time to death following disconnection was 32 (0.3-164) h during ASC and 0.3 (0.2-0.6) h in CDS. In conclusion, a low ALSFRS-R, high incidence of ophthalmoplegia and extended ventilator dependency were found before WLTV. The presence or absence of ventilator-free tolerance determined the approach to the management of symptoms, the setting for immediate end-of-life care and the course of dying in WLTV.

  10. Lebensraum: paradoxically, population growth may eventually end wars. (United States)

    Simon, J L


    Population growth may progressively reduce 1 of the motives for making war. Namely, population growth threatens shortages of resources, and especially land. Impending shortages cause a search for ways to mitigate the shortages. The discoveries eventually produce greater availability of resources than if population growth and pressure on resources had never occurred. The argument runs as follows: 1) Rhetoric about resources scarcity induced by population density has often contributed to international conflict, even if economics has not been the main motive in making war. 2) In the pre-modern era, war to obtain land and other resources may sometimes have been an economically sound policy. 3) Politicians and others in industrially developed nations believe resources may still be a casus belli. 4) Land and other productive resources are no longer worth acquiring at the cost of war.

  11. Die funksie van die skeppingstradisie in die boek Jeremia

    African Journals Online (AJOL)

    gedeeites voor wat sterk ooreenkomste toon met die beskrywings van die skep pingsgebeure in die boek Jeremia. • Volgpns Von Rad (1957:144-146) het daar wel 'n groep bestaan wat belange ge- had liet by die oorlewering van die skeppingstradisies. Dit was waarskynlik die. Sadokitiese priesters wat om twee redes aan ...

  12. The predictive value of 2-year posttreatment biopsy after prostate cancer radiotherapy for eventual biochemical outcome

    International Nuclear Information System (INIS)

    Vance, Waseet; Tucker, Susan L.; Crevoisier, Renaud de; Kuban, Deborah A.; Cheung, M. Rex


    Purpose: To determine the value of a 2-year post-radiotherapy (RT) prostate biopsy for predicting eventual biochemical failure in patients who were treated for localized prostate cancer. Methods and Materials: This study comprised 164 patients who underwent a planned 2-year post-RT prostate biopsy. The independent prognostic value of the biopsy results for forecasting eventual biochemical outcome and overall survival was tested with other factors (the Gleason score, 1992 American Joint Committee on Cancer tumor stage, pretreatment prostate-specific antigen level, risk group, and RT dose) in a multivariate analysis. The current nadir + 2 (CN + 2) definition of biochemical failure was used. Patients with rising prostate-specific antigen (PSA) or suspicious digital rectal examination before the biopsy were excluded. Results: The biopsy results were normal in 78 patients, scant atypical and malignant cells in 30, carcinoma with treatment effect in 43, and carcinoma without treatment effect in 13. Using the CN + 2 definition, we found a significant association between biopsy results and eventual biochemical failure. We also found that the biopsy status provides predictive information independent of the PSA status at the time of biopsy. Conclusion: A 2-year post-RT prostate biopsy may be useful for forecasting CN + 2 biochemical failure. Posttreatment prostate biopsy may be useful for identifying patients for aggressive salvage therapy

  13. No Negative Impact of Palliative Sedation on Relatives' Experience of the Dying Phase and Their Wellbeing after the Patient's Death: An Observational Study.

    Directory of Open Access Journals (Sweden)

    S M Bruinsma

    Full Text Available Palliative sedation is the widely-used intervention of administering sedating agents to induce a state of unconsciousness to take away a dying patient's perception of otherwise irrelievable symptoms. However, it remains questionable whether this ethically complex intervention is beneficial for patients and whether the associated lack of communication in the last phase of life has a negative impact on relatives' wellbeing.An observational questionnaire study was conducted among relatives of a consecutive sample of patients who died a non-sudden death in the Erasmus MC Cancer Institute or in the hospice 'Laurens Cadenza' (both in Rotterdam between 2010 and 2013.Relatives filled in questionnaires regarding 151 patients who had been sedated and 90 patients who had not been sedated. The median time since all patients had passed away was 21 (IQR 14-32 months. No significant differences were found in relatives´ assessments of the quality of end-of-life care, patients´ quality of life in the last week before death and their quality of dying, between patients who did and did not receive sedation, or in relatives' satisfaction with their own life, their general health and their mental wellbeing after the patient's death.The use of sedation in these patients appears to have no negative effect on bereaved relatives' evaluation of the patient's dying phase, or on their own wellbeing after the patient's death.

  14. No Negative Impact of Palliative Sedation on Relatives' Experience of the Dying Phase and Their Wellbeing after the Patient's Death: An Observational Study. (United States)

    Bruinsma, S M; van der Heide, A; van der Lee, M L; Vergouwe, Y; Rietjens, J A C


    Palliative sedation is the widely-used intervention of administering sedating agents to induce a state of unconsciousness to take away a dying patient's perception of otherwise irrelievable symptoms. However, it remains questionable whether this ethically complex intervention is beneficial for patients and whether the associated lack of communication in the last phase of life has a negative impact on relatives' wellbeing. An observational questionnaire study was conducted among relatives of a consecutive sample of patients who died a non-sudden death in the Erasmus MC Cancer Institute or in the hospice 'Laurens Cadenza' (both in Rotterdam) between 2010 and 2013. Relatives filled in questionnaires regarding 151 patients who had been sedated and 90 patients who had not been sedated. The median time since all patients had passed away was 21 (IQR 14-32) months. No significant differences were found in relatives´ assessments of the quality of end-of-life care, patients´ quality of life in the last week before death and their quality of dying, between patients who did and did not receive sedation, or in relatives' satisfaction with their own life, their general health and their mental wellbeing after the patient's death. The use of sedation in these patients appears to have no negative effect on bereaved relatives' evaluation of the patient's dying phase, or on their own wellbeing after the patient's death.

  15. Relatives' Perspective on the Terminally Ill Patients Who Died after Euthanasia or Physician-Assisted Suicide: A Retrospective Cross-Sectional Interview Study in the Netherlands (United States)

    Georges, Jean-Jacques; Onwuteaka-Philipsen, Bregje D.; Muller, Martien T.; van der Wal, Gerrit; van der Heide, Agnes; van der Maas, Paul J.


    This study used retrospective interviews with 87 relatives to describe the experiences of patients who died by euthanasia or physician-assisted suicide (EAS) in the Netherlands. Most of the patients suffered from cancer (85%). The relatives were most often a partner (63%) or a child (28%) of the patient. Before explicitly requesting EAS most…

  16. Die regsposisie van die gemolesteerde kind 1

    Directory of Open Access Journals (Sweden)

    P.J. Schabort


    Full Text Available Hoe reik die reg uit na die seksueel gemolesteerde kind? As na die reg in wye verband gekyk word, sou dit alie wetgewing en alle gemeneregsbeginsels en alle regsprosedures insluit waardeur die Staat poog om molestering te voorkom en die gemolesteerde kind in beskerming te neem. Dit le baie wyd en sou byvoorbeeld die maatreels insluit van die Kindenvet 33 van 1960; die Wet op Egskeiding 70 van 1979; die Wet op Kindersorg 74 van 1983; die Wet op die Status van Kinders 82 van 1987 en die Wet op Bemiddeling in Sekere Egskeidingsaangeleenthede 24 van 1987. Eersdaags sal dit moontlik ook ’n Manifes vir die Regte van Kinders insluit wat vermoedelik geskoei sal wees op die W O se Konvensie vir die Regte van die Kind (1989 w a arv an die RSA tan s nog nie ’n ondertekenaar is nie.

  17. [Dignity in the care of terminal ill and dying patients. Definitions and supportive interventions in palliative care]. (United States)

    Mehnert, A; Schröder, A S; Puhlmann, K; Müllerleile, U; Koch, U


    Most patients, family members, health care professional as well as volunteers would agree that dignified care and being allowed to die with dignity are superior and unquestionable goals of palliative care. Although the majority of people have a more or less vague concept of dignity and despite its significance for palliative care, only a few empirical approaches to describe the sense of dignity from patients' and health care professionals' perspectives have been undertaken. However, individual descriptions of the dignity concept and definitions can serve as an impetus to improve the current palliative care practice by the development and evaluation of psychotherapeutic interventions for patients near the end of life and the allocation of resources. This article considers an internationally developed empirical-based model of dignity in severe and terminal ill patients by Chochinov et al. Furthermore, it illustrates the understanding of dignity as well as self-perceived exertions of influence on a patient's dignity from the perspective of health care professionals and volunteers. Psychotherapeutic interventions and strategies are introduced that can help conserve the sense of dignity of patients during palliative care.

  18. Why do even satisfied newlyweds eventually go on to divorce? (United States)

    Lavner, Justin A; Bradbury, Thomas N


    Although divorce typically follows an extended period of unhappiness that begins early in marriage, some couples who are very happy throughout the first several years of marriage will also go on to divorce. This study aimed to identify risk factors early in marriage that distinguish initially satisfied couples who eventually divorce from those who remain married. We identified 136 couples reporting stably high levels of relationship satisfaction in the first 4 years of marriage. We compared the couples who went on to divorce by the 10-year follow-up with the couples who remained married on initial measures of commitment, observed communication, stress, and personality. Divorcing couples displayed more negative communication, emotion, and social support as newlyweds compared with couples who did not divorce. No significant differences were found in the other domains, in relationship satisfaction, or in positive behaviors. Overall, results indicate that even couples who are very successful at navigating the early years of marriage can be vulnerable to later dissolution if their interpersonal exchanges are poorly regulated. We speculate that, paradoxically, the many strengths possessed by these couples may mask their potent interpersonal liabilities, posing challenges for educational interventions designed to help these couples.

  19. Electrolysis with diamond anodes: Eventually, there are refractory species! (United States)

    Mena, Ismael F; Cotillas, Salvador; Díaz, Elena; Sáez, Cristina; Rodríguez, Juan J; Cañizares, P; Mohedano, Ángel F; Rodrigo, Manuel A


    In this work, synthetic wastewater polluted with ionic liquid 1-butyl-3-methylimidazolium (Bmim) bis(trifluoromethanesulfonyl)imide (NTf 2 ) undergoes four electrolytic treatments with diamond anodes (bare electrolysis, electrolysis enhanced with peroxosulfate promoters, irradiated with UV light and with US) and results obtained were compared with those obtained with the application of Catalytic Wet Peroxide Oxidation (CWPO). Despite its complex heterocyclic structure, Bmim + cation is successfully depleted with the five technologies tested, being transformed into intermediates that eventually can be mineralized. Photoelectrolysis attained the lowest concentration of intermediates, while CWPO is the technology less efficient in their degradation. However, the most surprising result is that concentration of NTf 2 - anion does not change during the five advanced oxidation processes tested, pointing out its strong refractory character, being the first species that exhibits this character in wastewater undergoing electrolysis with diamond. This means that the hydroxyl and sulfate radicals mediated oxidation and the direct electrolysis are inefficient for breaking the C-S, C-F and S-N bounds of the NTf 2 - anion, which is a very interesting mechanistic information to understand the complex processes undergone in electrolysis with diamond. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. De-tabooing dying control - a grounded theory study (United States)


    Background Dying is inescapable yet remains a neglected issue in modern health care. The research question in this study was “what is going on in the field of dying today?” What emerged was to eventually present a grounded theory of control of dying focusing specifically on how people react in relation to issues about euthanasia and physician-assisted suicide (PAS). Methods Classic grounded theory was used to analyze interviews with 55 laypersons and health care professionals in North America and Europe, surveys on attitudes to PAS among physicians and the Swedish general public, and scientific literature, North American discussion forum websites, and news sites. Results Open awareness of the nature and timing of a patient’s death became common in health care during the 1960s in the Western world. Open dying awareness contexts can be seen as the start of a weakening of a taboo towards controlled dying called de-tabooing. The growth of the hospice movement and palliative care, but also the legalization of euthanasia and PAS in the Benelux countries, and PAS in Montana, Oregon and Washington further represents de-tabooing dying control. An attitude positioning between the taboo of dying control and a growing taboo against questioning patient autonomy and self-determination called de-paternalizing is another aspect of de-tabooing. When confronted with a taboo, people first react emotionally based on “gut feelings” - emotional positioning. This is followed by reasoning and label wrestling using euphemisms and dysphemisms - reflective positioning. Rarely is de-tabooing unconditional but enabled by stipulated positioning as in soft laws (palliative care guidelines) and hard laws (euthanasia/PAS legislation). From a global perspective three shapes of dying control emerge. First, suboptimal palliative care in closed awareness contexts seen in Asian, Islamic and Latin cultures, called closed dying. Second, palliative care and sedation therapy, but not euthanasia

  1. Families' experiences with patients who died after assisted suicide: a retrospective interview study in southern Switzerland. (United States)

    Gamondi, C; Pott, M; Payne, S


    In Switzerland, if certain conditions are met, assisted suicide is not prosecuted. International debate suggests that requests for hasten death are often altered by the provision of palliative care. Aims of the study were to explore patients' reasons for choice of assisted suicide and family perceptions of the interactions with health care professionals. This is a qualitative study upon 11 relatives of 8 patients cared for by a palliative care team, deceased of assisted suicide. Pain and symptom burden were not regarded by patients as key reasons to seek assisted suicide: existential distress and fear of loss of control were the determinants. Most patients had made pre-illness decisions to use assisted suicide. A general need for perceived control and fear of dependency were reported as a common characteristic of these patients. Patients held misunderstandings about the nature and purpose of palliative care, and the interviewed indicated that patients did not regard provision of palliative care services as influential in preventing their decision. Assisted suicide was preferred despite provision of palliative care. Better understanding of the importance placed on perceived control and anticipated dependency is needed. Further research is needed to develop appropriate support for patients contemplating assisted suicide.

  2. Residents Learning from a Narrative Experience with Dying Patients: A Qualitative Study (United States)

    Tait, Glendon R.; Hodges, Brian D.


    For patients at the end of life, it is crucial to address the psychological, existential, and spiritual distress of patients. Medical education research suggests trainees feel unprepared to provide the whole person, humanistic care held as the ideal. This study used an empirically based narrative intervention, the dignity interview, as an…

  3. Hope, Life, and Death: A Qualitative Analysis of Dying Cancer Patients' Talk about Hope (United States)

    Eliott, Jaklin A.; Olver, Ian N.


    Although deemed vital to patient well-being, hope in persons who are terminally ill is often thought to be problematic, particularly when centered on cure. As part of a study on end-of-life decision-making, we asked 28 patients with cancer, believed to be within weeks of their death, to talk about hope. Responses were transcribed and discursively…

  4. End-of-Life Care and Circumstances of Death in Patients Dying As a Result of Cancer in Belgium and the Netherlands: A Retrospective Comparative Study

    NARCIS (Netherlands)

    Meeussen, K.; van den Block, L.; Echteld, M.A.; Boffin, N.; Bilsen, J.; van Casteren, V.; Abarshi-Fatiregun, E.A.B.; Donker, G.; Onwuteaka-Philipsen, B.D.; Deliens, L.


    Purpose: To examine and compare end-of-life care in patients with cancer dying in Belgium and the Netherlands. Patients and Methods: A mortality follow-back study was undertaken in 2008 via representative nationwide sentinel networks of general practitioners (GPs) in Belgium and the Netherlands. By

  5. End-of-life care and circumstances of death in patients dying as a result of cancer in Belgium and the Netherlands: a retrospective comparative study.

    NARCIS (Netherlands)

    Meeussen, K.; Block, L. van den; Echteld, M.A.; Boffin, N.; Bilsen, J.; Casteren, V. van; Abarshi, E.; Donker, G.; Onwuteaka-Philipsen, B.; Deliens, L.


    Purpose: To examine and compare end-of-life care in patients with cancer dying in Belgium and the Netherlands. Patients and methods: A mortality follow-back study was undertaken in 2008 via representative nationwide sentinel networks of general practitioners (GPs) in Belgium and the Netherlands. By

  6. Differences between terminally ill cancer patients who died after euthanasia had been performed and terminally ill cancer patients who did not request euthanasia. (United States)

    Georges, Jean-Jacques; Onwuteaka-Philipsen, Bregje D; van der Wal, Gerrit; van der Heide, Agnes; van der Maas, Paul J


    Palliative care, directed at improving the quality of life of terminally ill patients, is generally not aimed at any form of postponing or hastening death. It is possible that high quality palliative care could prevent requests for euthanasia. However, empirical evidence on this issue is scarce. In a national survey of end-of-life medical decisions in The Netherlands the subject of care at the end of life has been addressed. Data on terminally ill cancer patients who died after their request was granted and euthanasia had been performed were compared with those of terminally ill cancer patients who did not request euthanasia. The results show that the prevalence and severity of symptoms e.g., pain, feeling unwell, nausea, was higher in patients who died after their request was granted and euthanasia had been performed. No differences concerning the treatment of symptoms or the care provided were found between the two groups. The results suggest that the practice of euthanasia is mainly related to the patient's suffering.

  7. Influence of Training on First-Year Nursing Department Students' Attitudes on Death and Caring for Dying Patients: A Single-Group Pretest-Posttest Experimental Study. (United States)

    Cerit, Birgül


    The study examined the influence of training on first-year nursing department students' attitudes on death and caring for dying patients. Utilizing the experimental model, the study sample consisted of 81 first-year students attending the nursing department of a university. Death Attitude Profile-Revised and Frommelt Attitude toward Care of the Dying Scale were used for data collection. Data analysis included means, standard deviation, and t test for related samples. Student attitudes toward death were measured as 146.43 (16.741) and 152.75 (15.132) for pre- and posttraining, respectively. Student attitudes toward caring for dying patients were established to be 103.02 (7.655) during pretraining period and 111.02 (10.359) at posttraining period. The difference between pre- and posttests for mean attitudes toward death and caring for the dying patient was statistically significant. Study results determined that training was effective in forming positive student attitudes toward death and caring for dying patients.

  8. Living and dying with dignity in Chinese society: perspectives of older palliative care patients in Hong Kong. (United States)

    Ho, Andy Hau Yan; Chan, Cecilia Lai Wan; Leung, Pamela Pui Yu; Chochinov, Harvey Max; Neimeyer, Robert A; Pang, Samantha Mei Che; Tse, Doris Man Wah


    the empirical Dignity Model has profoundly influenced the provision of palliative care for older terminally ill patients in the West, as it provides practical guidance and intervention strategies for promoting dignity and reducing distress at the end-of-life. to examine the concept of 'living and dying with dignity' in the Chinese context, and explore the generalisability of the Dignity Model to older terminal patients in Hong Kong. using qualitative interviews, the concept of dignity was explored among 16 older Chinese palliative care patients with terminal cancer. Framework analysis with both deductive and inductive methods was employed. the three major categories of themes of the Dignity Model were broadly supported. However, the subtheme of death anxiety was not supported, while two subthemes of generativity/legacy and resilience/fighting spirit manifested differently in the Chinese context. Furthermore, four new emergent themes have been identified. They include enduring pain, moral transcendence, spiritual surrender and transgenerational unity. these findings highlight both a cultural and a familial dimension in the construct of dignity, underline the paramount importance of cultural awareness and competence for working with ethnically diverse groups, and call for a culturally sensitive and family oriented approach to palliative care interventions with older Chinese terminal patients.

  9. Learning from dying patients during their final days: life reflections gleaned from dignity therapy. (United States)

    Hack, Thomas F; McClement, Susan E; Chochinov, Harvey M; Cann, Beverley J; Hassard, Thomas H; Kristjanson, Linda J; Harlos, Mike


    Dignity therapy is a novel therapeutic approach designed to decrease suffering, enhance quality of life and bolster a sense of dignity for patients approaching death. The benefits of dignity therapy were previously documented in a sample of 100 terminally ill patients. One of the products of dignity therapy is a transcript of the edited therapy session(s). In this qualitative study, 50 of the 100 (17 from Winnipeg, Manitoba, Canada, and 33 from Perth, Australia) dignity therapy transcripts were randomly drawn, and independently coded and analysed by three investigators using a grounded theory approach. The transcripts revealed that dignity therapy serves to provide a safe, therapeutic environment for patients to review the most meaningful aspects of their lives in such a manner that their core values become apparent. The most common values expressed by the patients included 'Family', 'Pleasure', 'Caring', 'A Sense of Accomplishment', 'True Friendship', and 'Rich Experience'. Exemplars of each of these values illustrate the pervasive, defining role of values in our lives. The findings are discussed in terms of values theory, the role of dignity therapy, and consideration of values clarification in clinicians' efforts to enhance the dignity of terminally ill patients.

  10. Clinical features analysis of elderly patients with malignant tumor before dying

    International Nuclear Information System (INIS)

    Tang Haiying


    Objective: To analyse the clinical features of elderly patients with malignant tumor before death. Method: Fifty-two elderly patients with malignant tumor were retrospectively analyzed respectively from sputum culture and plasma FIB, D-dimer, albumin, hemoglobin aspects. Result: Results of sputum cultures showed the percentage of gram-negative bacteria was 56. 6%, gram-positive bacteria was 24. 5% and fungus was 18. 8%. The level of plasma FIB and D-dimer in the tumor group significantly higher than those in the control (P < 0. 05). The level of plasma albumin and hemoglobin in the tumor group were significantly lower than those in the control (P < 0. 01). Conclusion: Elderly patients with malignant tumor has obvious clinical features before death. Understanding them has important significance for guidelines of clinical treatment and judgement of prognosis. (authors)

  11. Advice and care for patients who die by voluntarily stopping eating and drinking is not assisted suicide. (United States)

    McGee, Andrew; Miller, Franklin G


    A competent patient has the right to refuse foods and fluids even if the patient will die. The exercise of this right, known as voluntarily stopping eating and drinking (VSED), is sometimes proposed as an alternative to physician assisted suicide. However, there is ethical and legal uncertainty about physician involvement in VSED. Are physicians advising of this option, or making patients comfortable while they undertake VSED, assisting suicide? This paper attempts to resolve this ethical and legal uncertainty. The standard approach to resolving this conundrum has been to determine whether VSED itself is suicide. Those who claim that VSED is suicide invariably claim that physician involvement in VSED amounts to assisting suicide. Those who claim that VSED is not suicide claim that physician involvement in VSED does not amount to assisting suicide. We reject this standard approach. We instead argue that, even if VSED is classified as a kind of suicide, physician involvement in VSED is not a form of assisted suicide. Physician involvement in VSED does not therefore fall within legal provisions that prohibit VSED.

  12. Die rol van die blanke werker in die motivering van die swart werker

    Directory of Open Access Journals (Sweden)

    G. J. Oosthuizen


    Opsomming Die motivering van die Swart werker kan nie in die huidige situasie in isolasie bestudeer word nie, omdat die Blanke werker steeds in die bestuursposisie is en daarom die motivering van die Swart werker kan beïnvloed. Hierdie ondersoek was daarop gerig om die rol van die Blanke werker in die motivering van die Swart werker nader te ondersoek. Die houding en die leierskapsbenadering van die Blanke werker teenoor die Swart werker is gemeet, asook die behoeftes wat volgens die Blanke werker by die Swart werker bestaan, bevredig is, of nie bestaan nie. Die behoeftes van Swart werkers, soos deur hulleself gesien, is ook ondersoek. Ten opsigte van sekere aspekte is beduidende verskille gevind.

  13. How is agitation and restlessness managed in the last 24 h of life in patients whose care is supported by the Liverpool care pathway for the dying patient? (United States)

    Gambles, M; McGlinchey, T; Latten, R; Dickman, A; Lowe, D; Ellershaw, J E


    Guidance regarding the patient centred management of agitation and restlessness reinforces the importance of considering underlying causes, non-pharmacological approaches to treatment and judicious use of medications titrated to patient need. In contrast, recent reports in the literature suggest that the practice of continuous deep sedation until death is prevalent in the UK. To use data from the National Care of the Dying Audit-Hospitals (NCDAH) to explore the administration of medication for management of agitation and restlessness in the last 24 h of life. Hospitals submitted data from up to 30 consecutive adult patients whose care in the final hours/days of life was supported by the Liverpool Care Pathway for the Dying Patient (LCP). Data on the total dose received in the last 24 h of life PRN and the last dose prescribed for administration via continuous subcutaneous infusion (CSCI) for agitation and restlessness were submitted. 155 hospitals provided data from 3893 patients. Median total doses in the last 24 h for midazolam, haloperidol and levomepromazine, respectively, were: PRN only, 2.5, 1.5 and 6.25 mg; CSCI only, 10, 3 and 6.25 mg; PRN+CSCI, 15, 3 and 12.5 mg. Only 51% of patients received medication to alleviate agitation and restlessness in the last 24 h of life. Median doses were low in comparison to doses recommended for continuous deep sedation, suggesting that there is no 'blanket' policy for continuous deep sedation at the end of life for patients whose care is supported by the LCP.

  14. Patterns of Cost for Patients Dying in the Intensive Care Unit and Implications for Cost Savings of Palliative Care Interventions. (United States)

    Khandelwal, Nita; Benkeser, David; Coe, Norma B; Engelberg, Ruth A; Teno, Joan M; Curtis, J Randall


    Terminal intensive care unit (ICU) stays represent an important target to increase value of care. To characterize patterns of daily costs of ICU care at the end of life and, based on these patterns, examine the role for palliative care interventions in enhancing value. Secondary analysis of an intervention study to improve quality of care for critically ill patients. 572 patients who died in the ICU between 2003 and 2005 at a Level-1 trauma center. Data were linked with hospital financial records. Costs were categorized into direct fixed, direct variable, and indirect costs. Patterns of daily costs were explored using generalized estimating equations stratified by length of stay, cause of death, ICU type, and insurance status. Estimates from the literature of effects of palliative care interventions on ICU utilization were used to simulate potential cost savings under different time horizons and reimbursement models. Mean cost for a terminal ICU stay was 39.3K ± 45.1K. Direct fixed costs represented 45% of total hospital costs, direct variable costs 20%, and indirect costs 34%. Day of admission was most expensive (mean 9.6K ± 7.6K); average cost for subsequent days was 4.8K ± 3.4K and stable over time and patient characteristics. Terminal ICU stays display consistent cost patterns across patient characteristics. Savings can be realized with interventions that align care with patient preferences, helping to prevent unwanted ICU utilization at end of life. Cost modeling suggests that implications vary depending on time horizon and reimbursement models.

  15. Sifat Strong Perron-Frobenius Pada Solusi Positif Eventual Sistem Persamaan Differensial Linier Orde Satu

    Directory of Open Access Journals (Sweden)

    Yulian Sari


    Full Text Available Artikel ini membicarakan tentang sifat strong Perron-Frobenius pada solusi positif eventual sistem persamaan differensial linier orde satu. Syarat perlu agar solusi positif eventual sistem persamaan differensial linier orde satu diajukan. Beberapa kriteria tentang matriks eksponensial positif eventual dan matriks positif eventual juga akan digunakan dalam teorema.

  16. Sifat Strong Perron-Frobenius Pada Solusi Positif Eventual Sistem Persamaan Differensial Linier Orde Satu

    Directory of Open Access Journals (Sweden)

    Yulian Sari


    Full Text Available Artikel ini membicarakan tentang sifat strong Perron-Frobenius pada solusi positif eventual sistem persamaan differensial linier orde satu. Syarat perlu agar solusi positif eventual sistem persamaan differensial linier orde satu diajukan. Beberapa kriteria tentang matriks eksponensial positif eventual dan matriks positif eventual juga akan digunakan dalam teorema.

  17. Clinical and Socio-Demographic Predictors of Home Hospice Patients Dying at Home: A Retrospective Analysis of Hospice Care Association's Database in Singapore. (United States)

    Lee, Yee Song; Akhileswaran, Ramaswamy; Ong, Eng Hock Marcus; Wah, Win; Hui, David; Ng, Sheryl Hui-Xian; Koh, Gerald


    Hospice care can be delivered in different settings, but many patients choose to receive it at home because of familiar surroundings. Despite their preferences, not every home hospice patient manages to die at home. To examine the independent factors associated with home hospice patient dying at home. Retrospective analysis of Hospice Care Association's database. Hospice Care Association is the largest home hospice provider in Singapore. The study included all patients who were admitted into home hospice service from January 1, 2004 to December 31, 2013. Cox proportional hazards modeling with time as constant was used to study the relationship between independent variables and home death. A total of 19,721 patients were included in the study. Females (adjusted risk ratio [ARR] 1.09, 95% CI 1.04-1.15), older patients (ARR 1.01, 95% CI 1.00-1.01), shorter duration of home hospice stay (ARR 0.88, 95% CI 0.82-0.94), fewer episodes of hospitalization (ARR 0.81, 95% CI 0.75-0.86), living with caregivers (ARR 1.54, 95% CI 1.05-2.26), doctor (ARR 1.05, 95% CI 1.01-1.08) and nurse (ARR 1.06, 95% CI 1.04-1.08) visits were positive predictors of dying-at-home. Diagnosis of cancer (ARR 0.93, 95% CI 0.86-1.00) was a negative predictor of dying-at-home. Female, older age, living with a caregiver, non-cancer diagnosis, more doctor and nurse visits, shorter duration of home hospice stays, and fewer episodes of acute hospitalizations are predictive of dying-at-home for home hospice patients. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  18. The end of life decisions -- should physicians aid their patients in dying? (United States)

    Sharma, B R


    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.

  19. Die hervertolking van die paradigma in verband met die ...

    African Journals Online (AJOL)

    Kerkorde van De Mist en die Algemene Reglement van 1816, wat onderskeidelik vir die Kaapse Kerk en die .... Een van die eerstes was Sam Freiherr von Pufendorf (1632-1694) wat in sy werk De habitu religionis ..... Koning was weer aan bewind (vgl Diepenhorst sj:74w; De Visser 1926/1927 lll:202w). 43.1 JD Janssen ...

  20. die heidelbergse kategismus en die kategesemateriaal van die ned

    African Journals Online (AJOL)

    subjek, objek, leerstof en die metodiek van die senior kategese. Bloemfontein: Algemene Jeugkommissie Sondagskoolboekhandel. de rAAd oer ned ger kerken in Zuid AfrikA. 1921. De zevende vergadering: handelinge. 1925. De negende vergadering: handelinge. de villierS, d. W. 1957. Die Kategese in die Ned. Geref.

  1. die sinodale verband van die nederduitse gereformeerde kerk in die

    African Journals Online (AJOL)


    Strauss. Die sinodale verband van die Nederduitse Gereformeerde Kerk. 122 die Vrystaatse Sinode anti-veranderingsgesind of eerder gesond-behoudend of gereformeerd-gematig? Veral as dit .... howe) in moeilike omstandighede gebring is (NG Kerk in die OVS 1865-1912:5). In 'n brief op 8 Augustus 1864 ontken Ds.

  2. Die kerkregtelike posisie van die ouderling en diaken in die ...

    African Journals Online (AJOL)

    ... drie dekades die Kerkreg gevestig as 'n selfstandige vak in die teologiese curriculum, maar ook 'n baie groot rol gespeel daarin dat die beginsels van die kerk like reg beter begryp word. Naas sy wetenskaplike bydrae word met eweveel genoegdoening gedink aan sy bcsondere persoonlikheid, sy werkvermoe, sy humor-.

  3. A Retrospective Medical Records Review of Risk Factors for the Development of Respiratory Tract Secretions (Death Rattle) in the Dying Patient. (United States)

    Kolb, Hildegard; Snowden, Austyn; Stevens, Elaine; Atherton, Iain


    Identification of risk factors predicting the development of death rattle. Respiratory tract secretions, often called death rattle, are among the most common symptoms in dying patients around the world. It is unknown whether death rattle causes distress in patients, but it has been globally reported that distress levels can be high in family members. Although there is a poor evidence base, treatment with antimuscarinic medication is standard practice worldwide and prompt intervention is recognised as crucial for effectiveness. The identification of risk factors for the development of death rattle would allow for targeted interventions. A case ̶ control study was designed to retrospectively review two hundred consecutive medical records of mainly cancer patients who died in a hospice inpatient setting between 2009 - 2011. Fifteen potential risk factors including the original factors weight, smoking, final opioid dose and final Midazolam dose were investigated. Binary logistic regression to identify risk factors for death rattle development. Univariate analysis showed death rattle was significantly associated with final Midazolam doses and final opioid doses, length of dying phase and anticholinergic drug load in the pre-terminal phase. In the final logistic regression model only Midazolam was statistically significant and only at final doses of 20 mg/24hrs or over (OR 3.81 CI 1.41-10.34). Dying patients with a requirement for a high dose of Midazolam have an increased likelihood of developing death rattle. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  4. Hospice assist at home : does the integration of hospice care in primary healthcare support patients to die in their preferred location - A retrospective cross-sectional evaluation study

    NARCIS (Netherlands)

    de Graaf, Everlien; Zweers, Daniëlle; Valkenburg, Anna Ch; Uyttewaal, Allegonda; Teunissen, Saskia Ccm

    BACKGROUND: A majority of patients prefer to die at home. Specialist palliative care aims to improve quality of life. Hospice assist at home is a Dutch model of general/specialised palliative care within primary care, collaboratively built by general practitioners and a hospice. AIM: The aims of

  5. No negative impact of Palliative sedation on relatives' experience of the dying phase and their wellbeing after the patient's death: An observational study

    NARCIS (Netherlands)

    S.M. Bruinsma (Sophie); A. van der Heide (Agnes); M. Van Der Lee; Y. Vergouwe (Yvonne); J.A.C. Rietjens (Judith)


    textabstractBackground: Palliative sedation is the widely-used intervention of administering sedating agents to induce a state of unconsciousness to take away a dying patient's perception of otherwise irrelievable symptoms. However, it remains questionable whether this ethically complex intervention

  6. Factors associated with dying at the place of wish: a cross-country comparison of cancer patients with the EURO SENTI-MELC Study 2009-2010.

    NARCIS (Netherlands)

    Ko, W.; Miccinesi, G.; Beccaro, M.; Vanthomme, K.; Donker, G.A.; Onwuteaka-Philipsen, B.; Alonso, T.V.A.V; Deliens, L.; Block, L. van den


    Aims: 1) To study demographic and clinical factors associated with dying at a preferred place for cancer patients 2) To study cross-country differences in the intensity of factors Methods: A mortality follow-back study was undertaken in 2009-2010 via representative nationwide networks of general

  7. Radiation exposure to the patient caused by single-photon transmission measurement for 3D whole-body PET; Die Strahlenexposition des Patienten durch die Einzelphotonen-Transmissionsmessung bei der PET

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    Schaefer, A.; Donsch, P.; Kirsch, C.M. [Universitaet des Saarlandes, Homburg/Saar (Germany). Abt. fuer Nuklearmedizin; Seifert, H. [Universitaet des Saarlandes, Homburg/Saar (Germany). Abt. Strahlentherapie der Radiologischen Klinik


    Aim: The aim of the study was the determination of the radiation exposure to the patient caused by single-photon transmission measurement for 3D whole-body PET. Material and method: Single-photon-transmission measurement is performed using two Cs-137 pointsources (E{gamma}=662 keV, A=2*614 MBq) on a 3D PET scanner (ECAT ART). During a simulation of a whole body transmission scan (axial length: 75 cm, 6 contigous bed positions) dose measurements with thermoluminescent dosimeters were carried out using a thorax and an abdomen phantom. Following the guidelines of the ICRU report No. 60 an estimation of the effective dose caused by a single-photon transmission measurement was calculated. Results: For a total acquisition time of 360 min (6 beds with an acquisition time of 60 min per bed) the absorbed doses amounted to: Surface (xyphoid) 189 {mu}Gy, heart 196 {mu}Gy, lungs 234 {mu}Gy, vertebra 240 {mu}Gy, liver 204 {mu}Gy, gonads 205 {mu}Gy, thyroid 249 {mu}Gy and bladder 185 {mu}Gy resulting in a conversion factor of 1.7*10{sup -4} mSv/(h*MBq). The estimation of the effective dose for a patient's transmission (acquisition time of 3.2 min per bed) yields a value of 11 {mu}Sv. An estimation of the ratio of the conversion factors for transmission measurements in single-photon- and in coincidence mode (two Ge-68/Ga-68 rod sources of 40 MBq each), respectively, resulted in a value of 0.18. The comparison of the effective doses caused by single-photon transmission and by emission measurement (injection of 250 MBq of FDG) yields a ratio of 2.3*10{sup -3}. Conclusion: The radiation exposure of the patient caused by the transmission measurement for 3D whole-body-PET can be neglected. In comparison with the coincidence-transmission using uncollimated line sources of low activity the radiation exposure is still reduced using single photon transmission with collimated point sources of high activity. (orig.) [German] Ziel: Ziel war die Bestimmung der Strahlenexposition des

  8. Trends in the aggressiveness of end-of-life care for Korean pediatric cancer patients who died in 2007-2010.

    Directory of Open Access Journals (Sweden)

    June Dong Park

    Full Text Available In light of the Korean Supreme Court's 2009 ruling favoring a patient's right to die with dignity, we evaluated trends in aggressive care in a cohort of pediatric cancer patients. Methods We conducted a population-based retrospective study that used administrative data for patients who died in 2007-2010 among the 5,203 pediatric cancer patients registered at the Korean Cancer Central Registry (KCCR during 2007-2009.In the time period covered, 696 patients died. The proportion who had received chemotherapy in the last 30 days of life decreased from 58.1% to 28.9% (P<0.001, those who received new chemotherapy in the same time period decreased from 55.2% to 15.1% (P<0.001, and those who received treatment in the last 2 weeks of life decreased from 51.4% to 21.7% (P<0.001. In the last 30 days of life, the proportion of patients whose hospital admission period was over 14 days increased from 70.5% to 82.5% (P = 0.03, the proportion who received cardiopulmonary resuscitation decreased from 28.6% to 9.6% (P<0.001, and we found no statistically significant trends in the proportion of emergency department visits, intensive care unit admissions, or mechanical ventilation.In this study, in contrast with earlier ones, the aggressiveness of end-of-life care of Korean pediatric cancer patients decreased dramatically.

  9. Riglyne vir die onderwys.

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    J. L. du Plooy


    Full Text Available In die afgelope vyftig jaar sedert die Unie tot stand gekom het, is veel op die gebied van onderwys tot stand gebring. Dit is heel natuurlik dat ’n mens sou vra: Wat van die toekoms?

  10. Patients with neuromyelitis optica have a more severe disease than patients with relapsingremitting multiple sclerosis, including higher risk of dying of a demyelinating disease

    Directory of Open Access Journals (Sweden)

    Denis Bernardi Bichuetti


    Full Text Available Although neuromyelitis optica (NMO is known to be a more severe disease than relapsing-remitting multiple sclerosis (RRMS, few studies comparing both conditions in a single center have been done. Methods: Comparison of our previously published cohort of 41 NMO patients with 177 RRMS patients followed in the same center, from 1994 to 2007. Results: Mean age of onset was 32.6 for NMO and 30.2 for RRMS (p=0.2062 with mean disease duration of 7.4 years for NMO and 10.3 years for RRMS. Patients with NMO had a higher annualized relapse rate (1.0 versus 0.8, p=0.0013 and progression index (0.9 versus 0.6, p≪0.0001, with more patients reaching expanded disability status scale (EDSS 6.0 (39 versus 17%, p=0.0036. The odds ratio for reaching EDSS 6.0 and being deceased due to NMO in comparison to RRMS were, respectively, 3.14 and 12.15. Conclusion: Patients with NMO have a more severe disease than patients with RRMS, including higher risk of dying of a demyelinating disease.

  11. Die partypolitiek en die toekoms van die Afrikaanse volkskultuur

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    A.P. Treurnicht


    Full Text Available Reeds in 1853 het die Zuid Afrikaan hom soos volg uitgelaat: „Dis ’n dwaling wat ons reeds meermale bestry het dat ons as Britse onderdane verplig sou wees, om die Britse nasionaliteit ons s’n te maak. Die Kolonis van Hollandse oorsprong kan geen Engelsman word nie, en moet ook geen Nederlander wil wees nie. Wanneer hy weet om sy standpunt te waardeer, dan sal hy as verligte kolonis die grondtrekke van die Engelse volkskarakter met dié van die Nederlandse harmonies leer verenig en daardeur word wat hy as Kapenaar moet word.”

  12. Concepts of mental capacity for patients requesting assisted suicide: a qualitative analysis of expert evidence presented to the Commission on Assisted Dying. (United States)

    Price, Annabel; McCormack, Ruaidhri; Wiseman, Theresa; Hotopf, Matthew


    In May 2013 a new Assisted Dying Bill was tabled in the House of Lords and is currently scheduled for a second reading in May 2014. The Bill was informed by the report of the Commission on Assisted Dying which itself was informed by evidence presented by invited experts.This study aims to explore how the experts presenting evidence to the Commission on Assisted Dying conceptualised mental capacity for patients requesting assisted suicide and examine these concepts particularly in relation to the principles of the Mental Capacity Act 2005. This study was a secondary qualitative analysis of 36 transcripts of oral evidence and 12 pieces of written evidence submitted by invited experts to the Commission on Assisted Dying using a framework approach. There was agreement on the importance of mental capacity as a central safeguard in proposed assisted dying legislation. Concepts of mental capacity, however, were inconsistent. There was a tendency towards a conceptual and clinical shift toward a presumption of incapacity. This appeared to be based on the belief that assisted suicide should only be open to those with a high degree of mental capacity to make the decision.The 'boundaries' around the definition of mental capacity appeared to be on a continuum between a circumscribed legal 'cognitive' definition of capacity (in which most applicants would be found to have capacity unless significantly cognitively impaired) and a more inclusive definition which would take into account wider concepts such as autonomy, rationality, voluntariness and decision specific factors such as motivation for decision making. Ideas presented to the Commission on Assisted Dying about mental capacity as it relates to assisted suicide were inconsistent and in a number of cases at variance with the principles of the Mental Capacity Act 2005. Further work needs to be done to establish a consensus as to what constitutes capacity for this decision and whether current legal frameworks are able to

  13. Die Voortrekker-Monument

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    Gerard Moerdyk


    Full Text Available Die Eeufeesjaar is vir die Afrikaner ’n tydperk van besieling. Nog nooit sedert die ontstaan van ons volk het een enkele gebeurtenis soveel nasietrots gewek as die honderdjarige herdenking van die Groot Trek. Vir die eerste keer in ons geskiedenis voel ons ons nie meer Kapenaars, Vrystaters, Natalers, en Transvalers nie, maar Afrikaners, saamgesnoer deur die tradisies van ’n selfstandige kultuurvolk. Wanneer die klimaks van die Ossewatrek met die hocksteenlegging van die Voortrekker-Monument bereik word, sal die besieling nie uitsterf nie, die krag wat geskep is sal bly voortgroei tot ’n onweerstaanbare mag. Die Afrikaner sal homself vind, en as die Monument na sowat vyf jaar onthul word, sal die saad wat in hierdie jaar gesaai is, tot voile rypheid gekom het. Dan sal die Monument self tot die volk spreek; intussen egter, is dit wenslik, nee noodsaaklik selfs, om die Monument aan die Afrikaners te verklaar, om ‘n uiteensetting te gee van die noodsaaklikheid van so ’n Monument, sowel as om die motief te verduidelik wat as inspirasie gedien het vir die ontwerpdaar van.

  14. Let him not be alone: perspectives of older British South Asian minority ethnic patients on dying in acute hospitals. (United States)

    Venkatasalu, Munikumar Ramasamy


    To investigate older British South Asians' views on dying at acute hospitals. Older people, including those from ethnic minorities prefer 'home as a haven' for their last days of life; however, they are more likely to die in hospital. Constructive grounded theory was used as a methodological approach that informed data collection to data analysis. Open meetings with 11 local South Asian community organisations enabled the researchers to recruit a total of 55 older South Asians in this study. Data were collected using gender-based focus groups (n=5) and in-depth, semi-structured interviews (n=29). Transcripts were analysed using Nvivo 9. Three key themes were identified: 'mistrust', 'let him not be alone' and 'family as a protective shield'. The theme 'mistrust' is explored through examination of beliefs, attitudes and expectations about 'hospital' as a place in the care of the dying. The theme of 'let him not be alone' draws the family's preferences and concerns in relation to leaving their older dying relative alone in the hospital. The final theme of 'family as a protective shield' describes the element of family care as a protective shield for their older one to have peaceful end-of-life care moments in the hospital. Allowing older relatives to die in hospital seems to evoke feelings of missed filial responsibilities and guilt among family carers among older ethnic minorities. The presence of cultural paranoia and mistrust often led minorities to experience sub-standard end-of-life care in acute hospitals.

  15. Die Britse owerheid en die onderwys op Heidelberg gedurende die ...

    African Journals Online (AJOL)

    The establishment of Christian National Education (CNE) Schools stimulated the concept of mother tongue education. Oor die klaskamerpraktyk en die werklike gehalte van onderrig tydens die kampskooltydperk is daar min bekend. Heidelberg wat na 1902 in 'n belangrike onderwyssentrum in Transvaal ontwikkel het, het ...

  16. Die belangrikste kenmerk van die diereproduksie- bedrywe oor die ...

    African Journals Online (AJOL)

    digdhede teen 1980 uit 'n kudde van 30 rnilj.skape ge- produseer moet word. Tweedens sal die faktore ... die Republiek van Suid-Mrika teen 1980 in totaal 28 milj. sal wees. Indien die produsente dit as 'n ..... Appendix Table 4 in Digestive Physiology and nutrition of ruminants Vol. 3 Ed. and Publ. D.C. Church, Oregon State ...


    African Journals Online (AJOL)

    aanslag op die sogenaamde "Intentional Fallacy", heelwat verder. n. Mens sou hier eintlik ook op die invloed van Lacan se toepassing van. De Sacs sure op Freud moet wys, en op Macherey se Theory of Literary. Production. Barthes is naamlik besig om repressie teen te werk, en die teks as produksieproses in stede van ...

  18. Organ donation after medical assistance in dying or cessation of life-sustaining treatment requested by conscious patients: the Canadian context. (United States)

    Allard, Julie; Fortin, Marie-Chantal


    In June 2016, following the decision of the Supreme Court of Canada to decriminalise assistance in dying, the Canadian government enacted Bill C-14, legalising medical assistance in dying (MAID). In 2014, the province of Quebec had passed end-of-life care legislation making MAID available as of December 2015. The availability of MAID has many implications, including the possibility of combining this practice with organ donation through the controlled donation after cardiac death (cDCD) protocol. cDCD most often occurs in cases where the patient has a severe neurological injury but does not meet all the criteria for brain death. The donation is subsequent to the decision to withdraw life-sustaining treatment (LST). Cases where patients are conscious prior to the withdrawal of LST are unusual, and have raised doubts as to the acceptability of removing organs from individuals who are not neurologically impaired and who have voluntarily chosen to die. These cases can be compared with likely scenarios in which patients will request both MAID and organ donation. In both instances, patients will be conscious and competent. Organ donation in such contexts raises ethical issues regarding respect for autonomy, societal pressure, conscientious objections and the dead-donor rule. In this article, we look at relevant policies in other countries and examine the ethical issues associated with cDCD in conscious patients who choose to die. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  19. Finding common ground to achieve a "good death": family physicians working with substitute decision-makers of dying patients. A qualitative grounded theory study. (United States)

    Tan, Amy; Manca, Donna


    Substitute decision-makers are integral to the care of dying patients and make many healthcare decisions for patients. Unfortunately, conflict between physicians and surrogate decision-makers is not uncommon in end-of-life care and this could contribute to a "bad death" experience for the patient and family. We aim to describe Canadian family physicians' experiences of conflict with substitute decision-makers of dying patients to identify factors that may facilitate or hinder the end-of-life decision-making process. This insight will help determine how to best manage these complex situations, ultimately improving the overall care of dying patients. Grounded Theory methodology was used with semi-structured interviews of family physicians in Edmonton, Canada, who experienced conflict with substitute decision-makers of dying patients. Purposeful sampling included maximum variation and theoretical sampling strategies. Interviews were audio-taped, and transcribed verbatim. Transcripts, field notes and memos were coded using the constant-comparative method to identify key concepts until saturation was achieved and a theoretical framework emerged. Eleven family physicians with a range of 3 to 40 years in clinical practice participated.The family physicians expressed a desire to achieve a "good death" and described their role in positively influencing the experience of death.Finding Common Ground to Achieve a "Good Death" for the Patient emerged as an important process which includes 1) Building Mutual Trust and Rapport through identifying key players and delivering manageable amounts of information, 2) Understanding One Another through active listening and ultimately, and 3) Making Informed, Shared Decisions. Facilitators and barriers to achieving Common Ground were identified. Barriers were linked to conflict. The inability to resolve an overt conflict may lead to an impasse at any point. A process for Resolving an Impasse is described. A novel framework for developing

  20. Wêreldmededingendheid en die tegnologie

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    C. W. I. Pistorius


    Full Text Available Afgesien van die interne uitdagings wat die Heropbou- en Ontwikkelingsprogram (HOP aan Suid-Afrika bied, moet die land ook tred hou met die veranderende globale omgewing, spesifiek die toenemende belangrikheid van ekonomiese sekuriteit as komponent van nasionale sekuriteit. Die konsep van mededingendheid vergestalt die doelwit wat nagestreef moet word ten einde die ontluikende globale ekonomiese stryd aan te durf. As ’n belangrike drywer van ekonomiese welvaart is tegnologie een van die belangrikste sleutels tot internasionale mededingendheid. Tegnologiese innovasie is die proses wat as hefboom hiervoor gebruik moet word. Dit is egter nodig dat tegnologie, en spesifiek die proses van tegnologiese innovasie, formeel en gestruktureerd bestuur moet word, sowel op nasionale as firmavlak. Op nasionale vlak is die voorsiene Nasionale Innovasiestelsel beslis ’n stap in die regte rigting.

  1. die ontstaan en die ontwikkeling van die skoolkadette-stelsel in die rsa

    African Journals Online (AJOL)

    toe algemene diensplig ingestel is. Die diens- plig het intussen sy volle beslag gekry en in. Weermagkringe het die gedagte posgevat dat skoolkadette. 'n deeglike ondersoek vereis ten einde die skoolgaande seun vir sy komende nasionale diensplig te orienteer. Tydens kadetopleldlng leer die seuns al die fynere kunsles ...

  2. Van die Gasredakteur

    African Journals Online (AJOL)

    cherish and teach.'1. Die Fakulteit Geneeskunde van die Universiteit van die Oranje-Vrystaat het pragtig gegroei ge- durende die eerste 21 jaar van sy bestaan. Die entoesiasme, doelgerigtheid, harde werk en inisia- tiewe van 'n groot aantal persone was hiervoor verantwoordelik. 'If we see a bit more clearly than they, it is ...

  3. Halfkrone vir die Nagmaal

    African Journals Online (AJOL)


    die omgewing van Velddrif en Laaiplek, ook noordwaarts verby Lambertsbaai tot by. Doringbaai en Strandfontein. “Haar seeverhale is Sussie (Kotze) se belangrikste bydrae tot die Afrikaanse letterkunde”, sê Kotzé-Myburgh in die voorwoord van die versamelbundel. Die leser word herinner aan Kotze se debuutroman, ...

  4. Die teologie in gesprek met die ekonomie

    African Journals Online (AJOL)

    (1723-1790) sy vertrekpunt neem, ontwikkel, as oorwinnaars uit die Franse Revolu .... Die onmiddellike sukses van Adam Smith se 'Wealth of Nations' was .... alle vorme van sosialisme niks anders as 'kommunisme' (Wassenaar 1977:12) nie.

  5. Genotyping of Toxoplasma gondii: DNA extraction from formalin-fixed paraffin-embedded autopsy tissues from AIDS patients who died by severe disseminated toxoplasmosis. (United States)

    Bastos da Silva, Inara; Batista, Tatiana Pimental de Andrade; Martines, Roosecelis Brasil; Kanamura, Cristina Takami; Ferreira, Isabelle Martins Ribeiro; Vidal, Jose Ernesto; Pereira-Chioccola, Vera Lucia


    This study investigated the genetic features of Toxoplasma gondii isolated directly in autopsies of HIV-infected patients who died with severe disseminated toxoplasmosis. This retrospective analysis was conducted in a cohort of 15 HIV-infected patients with clinical and laboratory data. They had previous cerebral toxoplasmosis at least 6 months before the disseminated toxoplasmosis episode. The hypothesis was that they were infected with highly virulent parasites due to the condition in which they died. T. gondii genotyping was done directly in DNA extracted from 30 autopsy brain and lung samples (2 per patient) and mutilocus PCR-RFLP genotyping was done using 12 molecular markers. The 30 clinical samples were genotyped successfully in 8 or more loci and six suggestive genotypes were identified. One of them was Toxo DB #11, previously identified in different domestic animals and virulent in experimental animals. The other five suggestive genotypes identified in 14 patients were not described. TgHuDis1 was the most frequent and was determined in 8 patients. TgHuDis3 and TgHuDis5 were identified in two patients each. TgHuDis2 and TgHuDis4 have been identified in one patient each. These suggestive genotypes could be considered as virulent, since they caused severe tissue damage and had similar characteristics as Toxo # DB 11. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Die dogmatiese binding van die prediking

    African Journals Online (AJOL)

    genoemde probleemstelling wat ons homileties na riglyne wil soek, sonder die pretensie dat finale oplossings gevind sal word. Om hierdie probleem te ontleed is dit nodig om eers kortliks 'n begripsbepaling van die begrippe dogma, binding en prediking te maak. Vanuit die begripsbepaling kan ons dan probeer vasstel wat ...


    African Journals Online (AJOL)

    aan dat 'n lewe onder die gesag van God tot volle vrede lei: “In coming under the rule of Yahweh, moreover, life was made whole and safe.” Dit is spesifiek in die tempel waar die volheid van God se vrede ondervind word (1997:662):. The temple is indeed the place where Israel entered into Yahweh's full zone of shalom.

  8. n Oorsig van die huidige stand van navorsing oor die

    African Journals Online (AJOL)


    7 Jun 2011 ... Die eerste maal wat dit as deel van die teks van 1 Johannes aangehaal word, is in die. 4de eeu in 'n Latynse teks, Liber Apologeticus (hf 4). Eers aan die einde van die 16de eeu is dit in 'n amptelike Katolieke uitgawe van die Vulgaat ingesluit. Die doel van die Johannesbriewe. Waarom is die Briewe ...

  9. Die Ware Buch und die Philologie

    Directory of Open Access Journals (Sweden)

    Bernhard Hurch


    Full Text Available Die im 19. Jahrhundert sich verändernden Produktionsbedingungen für Druckwerke (Buchdruck, Satz, Papier, Bindung wirkten katalysierend auf die Fachkonstitution und Institutionalisierung der Philologien. Hier steht der tatsächliche Buchmarkt im Vordergrund der Darstellung, das Käuferpublikum und die Voraussetzungen des Vertriebs. Dazu gehören auch die Rezension als entstehende Textsorte und die rasch arbeitenden Rezensionsorgane. F.-R. Hausmann wurde in den letzten Jahren unentbehrlicher Mitarbeiter dieses im Rahmen des Grazer Schuchardt-Projekts "Netzwerk des Wissens" angesiedelten Ansatzes.

  10. Legal physician‐assisted dying in Oregon and the Netherlands: evidence concerning the impact on patients in “vulnerable” groups (United States)

    Battin, Margaret P; van der Heide, Agnes; Ganzini, Linda; van der Wal, Gerrit


    Background Debates over legalisation of physician‐assisted suicide (PAS) or euthanasia often warn of a “slippery slope”, predicting abuse of people in vulnerable groups. To assess this concern, the authors examined data from Oregon and the Netherlands, the two principal jurisdictions in which physician‐assisted dying is legal and data have been collected over a substantial period. Methods The data from Oregon (where PAS, now called death under the Oregon Death with Dignity Act, is legal) comprised all annual and cumulative Department of Human Services reports 1998–2006 and three independent studies; the data from the Netherlands (where both PAS and euthanasia are now legal) comprised all four government‐commissioned nationwide studies of end‐of‐life decision making (1990, 1995, 2001 and 2005) and specialised studies. Evidence of any disproportionate impact on 10 groups of potentially vulnerable patients was sought. Results Rates of assisted dying in Oregon and in the Netherlands showed no evidence of heightened risk for the elderly, women, the uninsured (inapplicable in the Netherlands, where all are insured), people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations. The only group with a heightened risk was people with AIDS. While extralegal cases were not the focus of this study, none have been uncovered in Oregon; among extralegal cases in the Netherlands, there was no evidence of higher rates in vulnerable groups. Conclusions Where assisted dying is already legal, there is no current evidence for the claim that legalised PAS or euthanasia will have disproportionate impact on patients in vulnerable groups. Those who received physician‐assisted dying in the jurisdictions studied appeared to enjoy comparative social, economic, educational, professional and other privileges. PMID

  11. Various opportunistic infections and neoplasms in patients dying of AIDS in the last 12 years--report based on pathomorphological investigations. (United States)

    Kamiński, Z


    The aim of the study was microscopic diagnostics of infections and neoplasms in patients who died of AIDS. Post-mortem analyses were performed in the Hospital for Infectious Diseases in Warsaw. In total, 200 patients with AIDS who were treated and subsequently died were included in the analysis. The study group consisted of 175 men and 25 women. Patients' age ranged between 11 months and 64 years (mean age 43 years). The most frequent infection diagnosed in these subjects was cytomegalovirus, followed by bacterial, mycotic, tuberculotic infections and toxoplasmosis. As far as neoplasms are concerned, patients with AIDS suffered most frequently from malignant lymphoma, Kaposi's sarcoma and finally, from Hodgkin's disease. In most cases, many types of infections coexisted with one another or there was a co-occurrence of the infection and neoplasm. The author suggests that the material presented in this paper is representative for Polish population. Pulmonary changes is the most often cause of the death of the patients with AIDS.

  12. Machine Learning Algorithms Utilizing Quantitative CT Features May Predict Eventual Onset of Bronchiolitis Obliterans Syndrome After Lung Transplantation. (United States)

    Barbosa, Eduardo J Mortani; Lanclus, Maarten; Vos, Wim; Van Holsbeke, Cedric; De Backer, William; De Backer, Jan; Lee, James


    Long-term survival after lung transplantation (LTx) is limited by bronchiolitis obliterans syndrome (BOS), defined as a sustained decline in forced expiratory volume in the first second (FEV 1 ) not explained by other causes. We assessed whether machine learning (ML) utilizing quantitative computed tomography (qCT) metrics can predict eventual development of BOS. Paired inspiratory-expiratory CT scans of 71 patients who underwent LTx were analyzed retrospectively (BOS [n = 41] versus non-BOS [n = 30]), using at least two different time points. The BOS cohort experienced a reduction in FEV 1 of >10% compared to baseline FEV 1 post LTx. Multifactor analysis correlated declining FEV 1 with qCT features linked to acute inflammation or BOS onset. Student t test and ML were applied on baseline qCT features to identify lung transplant patients at baseline that eventually developed BOS. The FEV 1 decline in the BOS cohort correlated with an increase in the lung volume (P = .027) and in the central airway volume at functional residual capacity (P = .018), not observed in non-BOS patients, whereas the non-BOS cohort experienced a decrease in the central airway volume at total lung capacity with declining FEV 1 (P = .039). Twenty-three baseline qCT parameters could significantly distinguish between non-BOS patients and eventual BOS developers (P machine), we could identify BOS developers at baseline with an accuracy of 85%, using only three qCT parameters. ML utilizing qCT could discern distinct mechanisms driving FEV 1 decline in BOS and non-BOS LTx patients and predict eventual onset of BOS. This approach may become useful to optimize management of LTx patients. Copyright © 2018 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

  13. Die vrede van Münster / Westfale en die betekenis daarvan vir die ...

    African Journals Online (AJOL)

    In die Suid-Afrikaanse kerkgeskiedenis egter is die Vrede van Münster as epogmakende gebeure tot dusver nie net in die algemeen verwaarloos nie, maar boonop is die direkte verband tussen hierdie sentrale historiese baken aan die een kant en aan die ander kant die vestiging van die VOC se verversingspos aan die ...

  14. Fixed Point of Generalized Eventual Cyclic Gross in Fuzzy Norm Spaces for Contractive Mappings

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    S. A. M. Mohsenialhosseini


    Full Text Available We define generalized eventual cyclic gross contractive mapping in fuzzy norm spaces, which is a generalization of the eventual cyclic gross contractions. Also we prove the existence of a fixed point for this type of contractive mapping on fuzzy norm spaces.

  15. Tegnologie en die mens

    African Journals Online (AJOL)

    omgewingsbesoedeling, volgend op industrialisasie en verstedeliking, gee uit- ing tot krete van wanhoop en frustrasie. Die maatskaplike ontwrigting agv outomatisasie het die begrippe van vervreemding en naam- loosheid op die voorgrond van sosiale be- wustheid geplaas. • Die Neutrale Siening. Tegnologie was nag. 34.


    African Journals Online (AJOL)

    15 Mei 2010 ... Biezeveld, de Boer, Brümmer, Muis. 2001; Brown 2006; Durand 2007). ... Wanneer sal hy weer in God se teenwoordigheid verskyn (vers 3)? Dié vraag is vol onsekerheid. (Schuman 2004:8). Sy onsekerheid ... God se volk en die enkeling in die geskiedenis het al die trou van God ervaar waarop die digter ...

  17. Die ontwikkeling van die bestuursmotiveringsvraelys (BMV

    Directory of Open Access Journals (Sweden)

    A. S. Engelbrecht


    Full Text Available The development of the Managerial Motivation Questionnaire (MMQ: Several criticisms of the psychometric suitability of existing measures of managerial motivation are reported in the literature. This study aimed at developing a new psychometrically sound instrument, the Managerial Motivation Questionnaire (MMQ. This was done on the basis of a comprehensive study of the literature on managerial motivation and the role-motivation theory. The preliminary MMQ was systematically shortened and refined until the final MMQ of 98 items was composed. This was based on social desirability and semantic appraisal, item analysis and factor analysis of the questionnaire. The results indicate that it was possible to develop a final MMQ that was relatively free of social desirability. It further demonstrated satsifactory internal consistencies on two samples (a = 0/90, N = 360; a = 0/91, N = 535, where all subscale items were found to be relatively pure measures of the isolated factors. Although some evidence was found providing support for the reliability of the MMQ, a need for further research on the construct validity of managerial motivation still exists. Opsomming In die literatuur word verskeie punte van kritiek teen die psigometriese geskiktheid van bestaande meetinstrumente van bestuursmotivering gerapporteer. Die doelstelling van hierdie studie was dus om aan die hand van die konseptuele omiyning van bestuursmotivering, en die rolmotiveringsteorie as algemene verwysingsraamwerk, 'n nuwe psigometries aanvaarbare meetinstrument, die Bestuursmotiveringsvraelys (BMV, te ontwikkel. Op grond van sosiale wenslikheids- en semantiese beoordeling, itemontleding en faktorontleding van die voorlopige BMV is die vraelys stelselmatig verkort en verfyn totdat die finale BMV van 98 items saamgestel is. Die resultate dui daarop dat hierdie studie wel daarin geslaag het om 'n finale BMV te ontwikkel wat relatief vry van sosiale wenslikheid is, bevredigende interne

  18. Varswateralge en die ekonomie

    Directory of Open Access Journals (Sweden)

    W. E. Scott


    Full Text Available Die artikel bespreek die ekonomiese belong wat varswateralge alreeds het en hul moontlike verdere ontginning in die toekoms. Sowel gewenste as ongewenste aspekte word oorweeg en hoofsaaklik met voorbeelde uit Suid-Afrika geïllustreer. Die oormatige ontwikkeling van ongewenste alge in varswater verlaag die watergehalte dear verskeie chemiese veranderinge, wat kan wissel van smake en geure tot die produksie van verbindings wat gesondheidsgevare vir mens of dier inhou. Verwydering van ongewenste alge dra aansienlik by tot die koste van waterbehandeling. Oormatige alggroei belemmer ontspanningsgebruike en kan eiendomswaardes langs rivier- en damoewers beïnvloed.

  19. Prediking aan die hand van die metafoor van fiksieskryf

    African Journals Online (AJOL)


    HTS 64(3) 2008 siening van die self en waarheid. In die pre-moderne paradigma kan die dominante metafoor verstaan word aan die hand van 'n spieël wat die lig uit 'n transendente oorsprong weerkaats, terwyl die moderne paradigma uitgedruk word met die metafoor van 'n lamp wat 'n eie, oorspronklike lig binne die self.


    African Journals Online (AJOL)


    ENGELBRECHT ver antwoordelik vir die Ou-Testamentiese vakke en Hebreeus. Die aan stelling van 'n derde professor het noodsaaklik geword, want dit sou. 85 .... De .Spreuken ran 5a/o?no omvat die nuwe vertaling en die ekse gese van die eerste 24 hoofstukke van die Spreukeboek. Die geskoold- heid in die Semitiese ...

  1. Die dialogiese prinsipe

    Directory of Open Access Journals (Sweden)

    J. J. de Klerk


    Full Text Available Met die dialogiese prinsipe word daardie beginsel bedoel, waarin die tweerigtingverkeer of kommunikasie onder, of met, of deur die mense op 'n heel besondere gesprekmatige wyse gere�l word. Tot die wese van die dialogiese prinsipe behoort "als Grundvoraussetzung das Ernstnehmen des Gesprachspartners und das darin enthaltene zuhoren-konnen. Dialog ist also etwas anderes als Disput oder Diskussion. Er setzt gegenseitiges Vertrauen und Hochachtung voraus."

  2. Die sestienpersoonlikheidsfaktorvraelys as hulpmiddel by die takseersentrum

    Directory of Open Access Journals (Sweden)

    J. C. D. Augustyn


    Full Text Available The 16PF Personality Test as an aid to the assessment centre Assessment centres still remains costly and thime consuming. This study investigates the reduction of time and costs by the use of the 16 PF Personality Test as a method for measuring management dimensions. Promising results were obtained with a relatively small sample for the prediction of initiative and perseverance. Significant multiple correlations were also found for three criteria of management success. Further research may establish the use of the 16 PF as an aid to management assessment and thereby reduce the costs and time involved in assessment centres. Opsomming Takseersentrums se grootste probleem is gelee in die koste en tyd wat dit behels. Hierdie studie ondersoek die moontlikheid om beide te verminder deur die aanwending van die 16 PF Persoonlikheidsvraelys vir die meting van bestuursdimensies. Belowende resultate is met 'n relatiewe klein steekproef bevind ten opsigte van die voorspelling van inisiatiefen deursettingsvermoe. Beduidende meervoudige korrelasies is ook ten opsigte van drie kriteria van bestuursukses bevind. Verdere navorsing kan die gebruik van die 16 PF as hulpmiddel by bestuursevaluering vestig en sodoende die tydsduur en koste van takseersentrums verminder.


    African Journals Online (AJOL)

    1 Aug 1978 ... dan ook aangebied, Agv die probleem wat ont- staan het met die gebrek aan goedgekeurde poste vir die Afdeling en as gevolg van die ver- wagte vertraging met die ondersoek van die. DOS-span, het die Afdeling Logistiek en Afde- ling Personeel oorleg gepleeg en laasgenoemde het ingestem dat die ...

  4. Die relevansie van die boek Prediker

    African Journals Online (AJOL)

    ook in die dogmatiek te bespeur is nie. 'n Vinnige oorsig oor die teksverwysings van. 'n paar wydgelese dogmatiekhandboeke kan dit bevestig. In Karl Barth se omvang- ryke Kirchliche Dogmatik word Prediker slegs vyf en dertig maal aangehaal en slegs sewe maal word teksgedeeltes bespreek. Emil Brunner haal Prediker ...

  5. Finding privacy from a public death: a qualitative exploration of how a dedicated space for end-of-life care in an acute hospital impacts on dying patients and their families. (United States)

    Slatyer, Susan; Pienaar, Catherine; Williams, Anne M; Proctor, Karen; Hewitt, Laura


    To explore the experiences and perceptions of hospital staff caring for dying patients in a dedicated patient/family room (named Lotus Room). Dying in hospital is a common outcome for people across the world. However, noise and activity in acute environments present barriers to quality end-of-life care. This is of concern because care provided to dying patients has been shown to affect both the patients and the bereaved families. A qualitative descriptive approach was used. Semi-structured interviews were conducted with 17 multidisciplinary staff and seven families provided information through an investigator-developed instrument. Qualitative data analysis generated three categories describing: Dying in an hospital; The Lotus Room; and the Outcomes for patients and families. The Lotus Room was seen as a large, private and, ultimately, safe space for patients and families within the public hospital environment. Family feedback supported staff perspectives that the Lotus Room facilitated family presence and communication. The privacy afforded by the Lotus Room within this acute hospital provided benefits for the dying patients and grieving families. Improved outcomes included a peaceful death for patients, which may have assisted the family with their bereavement. This study provides evidence of how the physical environment can address well-established barriers to quality end-of-life care in acute hospitals. © 2015 John Wiley & Sons Ltd.

  6. Assessing the Eventual Publication of Clinical Trial Abstracts Submitted to a Large Annual Oncology Meeting. (United States)

    Massey, Paul R; Wang, Ruibin; Prasad, Vinay; Bates, Susan E; Fojo, Tito


    Despite the ethical imperative to publish clinical trials when human subjects are involved, such data frequently remain unpublished. The objectives were to tabulate the rate and ascertain factors associated with eventual publication of clinical trial results reported as abstracts in the Proceedings of the American Society of Clinical Oncology (American Society of Clinical Oncology). Abstracts describing clinical trials for patients with breast, lung, colorectal, ovarian, and prostate cancer from 2009 to 2011 were identified by using a comprehensive online database ( Abstracts included reported results of a treatment or intervention assessed in a discrete, prospective clinical trial. Publication status at 4-6 years was determined by using a standardized search of PubMed. Primary outcomes were the rate of publication for abstracts of randomized and nonrandomized clinical trials. Secondary outcomes included factors influencing the publication of results. A total of 1,075 abstracts describing 378 randomized and 697 nonrandomized clinical trials were evaluated. Across all years, 75% of randomized and 54% of nonrandomized trials were published, with an overall publication rate of 61%. Sample size was a statistically significant predictor of publication for both randomized and nonrandomized trials (odds ratio [OR] per increase of 100 participants = 1.23 [1.11-1.36], p publication (OR 2.37, p = .013; and 2.21, p = .01, respectively). Among nonrandomized studies, phase II trials were more likely to be published than phase I (p publication in randomized (OR 0.76 [0.38-1.52]; p = .441) or nonrandomized trials (OR 0.89 [0.61-1.29]; p = .532). This is the largest reported study examining why oncology trials are not published. The data show that 4-6 years after appearing as abstracts, 39% of oncology clinical trials remain unpublished. Larger sample size and advanced trial phase were associated with eventual publication; among randomized

  7. Student Nurses' Perception of Death and Dying (United States)

    Niederriter, Joan E.


    Student nurses are involved in caring for patients who are actively dying or who have been told they have a terminal illness and are faced with the process of dying. Students encounter these patients in hospitals, nursing homes, at home or in hospice care settings. According to Robinson (2004), "nurses are the healthcare providers that are most…

  8. Existential Needs among the Dying

    DEFF Research Database (Denmark)

    Moestrup, Lene

    meaning making. Methods: The key research question is: 1. What kind of existential needs are central to dying cancer patients and their relatives during the terminal phase in Danish hospices? Exploring this highly sensitive and complex research area entails substantial ethical responsibility during data...... based and practice relevant knowledge about the complexity of existential considerations and needs among dying cancer patients and their relatives in a secularized society as Denmark. Existential needs are seen as a multidimensional concept that encompasses religious, spiritual and secular existential...

  9. P. J. N. Smal, Die Universalisme in die Psalms. Academisch ...

    African Journals Online (AJOL)


    dat die historiese element in Israel se Godsopenbaring en daarmee die insig in sy betekenis te kort gedoen word. Die betekenis van die studie vir die historia revelationis is daardeur gering; as duidelike „tydlose” sistematisering van Outestamentiese gegewens oor die betrokke onder- werpe, soos die laaste hoofstuk, bl.


    African Journals Online (AJOL)


    DIE ONTVC'ERP VAN 'N SENDINGBELEID IN DIE. HUIDIGE SITUASIE. Sending is 'n deel van die vervulling van die apostoliese opdrag van die kerk. Dit geskied op grond van en in gehoorsaamheid aan Gods. \\C'oord. Teologiese besinning is daarom die eerste en grondliggende vereiste by die ontwerp van 'n ...

  11. End-of-life care: nurses' experiences in caring for dying patients with profound learning disabilities--a descriptive case study. (United States)

    Li, S; Ng, J


    This qualitative study identifies areas of expertise and deficits in the specific knowledge and practical skills of nurses in the care of dying patients with profound learning disabilities in one NHS Primary Care Trust in the UK. In response to these findings, we have developed a simple observational checklist applicable to profound learning disability nursing to identify disease-related personality and physiological changes. The method consists of a descriptive case study of five nurses qualified in learning disabilities nursing, using semi-structured interviews. The disease trajectory was used as a framework of reference to guide the data analysis. Themes showed were 'certainty of knowing' about disease-related changes in patients' habits and behaviour and 'uncertainty and ambiguity' in the patho-physiology of advanced diseases and disease progression. This study interprets a lack of patho-physiological knowledge in both malignant and non-malignant diseases leading to delayed diagnosis and timely intervention. Timeliness of observation and intervention are emphasised.


    African Journals Online (AJOL)


    Sy moet hierdie opdrag uitvoer deur mid del van die Prediking d.w.s. deur middel van die Woord-vorm, maar ook deur die bediening van die sakramente, dws. deur middel van die vorm van die Daad. Maar nou wil God nie hê dat die Kerk slegs één maal die Evangelie sal predik en die mense sal doop om hulle daarna.

  13. Packaged die heater (United States)

    Spielberger, Richard; Ohme, Bruce Walker; Jensen, Ronald J.


    A heater for heating packaged die for burn-in and heat testing is described. The heater may be a ceramic-type heater with a metal filament. The heater may be incorporated into the integrated circuit package as an additional ceramic layer of the package, or may be an external heater placed in contact with the package to heat the die. Many different types of integrated circuit packages may be accommodated. The method provides increased energy efficiency for heating the die while reducing temperature stresses on testing equipment. The method allows the use of multiple heaters to heat die to different temperatures. Faulty die may be heated to weaken die attach material to facilitate removal of the die. The heater filament or a separate temperature thermistor located in the package may be used to accurately measure die temperature.

  14. Die radio in Afrika

    Directory of Open Access Journals (Sweden)

    S. de Villiers


    Full Text Available Omvang van radio-uitsendings in en na Afrika. — Redes vir die versnelde tempo van uitbreiding. — Radio as die geskikste massa-kommunikasiemiddel vir Afrika. — Faktore wat die verspreiding bemoeilik. — Skouspelagtige toename in luistertalle.Toe Plinius, wat in die jaar 79 oorlede is, in sy „Historia Naturalis” verklaar het dat daar altyd iets nuuts uit Afrika afkomstig is, kon hy nouliks voorsien het dat die „iets" negentien eeue later in die lug sou setel wat hierdie reuse-vasteland oorspan — ’n Babelse spraakverwarring en ’n ongekende, verbete woorde-oorlog in die etergolwe, onder meer daarop bereken om die harte en hoofde van derduisendes te verower.

  15. Die Erfindung des Manuskripts

    DEFF Research Database (Denmark)

    Benne, Christian

    Die Entstehung der literarischen Moderne ging seit dem 18. Jahrhundert damit einher, dass die Anzahl literarischer Manuskripte ebenso wuchs wie deren Bedeutung. Der Buchdruck hatte die Handschrift keineswegs überflüssig gemacht, sondern provozierte im Gegenteil einen neuen, am Autographen...

  16. Die begrafnisdíens

    African Journals Online (AJOL)

    Num 20: 1; Jos 24: 30; Hand 5: 5 - 11). Selfs van die ... Gebruike rondom die begrafnis het van geslag tot geslag gewissel. De Vaux ... der geskied deur die hoorders 'te onderrig, te vermaan, te vertroos en te bestraf, soos dit in elke geval ..... gehandhaaf hoef te word, veral in die lig van die feit dat die predikant die kerklike.

  17. Die gebruik van parallelplaatreologie vir die bepaling van die intrinsieke viskositeit van poli-etileentereftalaat

    Directory of Open Access Journals (Sweden)

    O. C. Vorster


    Full Text Available Die bepaling van die intrinsieke viskositeit van poli-etileentereftalaat word bemoeilik deur die feit dat daar tans slegs twee metodes in gebruik is. In die eerste metode word die bepaling deur middel van oplossingsviskometrie gedoen, maar die toksisiteit van die oplosmiddel, asook die tydperk wat dit neem om die bepaling te doen, is ’n probleem. Die tweede metode word beperk deur die kompleksiteit en beskikbaarheid van die apparatuur in Suid-Afrika. In hierdie studie word ’n alternatiewe metode, gebaseer op parallelplaatreologie, voorgestel wat albei hierdie probleme oorkom en die resultate sodoende verkry, word vergelyk met dié wat met bestaande metodes verkry is.

  18. The application of cure models in the presence of competing risks: a tool for improved risk communication in population-based cancer patient survival. (United States)

    Eloranta, Sandra; Lambert, Paul C; Andersson, Therese M-L; Björkholm, Magnus; Dickman, Paul W


    Quantifying cancer patient survival from the perspective of cure is clinically relevant. However, most cure models estimate cure assuming no competing causes of death. We use a relative survival framework to demonstrate how flexible parametric cure models can be used in combination with competing-risks theory to incorporate noncancer deaths. Under a model that incorporates statistical cure, we present the probabilities that cancer patients (1) have died from their cancer, (2) have died from other causes, (3) will eventually die from their cancer, or (4) will eventually die from other causes, all as a function of time since diagnosis. We further demonstrate how conditional probabilities can be used to update the prognosis among survivors (eg, at 1 or 5 years after diagnosis) by summarizing the proportion of patients who will not die from their cancer. The proposed method is applied to Swedish population-based data for persons diagnosed with melanoma, colon cancer, or acute myeloid leukemia between 1973 and 2007.

  19. Die invloed van die neo-marxistiese kultuuranalise op die Wêreldraad van Kerke en die Gereformeerde Kerke van Nederland

    Directory of Open Access Journals (Sweden)

    J. M. Vorster


    Full Text Available Toe die studente dwarsoor die VSA en Europa in die laat sestigerjare ’n plotselinge en radikale verset openbaar het teen die bestaande orde, het hulle die deur geopen vir ’n nuwe mededinger om die hart van die Westerse kultuur. Dit is die nou reeds bekende neo-Marxisme. Sedertdien het hierdie jongeling sy voetspore op vele vlakke van die Westerse kultuur gelaat.

  20. Surgical nurses' work-related stress when caring for severely ill and dying patients in cancer after participating in an educational intervention on existential issues. (United States)

    Udo, Camilla; Danielson, Ella; Henoch, Ingela; Melin-Johansson, Christina


    The aim of this study was to describe surgical nurses' perceived work-related stress in the care of severely ill and dying patients with cancer after participating in an educational intervention on existential issues. This article reports a mixed methods pilot study of an education programme consisting of lectures and supervised discussions conducted in 2009-2010 in three surgical wards in a county hospital in Sweden. The concurrent data collections consisted of repeated interviews with eleven nurses in an educational group, and questionnaires were distributed to 42 nurses on four occasions. Directly after the educational intervention, the nurses described working under high time pressure. They also described being hindered in caring because of discrepancies between their caring intentions and what was possible in the surgical care context. Six months later, the nurses described a change in decision making, and a shift in the caring to make it more in line with their own intentions and patients' needs rather than the organizational structure. They also reported decreased feelings of work-related stress, decreased stress associated with work-load and feeling less disappointed at work. Results indicate that it may be possible to influence nurses' work-related stress through an educational intervention. According to nurses' descriptions, reflecting on their ways of caring for severely ill and dying patients, many of whom had cancer, from an existential perspective, had contributed to enhanced independent decision making in caring. This in turn appears to have decreased their feelings of work-related stress and disappointment at work. Copyright © 2013 Elsevier Ltd. All rights reserved.

  1. "What happens behind the curtains?" An exploration of ICU nurses' experiences of post mortem care on patients who have died in intensive care. (United States)

    de Swardt, Carien; Fouché, Nicola


    The aim of this study was to explore the experiences of intensive care nurses performing post mortem care on patients who had died in an intensive care unit at a private hospital in Cape Town. The study further sets out to identify educational needs and to offer recommendations that may address these needs for this sample of nurses. A qualitative research design using a descriptive method was used to explore the experiences of a purposive heterogeneous sample of six nurses who were working in an intensive care unit in a private hospital in Cape Town. A semi-structured interview which was audio-taped and transcribed verbatim was employed to collect data. Colaizzi's (1978) seven step inductive method was used to formulate naïve themes. Following participant feedback, three main themes emerged: care of the dead body, detachment and thanatophobia. Safeguarding the integrity and physical appearance of the dead body was the major finding and of the utmost priority for the participants in this study. Regardless of how the nurses felt about death, providing professional and quality care to the dead body and the family was seen as significantly important. The nurses, whilst performing post mortem care, experienced detachment from various relationships. This comprised of the nurse detaching him/herself professionally and emotionally from the dead patient, the family and him/herself from the death experience. This 'unspoken' experience of thanatophobia became apparent when the nurses were confronted by the reality of their own deaths. In a technological society, where answers to many questions can be pursued through science, understanding the experience of death, as opposed to dying, may be logically incomprehensible. Death remains one of the most traumatic events experienced by the patient and their family, and in some instances nurses themselves. The study has drawn attention to the nurses' experiences and in doing so; the emotional and educational needs have been

  2. A case study exploring the ethical and policy dimensions of allocating acute care resources to a dying patient. (United States)

    Cooke, Mary; Hurley, Ciarán


    We aimed to identify policy, process and ethical issues related to allocation of National Health Service resources when patients with end-of-life illness are referred to acute care services. Sharing healthcare decisions denotes a different partnership between professionals and patients when patients are empowered to define their needs. Implementation of a transition from professional to patient decision-making appears to be dependent upon its interpretation by personnel delivering care using the local trust policy. The outcome of this is a reformation of responsibility for budget allocation, choice of acute care provider and selecting services, currently in the realm of primary care; be it the general practitioner, community practitioners, or the patient. We used a 'lens' approach to case study analysis in which the lens is constructed of a model of policy analysis and four principles of biomedical ethics. A patient's decision to decline care proposed by an Accident and Emergency department nurse and the nurse's response to that decision expose a policy that restricts the use of ambulance transport and with that, flexibility in responses to patients' decisions. End-of-life care partnership decisions require sensitivity and flexibility from all healthcare practitioners. We found that policy-based systems currently used to deliver care across the primary care - hospital care border are far from seamless and can lead to foreseeable problems. Health professionals responsible for the care of a patient at the end of life should consider the holistic outcomes of resource allocation decisions for patients. Government and health professional agenda suggest that patients should be given a greater element of control over their healthcare than has historically been the case. When patients take responsibility for their decisions, healthcare personnel should recognize that this signals a shift in the nature of the professional-patient relationship to one of partnership.

  3. die pers as bron oor die geskiedenis van die eerste vrydeidsoorlog

    African Journals Online (AJOL)

    dood agv wonde wat hy tydens die slag opgedoen het. Dit was vir die Britse volk onaanvaarbaar dat slegs twee Boere gedood is nadat daar tussen. 20 000 en 30 000 rondtes op die Boere afgevuur is. Die pers kon net nie die ware syfers publiseer nie, want dit sou na 'n onwaarheid Iyk. Het die. Britse volk egter die Boere ...

  4. die impak van metodologie op die verstaan van die nuwe testament

    African Journals Online (AJOL)

    voorbeeld eers een maal deur die bril van die vorm- en redaksiekritiek na die Evangelies gekyk het, dink jy vir altyd anders oor hulle tot- standkoming. Inderdaad, nuwe metodes lei tot nuwe perspektiewe! Dit is dan ook waar die fokus van hierdie artikel val: die impak van metodologie op die verstaan van die Nuwe ...

  5. Verskuiwing in die moraal?

    Directory of Open Access Journals (Sweden)

    S.P. van der Walt


    Full Text Available Modewoorde het ons deesdae oorgenoeg in die Christelike sedeleer en hulle kan nogal verwarring stig. U moet my vergun om met u te spreek oor een so ’n modewoord nl „verskuiwing’’ in die moraal. Dis nogal ’n mooi woord, wat so dikwels gebruik word op baie terreine en tog meer wil aandui as maar net ’n veranderde sienswyse, ’n wysiging in opvattinge of nuwe riglyne wat al gangbaar geword het in die praktyk. Die begrip wil eintlik die ewolusionêre gang beklemtoon, want dit is dan eintlik net die ou norme wat effens anders bekyk word of nie meer so nou geneem of dik onderstreep word nie. Die verskuiwing beteken dan dat alles nog dieselfde bly, net die posisie of plek het verander. Verskuiwing beteken tog plekverandering of plekwisseling en dan sekerlik nie in die sin dat die plekke ver uitmekaar lê nie. Verskuiwing beteken net maar vlak langs die vorige te staan kom. As dit dan ’n beter plek is, is dit ewolusie, ontwikkeling, verbetering.

  6. oor die inhoud en boodskap van die heidelbergse kategismus

    African Journals Online (AJOL)

    Smit. Oor die Inhoud en Boodskap van die Heidelbergse Kategismus. 52. Uiteraard sal dié tema saamhang met die bedoelinge agter die opstel van die Kategismus. Ook die vraag na moontlike bedoelinge of motiewe is egter 'n ingewikkelder vraag as wat miskien gedink mag word. Uiteraard was daar agter elke kategismus ...

  7. Thomas Erastus oor die struktuur van die gemeenskap'^

    African Journals Online (AJOL)

    óók aansprake en regte het, is die opvatting dat sowel die burgerlike gemeenskap as die kerk 'n perfecta societas sibi sufficiens is, nié werklik aanvaar nie. Die Middeleeuse gemeenskap was die corpus christianum,. 'n gemeenskap wat nie deur fisiese of politieke grense beperk was nie. Sy grense het gelê waar die grense ...

  8. die doel en wese van opvoedende onderwys en die implikasies

    African Journals Online (AJOL)

    Oaar moet onderskei word tussen die doelstellings van opvoedende onderwys en die einddoel wat bereik word deur die nastrewing van hierdie doelstellings. Gunter praat van die naderliggende doelstellings (1981, b1.105). \\/at die enddoel van opvoedende onderwys bet ref, gaan die meeste opvoedkundi ges akkoord dat ...

  9. Treating palliative care patients with pain with the body tambura: A prospective case study at St. Joseph′s hospice for dying destitute in Dindigul South India

    Directory of Open Access Journals (Sweden)

    Cordula Dietrich


    Full Text Available Background: The Body Tambura is a recently invented stringed instrument that is used for receptive music therapy designed to be placed and attached on the human body. The aim of this study was to record perceived effects of a treatment with the Body Tambura on palliative care patients with special reference to pain. Materials and Methods: A prospective case study was carried out with patients of St. Joseph′s Hospice for Dying Destitute in Dindigul/South India. Patients were treated with a treatment after baseline assessment and also on the next day. Outcomes were measured quantitatively by using a numeric rating scale (0-10, 10 maximum intensity of pain felt at baseline, directly after treatment, and the day after the treatment to determine the intensity of the pain. Results: Ten patients (five women and five men participated in the study. The majority described the therapy as a pleasant experience. The pain intensity at baseline was reduced from 8.3 ± standard deviation (SD 1.16 to 4.6 ± 1.52 at day 1 and from 4.6 ± 2.07 to 2.4 ± 1.58 at day 2. Conclusion: A clinically relevant pain reduction was described as short time outcome; the therapy was received and perceived well. Forthcoming research should include a control group, randomization, a larger number of participants, and a longer period of treatment.

  10. Die tug oor ampsdraers tydens die doleansie van 1886

    Directory of Open Access Journals (Sweden)

    J. Visser


    Full Text Available In art 29 van die Nederlandse Geloofsbelydenis word bely: “Die merktekens om die ware Kerk te ken is die volgende: As die Kerk die suiwere prediking van die evangelie uitoefen, as dit die suiwer bediening van die sakramente gebruik soos Christus dit ingestel het, as die kerklike tug gebruik word om die sondes te straf.” Dit spreek vanself dat wanneer ampsdraers, aan wie Christus sy kudde toevertrou het (Hand 20 : 28, met leer en /of lewenswandel in sonde volhard en nie daarin met tug gestuit word nie, word die ware kerk nie gebou nie maar afgebreek. 0ns sal later in hierdie artikel aantoon hoedanig die suiwer tug oor ampsdraers, veral leertug, tydens die Doleansie tot skade van die kerk van Christus agterweë gebly het.

  11. Defending the Counseling Model and Its Eventual Synthesis with the Medical Model. (United States)

    Farrell, Madison, III

    This paper explores the strengths and weaknesses of the medical model in an effort to promote a counseling perspective that embraces some of the medical models strengths. Through inclusion, rather than exclusion, it is believed that the counseling model will eventually infiltrate the medical model by way of its own documentation system. With its…

  12. Neural Indices of Semantic Processing in Early Childhood Distinguish Eventual Stuttering Persistence and Recovery (United States)

    Kreidler, Kathryn; Wray, Amanda Hampton; Usler, Evan; Weber, Christine


    Purpose: Maturation of neural processes for language may lag in some children who stutter (CWS), and event-related potentials (ERPs) distinguish CWS who have recovered from those who have persisted. The current study explores whether ERPs indexing semantic processing may distinguish children who will eventually persist in stuttering…

  13. Die metafoor by Breyten Breytenbach

    African Journals Online (AJOL)


    23 Jun 2009 ... metafories, of spesifiek verwysend, te werk gegaan is. Tyd sou mens die hoofmotief van die bundel noem, tyd en geheue wat verbygaan: 1 en 2; en die einde van die storie wat gekom het: “fluit-fluit my storie is uit”. (Die tema van verbygaan word weer opgeneem in 8 en 9: die stories wat nooit meer gehoor ...


    African Journals Online (AJOL)

    In die verband kan genoem word dat die Russe nog grotendeels gebruik maak van 'n metode waarvolgens water in die oliestratum gepomp word om 'n opwaartse druk van ru-olie te verseker; een nadeel hiervan is dat die water mettertyd deur die oliehoudende laag ontsnap en agv die drukverlies isvoortgesette ontginning.

  15. Die singulation method (United States)

    Swiler, Thomas P.; Garcia, Ernest J.; Francis, Kathryn M.


    A method is disclosed for singulating die from a semiconductor substrate (e.g. a semiconductor-on-insulator substrate or a bulk silicon substrate) containing an oxide layer (e.g. silicon dioxide or a silicate glass) and one or more semiconductor layers (e.g. monocrystalline or polycrystalline silicon) located above the oxide layer. The method etches trenches through the substrate and through each semiconductor layer about the die being singulated, with the trenches being offset from each other around at least a part of the die so that the oxide layer between the trenches holds the substrate and die together. The trenches can be anisotropically etched using a Deep Reactive Ion Etching (DRIE) process. After the trenches are etched, the oxide layer between the trenches can be etched away with an HF etchant to singulate the die. A release fixture can be located near one side of the substrate to receive the singulated die.

  16. The situation of radiation oncology patients' relatives. A stocktaking; Die Situation der Angehoerigen von Strahlentherapiepatienten. Eine Bestandsaufnahme

    Energy Technology Data Exchange (ETDEWEB)

    Momm, Felix; Lingg, Sabine; Adebahr, Sonja; Grosu, Anca-Ligia [Klinik fuer Strahlenheilkunde, Univ. Freiburg (Germany); Xander, Carola; Becker, Gerhild [Palliativeinheit, Univ. Freiburg (Germany)


    Background and Purpose: Recent studies have shown a very high importance of relatives in decisions about medical interventions. Therefore, the situation of this group was investigated in the sense of a stocktaking by interviewing the closest relatives of radiotherapy patients. Interviewed Persons and Methods: In a defined span of time (6 weeks), a total of 470 relatives (evaluable: n = 287, 61%) of radiotherapy patients were interviewed by a newly developed questionnaire about their contentment with their inclusion in the therapy course. Further, they gave information about specific needs of relatives as well as proposals for direct improvements in the context of a radiation therapy. Results: In total, the relatives were satisfied with their inclusion in the radiotherapy course and with the patient care. As an example, more than 95% of the relatives agreed with the statement ''Here in the hospital my ill relative is cared for well.'' Nevertheless, direct possibilities for improvements were found in the interdisciplinary information about oncologic topics and in the organization of the therapy course. Conclusion: In the stocktaking the situation of radiotherapy patients' relatives was generally satisfactory. Further improvements for the future can be expected mainly from interdisciplinary cancer centers having the best suppositions to care for the relatives, if necessary. Structures known from palliative care can be used as a model. (orig.)

  17. Ontsporing van die regstaatsbegrip en sy konsekwensies vir die afrikanervolk

    Directory of Open Access Journals (Sweden)

    N. G.S. Van der Walt


    Full Text Available Die opvatting van die suiwere regstaat bring sy vraagstukke mee wanneer dit in verband gebring word met die leer van die soewereiniteit in eie kring. Laasgenoemde leer wortel in die geloof dat God die mens roep tot diens aan Hom, en dat die mens vry moet wees om ten opsigte van alle lewensaspekte God na die hoogste mate te kan dien. Hierdie verskeidenheid van aspekte is deur dr. A. Kuyper en sy volgelinge gesistemati- seer tot menslike verbande en lewenskringe, elk met ’n be- paalde sfeer waarin ander kringe nie mag inmeng nie. Elkeen is dan soewerein binne sy eie kring. Met verwysing na die staat is dan gespreek van die staatstaak as synde die hand- hawing van die reg, en omdat die staat in toenemende mate hom veral in die latere tyd ook besig gehou het met bedrywig- hede wat nouliks as van juridiese aard beskou kan word, is daar die onderskeid gemaak tussen die primêre en sekundêre taak van die staat. Die sistematiek van die wetsidee, deur prof. Dooyeweerd ontwikkel, waar die staat sy bestemmingsfunksie in die regsaspek vind, het vanselfsprekend geen plek vir so 'n dualistiese staatstaak nie, en die oplossing is deur sommige daarin gesoek om sulke staatsoptrede te vertolk as hebbende wel betrekking op die regsgemeenskap of die regsverkeer. Staatsondernemings soos paaie, spoorweë, spellingreëling, ens. word dan beskou as noodsaaklik vir die instandhouding van die regsgemeenskap en regsverkeer. Tereg wys A. M. Donner1 daarop dat so ’n vertolking eintlik neerkom op ’n oorspanning van die regsbegrip. Hy self sien dan die staatstaak in vrede- of orde-handhawing, wat in die eerste plaas wel regshandha- wing veronderstel. Onder orde word dan alles verstaan wat noodsaaklik is vir die gladde verkeer in die ontwikkelingsgang van die regsgemeenskap. Die wese van die staat het dan vol- gens hom te doen met reg, maar sy taak is meer as suiwere regshandhawing. Wat onrus verwek en die orde versteur, moet uit die openbare lewe verwyder word, en die

  18. Die sterwende kindjie

    Directory of Open Access Journals (Sweden)

    J.T. De Jongh van Arkel


    Full Text Available The thought of a child dying appears as an antithesis and thus the feelings evoked by the dying child are stronger than when older persons are dying. Around the child’s death bed there is no place for detached spectators and all become involved in caring for and supporting him. Caregivers also have a supporting responsibility towards the members of the child’s family.

  19. Au XXIème siècle, qui sont les patients dialysés souffrant d'une hyperparathyroïdie secondaire sévère ? Cohorte prospective, multicentrique de patients dialysés, incidents pour l'hyperparathyroïdie secondaire. EPHEYL (Etude PHarmacoEpidémiologique de l'hYperparathyroïdie secondaire en Lorraine)


    Thomas-Laurain , Emmanuelle


    Non disponible / Not available; L'hyperparathyroïdie secondaire (HPTS) est une complication fréquente de l'insuffisance rénale chronique. Mais son diagnostic et sa prise en charge sont encore complexes et mal codifiés. Dans notre étude, nous faisons l'hypothèse que la population de patients atteints d'HPTS est hétérogène. L'objectif de notre étude était d'identifier des sous-groupes de patients présentant un profil d'HPTS commun à partir des données cliniques, biologiques et thérapeutiques di...

  20. Analise van die Tswanaraaisel

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    S. A. Swanepoel


    Full Text Available ’n Strukturele, stilistiese en funksionele bcskrywing van die Twanaraaisel bring mee dat daar aan die volgende aspekte aandag gegee moet word: •\tWat is ’n raaisel en lioe word dit in Tswana genoem. •\tTot watter studiegebied en literere genre hoort die raaisel en watter subvorme kan vir Tswana onderskei word. •\tHoe sien die struktuur van Tswanaraaisels daar uit. •\tDeur wie, waar, wanneer en hoe word Tswanaraaisels voorgedra. •\tWatter stilistiese kenmcrke kan in Tswanaraaisels onderskei word. •\tWatter funksies vervul raaisels in ’n Tswanagcmeenskap.

  1. The Liverpool Care Pathway for the Dying Patient: a critical analysis of its rise, demise and legacy in England [version 2; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Jane Seymour


    Full Text Available Background: The Liverpool Care Pathway for the Dying Patient (‘LCP’ was an integrated care pathway (ICP recommended by successive governments in England and Wales to improve end-of-life care. It was discontinued in 2014 following mounting criticism and a national review.  Understanding the problems encountered in the roll out of the LCP has crucial importance for future policy making in end of life care. We provide an in-depth account of LCP development and implementation with explanatory theoretical perspectives. We address three critical questions: 1 why and how did the LCP come to prominence as a vehicle of policy and practice? 2 what factors contributed to its demise? 3 what immediate implications and lessons resulted from its withdrawal? Methods: We use primary and secondary sources in the public domain to assemble a critical and historical review. We also draw on the ‘boundary object’ concept and on wider analyses of the use of ICPs. Results: The rapidity of transfer and translation of the LCP reflected uncritical enthusiasm for ICPs in the early 2000s. While the LCP had some weaknesses in its formulation and implementation, it became the bearer of responsibility for all aspects of NHS end-of-life care. It exposed fault lines in the NHS, provided a platform for debates about the ‘evidence’ required to underpin innovations in palliative care and became a conduit of discord about ‘good’ or ‘bad’ practice in care of the dying. It also fostered a previously unseen critique of assumptions within palliative care. Conclusions: In contrast to most observers of the LCP story who refer to the dangers of scaling up clinical interventions without an evidence base, we call for greater assessment of the wider risks and more careful consideration of the unintended consequences that might result from the roll out of new end-of-life interventions.

  2. Die brein soos beskou deur die Grieke en Romeine

    Directory of Open Access Journals (Sweden)

    Francois P. Retief


    Full Text Available In Ou Egipte is mummifikasie met uitgebreide reseksie of uitsnyding van organe geassosieer, maar geen kennis is geneem van die morfologie van die brein nie. Griekse skrywers van die sesde en vyfde eeue v.C. het die brein aanvanklik gesien as die setel van intelligensie, die orgaan van sensoriese waarneming en gedeeltelik die oorsprong van sperma. Pneuma het ’n belangrike rol in breinfunksie gespeel. Hippokrates was die eerste om die brein te beskryf as ’n dubbele orgaan, wat met harsingvlies (meninges bedek, funksioneel van pneuma afhanklik en vertolker van begrip is. Tydgenote soos Plato, Aristoteles en Diokles het tot die beskrywing bygedra, maar laasgenoemde twee het beweer dat die hart die middelpunt van intelligensie is en nie die brein nie. Gedurende die laaste helfte van die vierde eeu v.C. is disseksie van die menslike liggaam tydelik aan die mediese skool van Alexandrië toegelaat en het dit tot merkwaardige vooruitgang in die begrip van die menslike anatomie en fisiologie gelei. Herofilus en Erasistratus het uitstekende beskrywings van die struktuur en funksie van die brein gegee wat eers in die tweede eeu n.C. deur Galenus geëwenaar is.


    African Journals Online (AJOL)

    dien. Die planke en velie moes keer dat die assegaaie die mense tref. Voor die geveg het die vrouens en groter dogters koeels gegiet. Tydens die geveg het die seuns gehelp skiet terwyl die vrouens en dogters die gewere vir die mans gelaai het. Van die dogters soos Nellie. Botha (11 jaar oud) en haar sussie Fya (15 jaar.

  4. Die uitbouing van die Bybelse kanon in antieke Judaïsme en die ...

    African Journals Online (AJOL)

    31 Jul 2015 ... die oer-Christelike boodskap tot by sy Ou Testamentiese wortels, die geskrifte van Israel wat cum grano salis die 'Bybel' van die oer-Christendom geword het en die blywende verwysingspunt van die Christelike boodskap is. Erkenning. Hierdie artikel is vertaal na Afrikaans deur Prof. Jan G. van der Watt.

  5. Die opleiding van bedryfsielkundiges aan die universiteit van Fort Hare

    Directory of Open Access Journals (Sweden)

    W. Botha


    Full Text Available Die Departement Bedryfsielkunde aan die Universiteit van Fort Hare is 'n relatiewe jong departement en het eers in 1965 tot stand gekom. Voor hierdie datum is Bedryfsielkunde as 'n kort kursus deur die departement van suiwer Sielkunde aangebied en een van die destydse dosente, Dr. W. Backer, het die inisiatief geneem om 'n selfstandige departement van Bedryfsielkunde in die Fakulteit van Ekonomiese Wetenskappe op die been te bring.

  6. Development of an in-home standardized end-of-life treatment program for pediatric patients dying of brain tumors. (United States)

    Arland, Lesley C; Hendricks-Ferguson, Verna L; Pearson, Joanne; Foreman, Nicholas K; Madden, Jennifer R


    To evaluate an end-of-life (EOL) program related to specific outcomes (i.e., number of hospitalizations and place of death) for children with brain tumors. From 1990 to 2005, a retrospective chart review was performed related to specified outcomes for 166 children with admission for pediatric brain tumors. Patients who received the EOL program were hospitalized less often (n = 114; chi-square = 5.001 with df = 1, p management and decrease required hospital admissions for children with brain tumors. © 2013, Wiley Periodicals, Inc.

  7. A special radiation shielding for the radiotherapy of a pregnant patient; Eine Spezialabschirmung fuer die Strahlentherapie von Schwangeren

    Energy Technology Data Exchange (ETDEWEB)

    Buchgeister, M.; Mondry, A. [Bereich Medizinische Physik, Universitaetsklinik fuer Radioonkologie, Tuebingen (Germany); Spillner, P.; Paulsen, F.; Belka, C.; Bamberg, M. [Strahlentherapie, Universitaetsklinik fuer Radioonkologie, Tuebingen (Germany)


    Purpose: measurement of the radiation dose of different radiotherapy techniques with a phantom at the position of the uterus of a pregnant patient with and without a special radiation shielding. Material and methods: a special radiation shielding for the radiation therapy of a pregnant patient was constructed in the shape of a tunnel over the abdomen from 1 cm thick lead to reduce scatter radiation to the uterus and the fetus therein. The reduction of the scatter radiation to the lower abdomen was measured for three typical cases (cerebrum with lateral opposed fields, 6-MV photons; tangential fields for mamma irradiation, 6 MV; and anteroposterior-posteroanterior [AP-PA] opposed fields of 15 MV for treatment of the mediastinum) at an anthropomorphic Alderson phantom with thermoluminescence dosimeters in different depths and with an ionization chamber positioned in an RW3 solid water phantom. In the case of lateral opposed fields, a movable lead wall was additionally positioned next to the accelerator's head to reduce the scatter radiation from this source. Results: depending on the geometry of the radiation fields and on the photon energy, a reduction of the dose to the lower abdomen averaged over the depths of 6, 9, and 12 cm from 16% (15 MV, mediastinum case) to 51% (6 MV, cerebrum with additional lead wall) was achieved. The absolute scattered dose with shielding in place for a 2-Gy fraction dose results to 3.85 mGy and 0.27 mGy, respectively. Conclusion: national and international recommendations on the radiation dose to a fetus of a pregnant patient state limits of 200 mSv (DGMP report no. 7) and 100 mGy (ICRP 84), below which an abortion should not be considered and above which an indication for termination of the pregnancy could be given, respectively. The dose to the fetus can be kept below these limits with the shielding described in this work. Therefore, a radiation therapy of a pregnant patient is possible when these special precautions to reduce

  8. Oor die Bybel in die Afrikaanse digkuns

    African Journals Online (AJOL)

    another. As a matter of fact, the development of Afri kaans, the instrument of the poet, has been significantly influenced the Afrikaans translation of the Bible. Belie ... ook gesê het: Saam met ons literatuur, so oud as hy is. Die eerste Afrikaanse digter by wie ons omvattende Bybelse invloed kry, is. Totius, een van ons vroegste ...

  9. Considerations on the role of natural ecosystems in the eventual contamination of man and his environment

    International Nuclear Information System (INIS)

    Desmet, G.; Myttenaere, C.


    After the Chernobyl event, the problem of contamination of natural and semi-natural ecosystems has been particularly salient even where these non-agricultural land areas appear to generate only a small fraction of the annual food intakes of certain populations. A concise discussion of some features of natural ecosystems is presented here, with the objective of stimulating a closer inspection of the relative impact of these natural ecosystems on the eventual dose to man. The ability of natural systems to scavenge considerable amounts of contamination is emphasized and it is suggested that there is a need for further work to quantify the importance of these environments, relative to agricultural systems, in terms of producing eventual transfers to man. (author)

  10. calvyn oor die leiding van die heilige gees in die verklaring van die

    African Journals Online (AJOL)

    Mittel alters, bis er zur Ruhe kommt bei den kanonischen Schriften der. Urzeit der christlichen Ära (Barth ... (ego tamen dimoveri non possum ab amore compendii, CO 10, 403). Deur die boodskap van die .... Idem ergo spiritus qui per os prophetarum loquutus est, in corda nostra penetret necesse est, ut persuadeat fideliter ...


    African Journals Online (AJOL)

    Acta Theologica is an accredited South. African journal publishing ... SciELO South Africa. REDAKSIE/ ... 'n persoon belydenis van geloof af wat instemming met die betrokke kerk se ...... Ek was na my ongeluk buite aksie en op Clarens. 'n Mede-lid ...... Die “formation of new confessions, change to current confessions, and.

  12. Dying with dignity


    S P Kalantri


    The concept of dignity has beeen one of the ambiguous concepts in biomedical ethics. Thus the ambiguous nature of this concept has been extended to what it means to die with dignity. This research work is an investigation into the complexity in the understanding of "dying with dignity" in Applied Ethics.

  13. The day Madiba died

    African Journals Online (AJOL)

    8 Apr 2016 ... shibien en ma is nie happy nie. Susan Gaigher se allegoriese fanta- sie- oftewel wetenskapsfiksieverhale. “Martine se teepot” (46–55) en “Maslow”. (56–67) is verfrissend. Gaigher is een van die min skrywers in die bundel wat 'n kenmerkende en oorspronklike stem laat klink. 'n Mens sal 'n Gaigher-verhaal.

  14. Die entwicklung, die metamorphose, die entstehung: Die konzepte des organismus von Aristoteles bis Darwin

    Directory of Open Access Journals (Sweden)

    Kamerer Eva


    Full Text Available (nemački In diesem Aufsatz versuche ich, die Elemente verschiedener Konzepte des Organismus in der Philosophie und in der Wissenschaft zu analysieren. Die Deutungen des Organismus und der Einheit der Natur bei Aristoteles, Kant und Goethe werden als ein Beispiel der Bewegung von einem finalistischen zum antifinalistischen Bild der Natur verstanden.

  15. A qualitative study of medical students in a rural track: views on eventual rural practice. (United States)

    Roseamelia, Carrie; Greenwald, James L; Bush, Tiffany; Pratte, Morgan; Wilcox, Jessica; Morley, Christopher P


    Rural tracks (RTs) exist within medical schools across the United States. These programs often target those students from rural areas and those with primary care career interests, given that these factors are robust predictors of eventual rural practice. However, only 26% to 64% of graduates from RTs enter eventual rural practice. We conducted a qualitative, exploratory study of medical students enrolled in one school's RT, examining their interests in rural training, specialization, and eventual rural practice, via open coding of transcripts from focus groups and in-depth individual interviews, leading to identification of emerging themes. A total of 16 out of 54 eligible first- and second-year preclinical medical students participated in focus group sessions, and a total of seven out of 17 eligible third- and fourth-year medical students participated in individual interviews. Analyses revealed the recognition of a "Rural Identity," typical characteristics, and the importance of "Program Fit" and "Intentions for Practice" that trended toward family medicine specialization and rural practice. However, nuances within the comments reveal incomplete commitment to rural practice. In many cases, student preference for rural practice was driven largely by a disinterest in urban practice. Students with rural and primary care practice interests are often not perfectly committed to rural practice. However, RTs may provide a haven for such students within medical school.

  16. Paradigmas en progressie in die teologie: *n Perspektief op die ...

    African Journals Online (AJOL)

    Die metodologie as besinningsterrein word egter al belangriker. Gedurende die tweede week van April 1988 het teoloë van dwarsoor Suid-. Afrika by die nuwe gebou van die Raad vir Geesteswetenskaplike Navorsing in. Pretoria byeen gekom vir 'n kongres van amper drie dae met die tema Paradigma.'> 476. ISSN 0259 ...

  17. die korrelasie tussen die gemiddelde daaglikse toename van ...

    African Journals Online (AJOL)

    'n Regressielyn is uit die gegewens bereken deur 'n beswaarde regressieanaliese en die 80 persent-voorspellings- bande is bepaal. Die punte wat ver buite die normale ver- spreidingsband geval hetkon almal met goeie rede as abnor- maal beskou word (sien tabel 1) en is nie ingesluit by die statistiese berekenings nie.

  18. amp' van die ouderling in die Nuwe Testament

    African Journals Online (AJOL)

    Jesus self het geen kerk gestig nie en daarom, veral omdat die Jesus-beweging inter mums ten opsigte van die Joodse godsdiens van sy tyd tot stand gekom het, het ...... Die klem val dus nie op die npoTCTT0fievo<; se rang of outoriteit nie, maar op sy pastorale funksie in die huishouding of huisgemeente (kyk Reicke.

  19. Die toekoms en ons roeping

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    S. du Toit


    Full Text Available Om te weet wat ons roeping in die toekoms sal wees, moet ons eers besef wat in ons eie tyd aan die gang is en langs watter lyne die dinge beweeg. Dit is ons plig om te let op die tekens van die tye in die lig van die profetiese Woord. En dan wil ons dadelik beklemtoon dat ons in Suid-Afrika nie in die waan moet lewe dat ons hier onbekommerd en onaangetas deur die wêreldgebeure ons roeping en bestemming kan uitwerk nie.

  20. Die Hervormde Teologiese Studies na vyftig jaar

    African Journals Online (AJOL)

    INLEIDEND. In die tweede helfte van die jaar 1943 het die Hervormde Teologiese Studies die eerste maal verskyn. Dit was die produk van lang besinning en beplanning. Die dryfkrag agter die totstandkoming was prof dr S P Engeibrecht, 'n man wie se idealisme en toewyding aan die kerk groot dinge vir die kerk en ook die ...

  1. Die owerheidsinmenging met betrekking tot kerklike tughandelinge.

    Directory of Open Access Journals (Sweden)

    L. Roeleveld


    Full Text Available Volgens art 29 NGB is die merktekens van die ware kerk die suiwere prediking van die Evangelie, die suiwere bediening van die Sakramente en die gebruik van die kerklike tug. Art. 32 NGB spreek uit dat die Kerkorde nie mag afwyk van wat Christus ingestel het nie. Menslike vindinge en wette om die gewetens te bind en te dwing, moet daarom verwerp word. Die ekskommunikasie of die ban moet toegepas word volgens die Woord van God.

  2. Pentateugtradisies in die boek Hosea

    African Journals Online (AJOL)

    om te bepaal of die verwysing na 'n gebeure te doen het met die verre verlede of met die .... Hosea 2:1-2 JHWH se trou aan sy beloftes. ... dat huile na Egipte sal terugkeer. Die presiese bedoeiing van die woorde 'huile sal terugkeer na Egipte' is omstre- de. Kommentatore soos Rudolph meen dat dit verstaan moet word as ...

  3. Die begrafnisdíens

    African Journals Online (AJOL)

    (De Vaux 1961:108). Was die begrafnis 'n familie of 'n kerklike aangeleentheid? Hierdie vraag word nie in die Bybel beantwoord nie. Abraham het sy vrou begrawe (Gen 23: 19-. 20). Isak en Ismael ..... ver gekom om die begrafnis 'n kerklike aangeleentheid te maak nie. Hierdie stap .... trou aan die sorg van God. * Die kerk ...

  4. Metodes in die Christelike etiek

    African Journals Online (AJOL)

    The basic question in Christian ethics is not primarily. 'What should I do?' The basic question is rather ' ... should therefore be accepted as being part of the method used in Christian ethics. 1. INLEIDEND ..... aan die kant van die onderdrukte' verkondig word, word die Christen opgeroep om horn te skaar aan die kant van die ...

  5. Die menswaardigheid van die menslike embrio: die debat tot dusver

    Directory of Open Access Journals (Sweden)

    J.M. Vorster


    Full Text Available The human dignity of the human embryo: the debate thus far This article examines some recent arguments regarding the ethics of stem cell research as they are discussed in the various essays in the publication of Gruen et al. (2007, “Stem cell research: the ethical issues”. Regarding the use of human embryos in stem cell research, these essays discuss among other things the potential of the human embryo, the moral status (human dignity of the human embryo, the creation of chimeras, the sale of ocytes and other ethical issues in modern bioethics. Eventually the article draws attention to the main ethical problems at stake to be dealt with by Christian ethics using a deontological ethical theory. Christian ethics should focus on these problems in the on-going ethical debate regarding stem cell research.

  6. Die menswaardigheid van die menslike embrio: die debat tot dusver

    Directory of Open Access Journals (Sweden)

    J.M. Vorster


    Full Text Available The human dignity of the human embryo: the debate thus farThis article examines some recent arguments regarding the ethics of stem cell research as they are discussed in the various essays in the publication of Gruen et al. (2007, “Stem cell research: the ethical issues”. Regarding the use of human embryos in stem cell research, these essays discuss among other things the potential of the human embryo, the moral status (human dignity of the human embryo, the creation of chimeras, the sale of ocytes and other ethical issues in modern bioethics. Eventually the article draws attention to the main ethical problems at stake to be dealt with by Christian ethics using a deontological ethical theory. Christian ethics should focus on these problems in the on-going ethical debate regarding stem cell research.

  7. Awareness of Dying Preface

    Directory of Open Access Journals (Sweden)

    Barney G. Glaser, PhD, Hon. PhD


    Full Text Available Recently The New York Times reported: “VERY ILL CHILDREN TOLD OF DISEASE; Leukemia Patients at N.I.H. Not Shielded From Truth. . . . A child should always be told the truth, even when he has an incurable disease such as leukemia, according to two researchers who interviewed 51 children hospitalized at the National Cancer Institute, Bethesda, Maryland, for treat¬ment of leukemia.” This kind of news item reflects the growing concern among researchers and public about matters which touch on morality as much as on the technical aspects of medi¬cine. The rapidly increasing proportion of elderly people in the American population presents a range of personal and social questions; not the least is how they view their newly won longevity (often including anticipated years of chronic disease as well as their attitudes toward death. In consequence, many geriatric specialists are beginning to study American attitudes toward death, while others, spurred on by what seems a sense-less prolonging of life within hospital walls by medical tech¬nology run wild, are raising questions about death and dying in American life.

  8. Die teologiese skool in die P.U.K vir C.H.O.: met die betekenis van die teologiese skool vir die Christelike wetenskap

    Directory of Open Access Journals (Sweden)

    F. Postma


    Full Text Available Die Teologiese Skool van die Gereformeerde Kerk gedink op 29 November 1944 sy vyf-en-sewentigjarige bestaan.Die Raad en Senaat van die P.U.K. vir C.H.O. wil ook langs hierdie weg die Teologiese Skool van harte gelukwens en die versekering gee dat daar by die outoriteite van die P.U.K. ’n diepgevoelde dankbaarheid heers dat hierdie inrigting sovele jare deur onse God en Vader gedra en gespaar is.

  9. The Liverpool Care Pathway for the Dying Patient: a critical analysis of its rise, demise and legacy in England [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Jane Seymour


    Full Text Available Background: The Liverpool Care Pathway for the Dying Patient (‘the LCP’ was an integrated care pathway (ICP recommended by successive governments in England and Wales to improve end-of-life care, using insights from hospice and palliative care. It was discontinued in 2014 following mounting criticism and a national review.  The ensuing debate among clinicians polarised between ‘blaming’ of the LCP and regret at its removal. Employing the concept of ‘boundary objects’, we aimed to address three questions: 1 why and how did the LCP come to prominence as a vehicle of policy and practice 2 what factors contributed to its demise? 3 what immediate implications and lessons resulted from its withdrawal? Methods: We use primary and secondary sources in the public domain to assemble a critical and historical review. Results: The rapidity of transfer and translation of the LCP reflected uncritical enthusiasm for ICPs in the early 2000s. The subsequent LCP ‘scandal’ demonstrated the power of social media in creating knowledge, as well as conflicting perceptions about end-of-life interventions. While the LCP had some weaknesses in its formulation and implementation, it became the bearer of responsibility for all aspects of NHS end-of-life care. This was beyond its original remit. It exposed fault lines in the NHS, provided a platform for debates about the ‘evidence’ required to underpin innovations in palliative care and became a conduit of discord about ‘good’ or ‘bad’ practice in care of the dying. It also fostered a previously unseen critique of assumptions within palliative care.  Conclusions:  In contrast to most observers of the LCP story who refer to the dangers of scaling up clinical interventions without an evidence base, we call for greater assessment of the wider risks and more careful consideration of the unintended consequences that might result from the roll out of new end-of-life interventions.

  10. Die Frage nach Gerechtigkeit.

    Directory of Open Access Journals (Sweden)

    Martin Jäggle


    Full Text Available ENGLISH: In the first part six stages in the author’s path of life are described, which have influenced his engagement with justice. The second part gives an insight into his religious educational work, in which the issue of justice was especially significant on the example of ‘religion in the context of migration’ and of the ecumenic initiative ‘’ (school worth living. The vision of the Kingdom of God and the necessity of participation become apparent. DEUTSCH: Im ersten Teil werden sechs Stationen am Lebensweg des Autors beschrieben, die seine Auseinandersetzung mit Gerechtigkeit geprägt haben. Der zweite Teil gibt Einblick in seine religionspädagogische Arbeit, in der die Frage nach Gerechtigkeit besonders bedeutsam war am Beispiel ‚Religion im Kontext Migration‘ und der ökumenischen Initiative ‚‘. Die Vision vom Reich Gottes und die Notwendigkeit von Partizipation werden dabei deutlich.

  11. Die EG-Kabotageverordnung


    Basedow, Jürgen


    Die EG-Kabotageverordnung : e. Schritt zur Verwirklichung d. Dienstleistungsfreiheit im Straßengüterverkehr / Jürgen Basedow ; Ansgar Held. - In: Europäische Zeitschrift für Wirtschaftsrecht. 1. 1990. S. 305-308

  12. Practicing patients, compassion, and hope at the end of life: mining the passion of Jesus in Luke for a Christian model of dying well. (United States)

    Vogt, Christopher P


    Four centuries ago, Christian moral theologians addressed the issue of dying by turning to scripture and the virtues. This work revives that tradition by showing that careful theological reflection upon the nature of Christian patience, compassion, and hope illuminates the shape of the Good Death. The author draws upon Luke's passion narrative to develop a better understanding of these virtues. He also takes up the question of whether Jesus' death can be a model of dying well for contemporary Christians. Christians are often advised to look to Jesus in his dying as a model for themselves, but this recommendation typically leaves unanswered what exactly it is about Jesus' dying that is to be imitated. The understanding of patience, compassion, and hope developed here provides a means of sorting through this issue.

  13. Die Bibliothek des Bezirksmuseums Josefstadt

    Directory of Open Access Journals (Sweden)

    Maria Ettl


    Josefstadt in Wien werden die Herkunft der Bibliotheksbestände und die beengte Raumsituation beschrieben. Abschließend wird auf die Erfassung der Medien mittels der Bibliothekssoftware „Biblioweb“ eingegangen.

  14. Die verband tussen die sielkundige kontrak en organisasieverbondenheid

    Directory of Open Access Journals (Sweden)

    K. J. Stanz


    Full Text Available The relationship between the psychological contract and organisational commitment. The aim of this study is to design a measuring instrument with acceptable metric characteristics for the strength of the psychological contract within the South African context, and to determine empirically the relation between the strength of the psychological contract and organisational commitment. The Dhammanungune Model served as foundation for the design of the Strength of the Psychological Contract Questionnaire which consists of two scales namely, a needs expectation scale and a needs fulfilment expectation scale. The items of each scale have been formulated in the manner that ensures that the respondent reacts consecutively to two instructions namely, (a the level of the expectation and (b the importance of the expectation. This questionnaire was administered together with the Organisational Commitment Questionnaire to two population groups within the military environment. The Pearson Product Moment Correlation was calculated between the strength of the psychological contract and organisational commitment and the significance of the correlations was evaluated. Opsomming Die doel van die studie is om 'n meetinstrument met aanvaarbare metriese eienskappe vir die sterkte van die sielkundige kontrak vir Suid-Afrikaanse omstandighede te ontwerp en om empirics die verband tussen die sterkte van die sielkundige kontrak en organisasieverbondenheid te bepaal. Die sterkte van die sielkundige kontrak vraelys is op grond van die Dhammanungune-model ontwerp en het uit twee skale naamlik, die behoefteverwagting- en vervullingsverwagtingskale bestaan. Items vir eike skaal is sodanig geformuleer dat die respondent agteropeenvolgens op twee instruksies naamlik (a die vlak van die verwagting en (b die belangrikheid van die verwagting moet reageer. Die vraelys is saam met die organisasieverbondenheidsvraelys op twee populasies uit 'n militere omgewing toegepas. Die Pearson

  15. Powering the future. How we will (eventually) solve the energy crisis and fuel the civilization of tomorrow; Der Letzte macht das Licht aus. Die Zukunft der Energie

    Energy Technology Data Exchange (ETDEWEB)

    Laughlin, Robert B. [Stanford Univ., CA (United States)


    When it gets dark, we turn on the light. When it gets cold, we heat. When we need energy for the global industry and technology, we make use of the energy. Every time. But soon the earth fuels such as coal, gas, oil and uranium are irrevocably depleted. And then? The Nobel laureate Robert B. Laughlin reports on the future of our energy supply.

  16. Die postpolitische Stadt

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    Erik Swyngedouw


    Full Text Available Die Polis ist tot, es lebe die kreative Stadt! Während die Stadt, zumindest in Teilen des städtischen Raums, blüht und gedeiht, scheint die Polis im idealisierten griechischen Sinn dem Untergang geweiht; in diesem Verständnis ist sie der Ort der öffentlichen politischen Auseinandersetzung und demokratischen Unterhandlung und somit eine Stätte (oft radikaler Abweichung und Unstimmigkeit, an der die politische Subjektivierung buchstäblich ihren Platz hat. Diese Figur einer entpolitisierten (oder postpolitischen und postdemokratischen Stadt im Spätkapitalismus bildet das Leitmotiv des vorliegenden Beitrags. Ich lehne mich dabei an Jacques Rancière, Slavoj Žižek, Chantal Mouffe, Mustafa Dikeç, Alain Badiou und andere Kritiker jenes zynischen Radikalismus an, der dafür gesorgt hat, dass eine kritische Theorie und eine radikale politische Praxis ohnmächtig und unfruchtbar vor jenen entpolitisierenden Gesten stehen, die in der polizeilichen Ordnung des zeitgenössischen neoliberalen Spätkapitalismus als Stadtentwicklungspolitik [urban policy] und städtische Politik [urban politics] gelten. Ziel meiner Intervention ist es, das Politische wieder in den Mittelpunkt der zeitgenössischen Debatten über das Urbane zu stellen. [...

  17. La Estructura del Dolo Eventual y las Nuevas Fenomenologías de Riesgo

    Directory of Open Access Journals (Sweden)

    Stefano Canestrari


    Full Text Available El texto aborda la discusión acerca de la estructura del dolo eventual, a partir de su fenomenología contemporánea, y el tratamiento que la jurisprudencia y doctrina alemana e italiana le han dado, particularmente en relación a supuestos relacionados con la transmisión de enfermedades de carácter sexual y de negativa de transfusión de sangre a menores por padres Testigos de Jehová. Se afirma que la doctrina dominante del consentimiento o aceptación no resuelve adecuadamente la fenomenología analizada y se plantea superar las dificultades que ello acarrea mediante la regulación legal del concepto de dolo eventual que se propone como conclusiónThe article discusses the structure of dolus eventualis (recklessness, considering its contemporary phenomenology, and the contributions of judicial decisions and legal scholarship in Germany and Italy. Especial consideration is given to the cases of sexually transmitted diseases and the refusal of blood transfusions to children by their Jehova's Witnesses parents. It is argued that the dominant doctrine of consent or acceptance does nor adequately resolve the analyzed phenomena, and a proposal is advanced towards a legal definition of the concept of recklessness.

  18. Die histologie en ultrastruktuur van die hepatopankreas van die bloukurper Oreochromis mossambicus

    Directory of Open Access Journals (Sweden)

    M. M. Nel


    Full Text Available Die histologie en ultrastruktuur van die hepatopankreas van die bloukurper Oreochromis mossambicus word beskryf. ’n Dun bindweefselkapsel omring die lewer. Die hepatosietrangskikking vertoon as lobules, met die koorde van hepatosiete wat vanaf ’n sentrale vene uitradieer en met mekaar anastomaseer. Indiwiduele lewerlohules vertoon nie duidelike grense nie, maar enkele duidelike triades word wel in die lewer van O. mossambicus aangetref. Die hepatosiete bevat ’n enkele ronde kern met ’n duidelike nukleolus en die growwe endoplasmiese retikula kom in twee of meer rye om die kerne en teen die selgrense van die hepatosiete voor. Die ander sitoplasmiese organelle kom verspreid in die hepatosietsitoplasma voor. Die eksokriene pankreasselle is om die portale venes gesetel. Die kerne van hierdie selle is rond en is hasaal in die kubies- tot silindervormige selle gelee. ’n Goedontwikkelde growwe endoplasmiese retikulum — vesikulêr, tubulêr en sirkulêr in vorm — en sektretoriese granules wat apikaal in die sel gelee is, kom voor.

  19. Transcriptome patterns from primary cutaneous Leishmania braziliensis infections associate with eventual development of mucosal disease in humans.

    Directory of Open Access Journals (Sweden)

    Ana Claudia Maretti-Mira

    Full Text Available INTRODUCTION: Localized Cutaneous Leishmaniasis (LCL and Mucosal Leishmaniasis (ML are two extreme clinical forms of American Tegumentary Leishmaniasis that usually begin as solitary primary cutaneous lesions. Host and parasite factors that influence the progression of LCL to ML are not completely understood. In this manuscript, we compare the gene expression profiles of primary cutaneous lesions from patients who eventually developed ML to those that did not. METHODS: Using RNA-seq, we analyzed both the human and Leishmania transcriptomes in primary cutaneous lesions. RESULTS: Limited number of reads mapping to Leishmania transcripts were obtained. For human transcripts, compared to ML patients, lesions from LCL patients displayed a general multi-polarization of the adaptive immune response and showed up-regulation of genes involved in chemoattraction of innate immune cells and in antigen presentation. We also identified a potential transcriptional signature in the primary lesions that may predict long-term disease outcome. CONCLUSIONS: We were able to simultaneously sequence both human and Leishmania mRNA transcripts in primary cutaneous leishmaniasis lesions. Our results suggest an intrinsic difference in the immune capacity of LCL and ML patients. The findings correlate the complete cure of L. braziliensis infection with a controlled inflammatory response and a balanced activation of innate and adaptive immunity.

  20. Die teologiese arbeid van Antonius HJ Gunneweg

    African Journals Online (AJOL)

    En dis 'n klein treetjie van klagte na aanklag en na protes teen die gode, die heersers wat die mens vernietig deur hom oor sy ware lewe te bedrieg. Die ideologie eis dan ook dienooreenkomstig die bevryding en emansipasie van die mens van die gode en van God (1983: 118—119). Volgens die Jahwis is dit die slang wat, ...

  1. ["Good dying"--definition and current state of research]. (United States)

    Hutter, Nico; Stößel, Ulrich; Meffert, Cornelia; Körner, Mirjam; Bozzaro, Claudia; Becker, Gerhild; Baumeister, Harald


    The advances of modern medicine did not only result in prolongation of life expectancy, but also led to a shift from dying at home to dying in public institutions. In western countries most people die at advanced age in medical facilities. Hence, the question regarding the conditions, which should be provided by society and especially medicine, to allow terminally ill people to experience "good dying" is substantial. For this purpose, an examination of patients', family members' and health care providers' understanding of the term " good dying" is required. The present paper aims at shedding light on the term "good dying" and to summarize the current state of research. Therefore, the attributes of "good dying" will be described from the perspectives of patients, family members and health care providers, which are discussed and examined in current medical-sociological research. These attributes can be illustrated on three dimensions: Quality of life at the end of life (e. g. pain relief, mental well-being), quality of dying (e. g. avoiding prolonged dying, autonomy, presence of relatives) and quality of health care at the end of life (e. g. patient-oriented health care, positive communication between health care providers and patients, availability of guidelines). Although the attributes of "good dying" are described in detail in the existing literature, further studies have to clarify the relevance and impact of these attributes as predictors of "good dying". © Georg Thieme Verlag KG Stuttgart · New York.

  2. Die benutting van vraelyste met die oog op meer effektiewe ...

    African Journals Online (AJOL)


    effektiewe stresbeheer as een van die temas te hanteer. Op grond van die navorsing deur onder andere Lawson (1985) en Taylor (1999) sou ek graag die proses van differensiasie2 ook by genoemde lys voeg as tema vir bespreking tydens huweliksvoorbereiding. 2 Differensiasie kan beskryf word as die losmaakproses ...

  3. die aard van wetgewende diskresies by die suid-afrikaanse ...

    African Journals Online (AJOL)


    In enige moderne demokrasie is daar een of ander vorm van skeiding van magte tussen die wetgewende, uitvoerende en regsprekende gesag. Hierdie skeiding van magte, die sogenaamde trias politica, kan sover teruggevoer word as 1215, met die ondertekening van die Magna Carta deur Koning John van Engeland.

  4. die doeltreffendheid van die afrikaanse woordelys en spelreels

    African Journals Online (AJOL)

    sluiting by die reel vir die verdubbeling van medeklinkers na 'n kort, be- klemtoonde klinker, woorde soos ballet, ballon, terras, terrein, dissipel en dissipline slegs met een konsonant na die eerste vokaal gespel moes word, omdat daardie voorafgaande vokaal onbeklemtoon is. Ook hierdie uit- sondering op die reel word ...

  5. Die aanspraak op Goddelike steun in 'n konfliksituasie volgens die ...

    African Journals Online (AJOL)

    laws, and ethical or political principles. A synchronic investigation of relevant Old ... die toneel gebring met die vraag: 'aan wie se kant is God' (vgl bv The road to. Damascus 1979:6)? Volgens .... betrekking tot die Ou Testament: Hoe moet ons vasstel wie se kant God nou regtig kies, of wie veg aan die kant van God en wie ...

  6. The Liverpool Care Pathway for cancer patients dying in hospital medical wards: a before-after cluster phase II trial of outcomes reported by family members. (United States)

    Costantini, Massimo; Pellegrini, Fabio; Di Leo, Silvia; Beccaro, Monica; Rossi, Carla; Flego, Guia; Romoli, Vittoria; Giannotti, Michela; Morone, Paola; Ivaldi, Giovanni P; Cavallo, Laura; Fusco, Flavio; Higginson, Irene J


    Hospital is the most common place of cancer death but concerns regarding the quality of end-of-life care remain. Preliminary assessment of the effectiveness of the Liverpool Care Pathway on the quality of end-of-life care provided to adult cancer patients during their last week of life in hospital. Uncontrolled before-after intervention cluster trial. The trial was performed within four hospital wards participating in the pilot implementation of the Italian version of the Liverpool Care Pathway programme. All cancer patients who died in the hospital wards 2-4 months before and after the implementation of the Italian version of Liverpool Care Pathway were identified. A total of 2 months after the patient's death, bereaved family members were interviewed using the Toolkit After-Death Family Interview (seven 0-100 scales assessing the quality of end-of-life care) and the Italian version of the Views of Informal Carers - Evaluation of Services (VOICES) (three items assessing pain, breathlessness and nausea-vomiting). An interview was obtained for 79 family members, 46 (73.0%) before and 33 (68.8%) after implementation of the Italian version of Liverpool Care Pathway. Following Italian version of Liverpool Care Pathway implementation, there was a significant improvement in the mean scores of four Toolkit scales: respect, kindness and dignity (+16.8; 95% confidence interval = 3.6-30.0; p = 0.015); family emotional support (+20.9; 95% confidence interval = 9.6-32.3; p family self-efficacy (+14.3; 95% confidence interval = 0.3-28.2; p = 0.049) and coordination of care (+14.3; 95% confidence interval = 4.2-24.3; p = 0.007). No significant improvement in symptom' control was observed. These results provide the first robust data collected from family members of a preliminary clinically significant improvement, in some aspects, of quality of care after the implementation of the Italian version of Liverpool Care Pathway programme. The poor effect for symptom control suggests


    Spencer, Caroline; Weber-Fox, Christine


    Purpose In preschool children, we investigated whether expressive and receptive language, phonological, articulatory, and/or verbal working memory proficiencies aid in predicting eventual recovery or persistence of stuttering. Methods Participants included 65 children, including 25 children who do not stutter (CWNS) and 40 who stutter (CWS) recruited at age 3;9–5;8. At initial testing, participants were administered the Test of Auditory Comprehension of Language, 3rd edition (TACL-3), Structured Photographic Expressive Language Test, 3rd edition (SPELT-3), Bankson-Bernthal Test of Phonology-Consonant Inventory subtest (BBTOP-CI), Nonword Repetition Test (NRT; Dollaghan & Campbell, 1998), and Test of Auditory Perceptual Skills-Revised (TAPS-R) auditory number memory and auditory word memory subtests. Stuttering behaviors of CWS were assessed in subsequent years, forming groups whose stuttering eventually persisted (CWS-Per; n=19) or recovered (CWS-Rec; n=21). Proficiency scores in morphosyntactic skills, consonant production, verbal working memory for known words, and phonological working memory and speech production for novel nonwords obtained at the initial testing were analyzed for each group. Results CWS-Per were less proficient than CWNS and CWS-Rec in measures of consonant production (BBTOP-CI) and repetition of novel phonological sequences (NRT). In contrast, receptive language, expressive language, and verbal working memory abilities did not distinguish CWS-Rec from CWS-Per. Binary logistic regression analysis indicated that preschool BBTOP-CI scores and overall NRT proficiency significantly predicted future recovery status. Conclusion Results suggest that phonological and speech articulation abilities in the preschool years should be considered with other predictive factors as part of a comprehensive risk assessment for the development of chronic stuttering. PMID:25173455

  8. Killing, letting die and euthanasia. (United States)

    Husak, D N


    Medical ethicists debate whether or not the moral assessment of cases of euthanasia should depend on whether the patient is 'killed' or 'allowed to die'. The usual presupposition is that a clear distinction between killing and letting die can be drawn so that this substantive question is not begged. I contend that the categorisation of cases of instances of killing rather than as instances of letting die depends in part on a prior moral assessment of the case. Hence is it trivially rather than substantively true that the distinction has moral significance. But even if a morally neutral (ie non-question begging) distinction could be drawn, its application to the euthanasia controversy is problematic. I illustrate the difficulties of employing this distinction to reach moral conclusions by critically discussing Philippa Foot's recent treatment of euthanasia. I conclude that even if an act of euthanasia is an instance of killing, and there exists a prima facie moral duty not to kill, and no more stringent duty overrides this duty, one still cannot determine such an act to be morally impermissible.

  9. Killing, letting die and euthanasia. (United States)

    Husak, D N


    Medical ethicists debate whether or not the moral assessment of cases of euthanasia should depend on whether the patient is 'killed' or 'allowed to die'. The usual presupposition is that a clear distinction between killing and letting die can be drawn so that this substantive question is not begged. I contend that the categorisation of cases of instances of killing rather than as instances of letting die depends in part on a prior moral assessment of the case. Hence is it trivially rather than substantively true that the distinction has moral significance. But even if a morally neutral (ie non-question begging) distinction could be drawn, its application to the euthanasia controversy is problematic. I illustrate the difficulties of employing this distinction to reach moral conclusions by critically discussing Philippa Foot's recent treatment of euthanasia. I conclude that even if an act of euthanasia is an instance of killing, and there exists a prima facie moral duty not to kill, and no more stringent duty overrides this duty, one still cannot determine such an act to be morally impermissible. PMID:541821

  10. Die huwelik as identiteitsmerker in die Ou Testament

    African Journals Online (AJOL)


    Gen 2:18). Uit die woorde van Genesis 2:24 dat man en vrou een sal wees, lei die derde formulier af dat dit “getuig dat die huwelik 'n allesinsluitende gemeenskap is ..... die formule gebruik word: “Hier volg die vertelling oor X se nageslag.” (Gen ..... verwys daarna as “intertwining the principal value concepts of tradition”.

  11. Narratiwiteit en die Ou Testament

    African Journals Online (AJOL)

    INLEIDING. Die literêre benadering tot die Ou-Testamentiese narratiewe word algemeen as 'n alternatiewe paradigma in die Bybelwetenskappe aanvaar. Oor die filosofiese uit- gangspunte wat hierdie nuwe paradigma ten grondslag lê, bestaan daar egter nog weinig eenstemmigheid. Heelwat probleme van filosofiese en ...

  12. Eksistensialisme in die Franse letterkunde

    Directory of Open Access Journals (Sweden)

    A. A. Teurlinckx


    Full Text Available Nooit sou die Franse jeug — en die van Europa en verder — in dié mate deur die eksistensialisme be'invloed gewees het nie, indien hierdie filosofie in wysgerige traktate sou begrawe gelê het. Die eksistensialiste het die koning van die filosofiese verhaal, Voltaire, met sukses op sy Candide- en Zadig-pad gevolg en hulle teorieë in letterkundige werke, ver- hale, romans en ook toneelstukke kwytgeraak, wat baie gelees is en waaruit ook ander literatore kragte en inspirasie geput het. Omrede daarvan is daar inderdaad baie eksistensialisme in die Franse letterkunde, maar ’n eintlike eksistensialistiese letterkunde was daar nie, en ’n Eksistensialistiese Letterkun­ dige skool het nooit bestaan nie. Ook sit hierdie eksistensialiste nie langs dieselfde vuur nie. Die Christelike eksistensialis Gabriel Marcel het op 21 April van hierdie jaar uitgevaar teen die „Sartriane” na aanleiding van die opvoering van Les Paravents, Die W indskerms van Jean Genêt in ’n Paryse staatsondersteunde teater. „Mens mag seker wees”, skryf Marcel in Les Nouvelles Littéraires, „dat die hele sartriaanse parogie sal skreeu: groot meesterwerk”. Voortgaande op sy distansiëring kan die literêre eksistensialiste in drie groepe ingedeel word: 1. Die Sartriane; 2. Die Christelike Eksistensialiste; 3. Die Onafhanklikes.

  13. Assisted Dying in Canada. (United States)

    Schuklenk, Udo

    This paper makes an affirmative ethical case in favour of the decriminalization of assisted dying in Canada. It then proceeds to defending the affirmative case against various slippery-slope arguments that are typically deployed by opponents of assisted dying. Finally, a recent case of questionable professional conduct by anti-euthanasia campaigners cum academics is flagged as a warning to all of us not to permit the quality of the professional debate to deteriorate unacceptably, despite the personal emotional investments involved on all sides of the debate.

  14. Differences between terminally ill cancer patients who died after euthanasia had been performed and terminally ill cancer patients who did not request euthanasia

    NARCIS (Netherlands)

    Georges, J.J.; Philipsen, B.D.; van der, Wal G.; van der, Heide A.; van der Maas, P.J.


    Palliative care, directed at improving the quality of life of terminally ill patients, is generally not aimed at any form of postponing or hastening death. It is possible that high quality palliative care could prevent requests for euthanasia. However, empirical evidence on this issue is scarce. In

  15. Videofluoroscopy of the pharynx and esophagus in patients with globus pharyngis. Comparison with static radiography; Die radiologische Abklaerung des Globus pharyngis. Vergleich der diagnostischen Wertigkeit von konventionellem Roentgen mit der Videokinematographie

    Energy Technology Data Exchange (ETDEWEB)

    Schober, E. [Abt. Roentgen fuer Konservative Faecher, Universitaetsklinik fuer Radiodiagnostik, Wien (Austria); Schima, W. [Abt. Roentgen fuer Konservative Faecher, Universitaetsklinik fuer Radiodiagnostik, Wien (Austria); Pokieser, P. [Abt. Roentgen fuer Chirurgische Faecher, Universitaetsklinik fuer Radiodiagnostik, Wien (Austria)


    The symptom is associated with a multitude of pharyngoesophageal abnormalities. Our study compares the diagnostic yield of videofluoroscopy to that of static radiography in patients suffering from globus pharnygis. A total of 150 consecutive patients complaining of a lump in the throat, but without evidence of dysphagia, were studied in a standardized fashion with both methods. Videofluoroscopy combined with static radiography revealed morphological or functional abnormalities in 75% of our patients. The combination of the two methods yielded significantly more abnormalities in the pharynx and esophagus than videofluoroscopy or static radiography alone. Esophageal motor disorders, pharyngoesophageal sphincter dysfunction and pharyngeal residue of contrast material proved to be the most common abnormalities. In conclusion, videofluoroscopy combined with static radiography is mandatory in the radiological assessment of patients suffering from the globus sensation. (orig.) [Deutsch] Unsere Studie vergleicht die diagnostische Wertigkeit des konventionellen Roentgens mit jener der Videokineamtographie von Pharynx und Oesophagus bei der Abklaerung des Globusgefuehls. Wir haben 150 konsekutive Patienten mit Globusgefuehl, jedoch ohne Dysphagie mit beiden Methoden nach einem standardisierten Protokoll untersucht. Mittels der Kombination von konventionellem Roentgen mit der Videokinematographie fanden sich bei 75% der Patienten pathologische Veraenderungen. Durch die Kombination beider Methoden konnten signifikant mehr morphologische und funktionelle Stoerungen des Pharynx sowie Oesophagus aufgezeigt werden, als mit der alleinigen konventionellen Technik oder der alleinigen Videokinematographie. Die haeufigsten pathologischen Veraenderungen in unserem Kollektiv waren Oesophagusmotilitaetsstoerungen, eine Dyskinesie des pharyngooesophagealen Sphinkters sowie eine abnorme pharyngeale Kontrastmittelretention. Unsere Ergebnisse belegen eindeutig, dass die radiologische

  16. Die afrikaner en sy pers*

    Directory of Open Access Journals (Sweden)

    G. D. Scholtz


    Full Text Available Die versoek w at van u inrigting tot my gekom het om buitengewone professor in die Persw etenskap te word, was vir my deels vererend, m aar deels het dit my in 'n moeilike posisie gestel. Dit was vir my vererend, om dat dit gekom het van 'n universiteit m et wie se Christelik- Nasionale koers ek my ten voile kan vereenselwig. Dit was dan ook vir my vererend, om dat ek daardeur in staat gestel kan w ord om die volk w aartoe ek behoort, op 'n vir my nuwe terrein te dien. As sodanig is dit vir my im m ers m oontlik om ook ’n beskeie bydrae te lewer tot die geestelike vorm ing van die jeug van ons volk. Dit het my m oeilik geval om, w aar ek reeds die m iddeljarige leeftyd bereik het, nou vir die eerste maal as dosent op te tree, aangesien ek daarvan in die verlede nie die m inste kennis en ervaring opgedoen het nie. As joernalis rig ek my im m ers tot die breë publiek deur middel van die pen. As dosent m oet ek my deur middel van die mond tot die studente rig. Dit lê voor die hand dat die eise w at so aan my gestel word, totaal anders is as dié waar- aan ek oor 'n tydperk van m eer as 'n kw arteeu as joer­ nalis gewoond geraak het.

  17. Preschool speech articulation and nonword repetition abilities may help predict eventual recovery or persistence of stuttering. (United States)

    Spencer, Caroline; Weber-Fox, Christine


    In preschool children, we investigated whether expressive and receptive language, phonological, articulatory, and/or verbal working memory proficiencies aid in predicting eventual recovery or persistence of stuttering. Participants included 65 children, including 25 children who do not stutter (CWNS) and 40 who stutter (CWS) recruited at age 3;9-5;8. At initial testing, participants were administered the Test of Auditory Comprehension of Language, 3rd edition (TACL-3), Structured Photographic Expressive Language Test, 3rd edition (SPELT-3), Bankson-Bernthal Test of Phonology-Consonant Inventory subtest (BBTOP-CI), Nonword Repetition Test (NRT; Dollaghan & Campbell, 1998), and Test of Auditory Perceptual Skills-Revised (TAPS-R) auditory number memory and auditory word memory subtests. Stuttering behaviors of CWS were assessed in subsequent years, forming groups whose stuttering eventually persisted (CWS-Per; n=19) or recovered (CWS-Rec; n=21). Proficiency scores in morphosyntactic skills, consonant production, verbal working memory for known words, and phonological working memory and speech production for novel nonwords obtained at the initial testing were analyzed for each group. CWS-Per were less proficient than CWNS and CWS-Rec in measures of consonant production (BBTOP-CI) and repetition of novel phonological sequences (NRT). In contrast, receptive language, expressive language, and verbal working memory abilities did not distinguish CWS-Rec from CWS-Per. Binary logistic regression analysis indicated that preschool BBTOP-CI scores and overall NRT proficiency significantly predicted future recovery status. Results suggest that phonological and speech articulation abilities in the preschool years should be considered with other predictive factors as part of a comprehensive risk assessment for the development of chronic stuttering. At the end of this activity the reader will be able to: (1) describe the current status of nonlinguistic and linguistic predictors for

  18. Die vestiging van die Kerk in Natal, die Vrystaat en Transvaal na ...

    African Journals Online (AJOL)

    as eerste predikant van die Voortrekkers laat orden en bevestig. Daama het verskeie kerksake van tyd tot tyd aandag geniet. Met betrekking tot die bevestiging van huwelike stel Retief 'n meer ordelike reëling daar, naamlik dat die gebooie van voomemende egpa- re van nou af drie maal in die kerk afgekondig moes wrord ...

  19. Computed tomography: influence of varying tube current on patient dose and correctness of effective dose calculations; Computertomografie: Einfluss des variablen Roehrenstroms auf die Patientendosis und die Genauigkeit von Berechnungen der effektiven Dosis

    Energy Technology Data Exchange (ETDEWEB)

    Hietschold, V. [Inst. und Poliklinik fuer Radiologische Diagnostik, Universitaetsklinikum Carl-Gustav-Carus der TU Dresden (Germany); Koch, A.; Laniado, M.; Abolmaali, N.D. [OncoRay, Molecular Imaging, TU Dresden (Germany)


    Purpose: determination of the influence of tube currents varying during a CT scan on organ doses and on the effective dose as a function of patient constitution. Evaluation of the accuracy of effective dose calculations based on summarizing parameters (effective mAs, dose length product [DLP]) compared to calculations based on slice-specific tube currents. Materials and methods: investigation of the CT datasets of 806 patients acquired from the skull base to the proximal thigh with respect to the body mass index (BMI). The effective dose was calculated by means of slice-specific as well as region-specific conversion factors. Results: dose optimization by means of variable tube current resulted in a reduction of the gonad dose in patients with BMI {<=} 20.. 21 kg/m{sup 2} and of the effective dose in patients with BMI {<=} 26 kg/m{sup 2}. Effective dose values calculated with the DLP for 90% of the patients are within an interval of {+-} 20% of the values calculated using slice-specific tube currents. Conclusion: if tube current optimization during the CT scan was applied, for the scan region under investigation, at a BMI already below the German mean value, an increased effective dose was observed. Calculations of the effective dose on the basis of summarizing values such as DLP or effective mAs are of sufficient accuracy. (orig.)

  20. Where is God in My Dying?

    DEFF Research Database (Denmark)

    Moestrup, Lene; Hvidt, Niels Christian


    Despite increased focus on the role of spiritual care in palliative care, there is limited knowledge about spirituality / religiosity among dying patients in secularized cultures such as Denmark. This study aims through semi-structured interviews with Danish hospice patients and participant obser......, important faith although it was not something they knew much about, let alone discussed or practiced much....

  1. Die skool en die onderwyser as faktore in die geestesgesondheid van die kind*

    Directory of Open Access Journals (Sweden)

    B. C. Schutte


    Full Text Available Ons hou geestesgesondheidsweke, stig beroepsentrums, samel geld in om mense wat geestelik siek is te genees, klae oor die tekort aan psigiaters, kliniese sielkundiges, bedryfsielkundiges, voorligters, skoolpsigoloë,ens. ’n Karige kwarteeu gelede het ons aan al hierdie dinge slegs akademiese aandag gewy. In hierdie kursus wordverskeie tipes kinders bespreek en geleer hoe om hulle probleme te benader.

  2. When Somebody Dies (United States)

    ... bottle became useless. The container is gone, but what's inside — the water — remains. The part of a person that's left after the body dies is often called the "soul" or "spirit." Some people believe the soul is the part ...

  3. Die Kunst des Scheiterns

    DEFF Research Database (Denmark)

    Juul, Jesper


    Menschen haben von Kindesbeinen an das Verlangen, Erfolge zu erzielen und Kompetenz zu erreichen. Computerspieler entscheiden sich jedoch fortlaufend für eine Aktivität, die oft und wiederholt zum Verlieren führen muss und ein taubes Gefühl der Unfähigkeit erzeugt. Im Kino, im Theatersaal und bei...

  4. Modelle in die onderrig van fisika

    Directory of Open Access Journals (Sweden)

    J. J. A. Smit


    Full Text Available Die rol van modelle in die onderrig van fisika is sedert die vroeë tagtigerjare erken. In die onderrig word die absent op die kwantitaiewe aspekte van die vak geplaas, terwyl die kwatitatiewe aspekte min aandag kry.


    African Journals Online (AJOL)

    31 Okt 1977 ... stelling van 'n higiene afdeling het in 'n belang- rike behoefte voorsien. Die pligte van die SAGO het dus op hierdie stadium die ondersoek van soldate, die sanita- sie van kampe, die verpleging van pasiente in militere hospitale en die opleiding van lede be- hels. 'n Hoogtepunt was die opening van die.

  6. Dimensional control of die castings (United States)

    Karve, Aniruddha Ajit

    The demand for net shape die castings, which require little or no machining, is steadily increasing. Stringent customer requirements are forcing die casters to deliver high quality castings in increasingly short lead times. Dimensional conformance to customer specifications is an inherent part of die casting quality. The dimensional attributes of a die casting are essentially dependent upon many factors--the quality of the die and the degree of control over the process variables being the two major sources of dimensional error in die castings. This study focused on investigating the nature and the causes of dimensional error in die castings. The two major components of dimensional error i.e., dimensional variability and die allowance were studied. The major effort of this study was to qualitatively and quantitatively study the effects of casting geometry and process variables on die casting dimensional variability and die allowance. This was accomplished by detailed dimensional data collection at production die casting sites. Robust feature characterization schemes were developed to describe complex casting geometry in quantitative terms. Empirical modeling was utilized to quantify the effects of the casting variables on dimensional variability and die allowance for die casting features. A number of casting geometry and process variables were found to affect dimensional variability in die castings. The dimensional variability was evaluated by comparisons with current published dimensional tolerance standards. The casting geometry was found to play a significant role in influencing the die allowance of the features measured. The predictive models developed for dimensional variability and die allowance were evaluated to test their effectiveness. Finally, the relative impact of all the components of dimensional error in die castings was put into perspective, and general guidelines for effective dimensional control in the die casting plant were laid out. The results of

  7. Die transvaalse ontwerp-ordonnansie oor die onderwys

    Directory of Open Access Journals (Sweden)

    J. C. Coetzee


    Full Text Available In ’n Buitengewone Provinsiale Koerant van die Provinsie Transvaal is onder datum 25 Junie 1952 gepubliseer ’n „Ontwerp-Ordonnansie tot samevatting en wysiging van die Wette betreffende die Sentrale Beheer van die Onderwys, die Plaaslike Beheer van Skole, Godsdiensonderrig in Openbare Skole, Taal en die Onderwys, Onderwyspersoneel, Verpligte Onderwys, Toelating van Leerlinge tot Skole, Klasse of Inrigtings, Openbare Onderwys, Private Skole, Onderwys vir Kleurlinge en Asiate en Onderwys vir Naturelle, en om vir sake in verband daarmee voorsiening te maak” .


    African Journals Online (AJOL)

    v a k t a a l k w a l i £ i k a s i e s ) neem d i e I n s t i t u t t a l l e take waar ter u i t b r e i d i n g van kennis van die Duitse taal in die buiteland. Sedert 1964 publiseer die. Institut die tydskrif Deutsch als Fremdsprache met die bylae Sprachpraxis, asook 'n handboek met die titel Deutsch - eln Lehrbuch Eur Auslander (Duits.

  9. Diagnosis, Surgical Treatment, Recovery, and Eventual Necropsy of a Leopard (Panthera pardus with Thyroid Carcinoma

    Directory of Open Access Journals (Sweden)

    Ashley Malmlov


    Full Text Available An 18-year-old, male, castrated, captive-born leopard (Panthera pardus presented to Colorado State University’s Veterinary Teaching Hospital with a two-week history of regurgitation. Thoracic radiographs and ultrasound revealed a well-differentiated cranioventral mediastinal mass measuring 7.5 × 10 × 5.5 cm, impinging the esophagus. A sternotomy followed by mass excision was performed. The mass was diagnosed as an ectopic thyroid carcinoma. The leopard recovered from surgery with minimal complications and returned to near-normal activity levels for just under 6 months before rapidly declining. He had an acute onset of severe dyspnea and lethargy and was euthanized. On postmortem examination the tumor was found to involve the lung, liver, thyroid, parietal pleura, bronchial lymph nodes, and the internal intercostal muscles. This case report describes the history, diagnosis, surgical treatment, postoperative care, and recovery as well as the eventual decline, euthanasia, and necropsy of a leopard with thyroid carcinoma. When compared to thyroid carcinomas of domestic animals, the leopard’s disease process more closely resembles the disease process seen in domestic canines compared to domestic cats.

  10. K. Schmitt’s Theory of Partisan: Socio - Political Eventuality of Partisan

    Directory of Open Access Journals (Sweden)

    Mihail Petrovich Ostromenskij


    Full Text Available Eventual socio-political conditions of the appearance of a partisan are considered. It is shown that the appearance of the partisan becomes possible when the socio-political uncertainty in the state and social anomie in society caused serious set into question the legitimacy of the sovereign. In such circumstances, falling value of public institutions, the rule of law and the rules of the routine, but the role of the individual and adopt independent decisions, in each case, increases. And increasing the area of independent ad hoc decisions. Such conditions arise in the occupied territory, especially in a situation of the continuing war. Besides, here indigenous people without taking any illegal actions, from the point of view of both clashing sovereigns, it is struck in the rights. All this makes a real opportunity to show the political subjectivity of the citizen, even with low social status. The behavior of the occupied population can follow three models: expectations of the solution of the conflict between sovereigns and the subsequent acceptance of its results as due - absolute majority population, the active help to the occupying sovereign for the purpose of the statement new political - the collaborator, active opposition of the occupying authority for the purpose of return former political - the partisan.

  11. Navigating "Assisted Dying". (United States)

    Schipper, Harvey


    Carter is a bellwether decision, an adjudication on a narrow point of law whose implications are vast across society, and whose impact may not be realized for years. Coupled with Quebec's Act Respecting End-of-life Care it has sharply changed the legal landscape with respect to actively ending a person's life. "Medically assisted dying" will be permitted under circumstances, and through processes, which have yet to be operationally defined. This decision carries with it moral assumptions, which mean that it will be difficult to reach a unifying consensus. For some, the decision and Act reflect a modern acknowledgement of individual autonomy. For others, allowing such acts is morally unspeakable. Having opened the Pandora's Box, the question becomes one of navigating a tolerable societal path. I believe it is possible to achieve a workable solution based on the core principle that "medically assisted dying" should be a very rarely employed last option, subject to transparent ongoing review, specifically as to why it was deemed necessary. My analysis is based on 1. The societal conditions in which have fostered demand for "assisted dying", 2. Actions in other jurisdictions, 3. Carter and Quebec Bill 52, 4. Political considerations, 5. Current medical practice. Leading to a series of recommendations regarding. 1. Legislation and regulation, 2. The role of professional regulatory agencies, 3. Medical professions education and practice, 4. Public education, 5. Health care delivery and palliative care. Given the burden of public opinion, and the legal steps already taken, a process for assisted-dying is required. However, those legal and regulatory steps should only be considered a necessary and defensive first step in a two stage process. The larger goal, the second step, is to drive the improvement of care, and thus minimize assisted-dying.

  12. Die historiese betroubaarheid van die aartsvadervertellinge. 'n Beknopte bespreking van die huidige debat na aanleiding van die jongste publikasie

    Directory of Open Access Journals (Sweden)

    W. Vosloo


    Full Text Available Die afgelope twintig jaar was daar �n toenemende belangstelling in die aartsvadervertellinge in Genesis. Benewens die talle tydskrifartikels het skrywers soos die volgende ook boeke oor die onderwerp die lig laat sien: A. Parrot (1962, W. M. Clark (1964, R. Kilian (1966, R. E. Clements (1967, N. Lohfink (1967, H. Weidemann (1968, R. Martin-Achard (1969, T. L. Thompson (1974, J. van Seters (1975, J. P. Fokkelman (1975, C. Westermann (1976, R. Rendtorff (1977, J. Bright (1977, W. McKane (1979 en A. R. Millard en D. J. Wiseman (1980.

  13. 'n Kwalitatiewe ondersoek na die invloed van aspekte van die ...

    African Journals Online (AJOL)

    S Blignaut

    ISSN 0378-5254 Journal of Family Ecology and Consumer Sciences, Vol 26: No1, 1998. 15 ...... van byvoorbeeld die televisie en gedrukte media 'n invloed op die .... fashion promotion and advertising. New York. ... Consumer behaviour to-.

  14. The evolution, etiology and eventualities of the global health security regime. (United States)

    Hoffman, Steven J


    Attention to global health security governance is more important now than ever before. Scientists predict that a possible influenza pandemic could affect 1.5 billion people, cause up to 150 million deaths and leave US$3 trillion in economic damages. A public health emergency in one country is now only hours away from affecting many others. Using regime analysis from political science, the principles, norms, rules and decision-making procedures by which states govern health security are examined in the historical context of their punctuated evolution. This methodology illuminates the catalytic agents of change, distributional consequences and possible future orders that can help to better inform progress in this area. Four periods of global health security governance are identified. The first is characterized by unilateral quarantine regulations (1377-1851), the second by multiple sanitary conferences (1851-92), the third by several international sanitary conventions and international health organizations (1892-1946) and the fourth by the hegemonic leadership of the World Health Organization (1946-????). This final regime, like others before it, is challenged by globalization (e.g. limitations of the new International Health Regulations), changing diplomacy (e.g. proliferation of global health security organizations), new tools (e.g. global health law, human rights and health diplomacy) and shock-activated vulnerabilities (e.g. bioterrorism and avian/swine influenza). This understanding, in turn, allows us to appreciate the impact of this evolving regime on class, race and gender, as well as to consider four possible future configurations of power, including greater authority for the World Health Organization, a concert of powers, developing countries and civil society organizations. This regime analysis allows us to understand the evolution, etiology and eventualities of the global health security regime, which is essential for national and international health

  15. Modeling the Mechanical Performance of Die Casting Dies

    Energy Technology Data Exchange (ETDEWEB)

    R. Allen Miller


    The following report covers work performed at Ohio State on modeling the mechanical performance of dies. The focus of the project was development and particularly verification of finite element techniques used to model and predict displacements and stresses in die casting dies. The work entails a major case study performed with and industrial partner on a production die and laboratory experiments performed at Ohio State.


    African Journals Online (AJOL)


    vergewe. Dit sou in orde gewees het as daar gestaan het, ReMomë- j^onta^is hepta?ds. wat die grieks is vir sewentig maal sewe. Die uitdrukking. heMom&ontabis heptd sien hoogswaarskynlik op Gen. 4 : 24 (LXX) waar. Lameg meedeel dat hy sewe-en-sewentig-maal gewreek sal word. Daar sit die Afr. Vert, die uitdrukking ...

  17. Film Presentation: Die Urknallmaschine

    CERN Multimedia

    Carolyn Lee


    Die Urknallmaschine, an Austrian film by Gerd Baldauf, narrated by Norbert Frischauf (Alpha Österreich - ORF, 2009).  In CERN’s gigantic complex particles are accelerated to almost the speed of light, brought to collision and made to divide into even smaller particles. Public opinion of CERN’s research is also divided. Sceptics fear that black holes may be created. Might the goal to study the origin of the world lead to its destruction? The Austrian researcher Norbert Frischauf worked at CERN for many years. With his guidance it is possible to explore the world’s largest research centre, get a glimpse of the fascinating work the scientists do there and take a crash course in particle physics. Die Urknallmaschine will be presented on Friday, 25 June from 13:00 to 14:00 in the Main Auditorium. Language: German

  18. Dying for security

    Directory of Open Access Journals (Sweden)

    Buchan, Bruce


    Full Text Available If political statements and media coverage are any guide, it seems Australians today are dying for security. At no other moment in our history has the spectre of war and terrorism so haunted popular, political and scholarly perceptions of Australia’s colonial past and of its geopolitical future. And yet, debates over colonial war or genocide and contemporary terrorism have been conducted in more or less complete isolation. In this article I argue that our contemporary obsession with ‘security’ is premised on the perennial threat of ‘insecurity’. This is the problem of in/security, and it has played a central role in the development of Western political thought. More importantly, its formulation in Western political thought provided a powerful justification for the violence of the early decades of Australia’s colonisation during which Indigenous Australians could also be said to have been dying for security.

  19. Dying for Security

    Directory of Open Access Journals (Sweden)

    Bruce Buchan


    Full Text Available If political statements and media coverage are any guide, it seems Australians today are dying for security. At no other moment in our history has the spectre of war and terrorism so haunted popular, political and scholarly perceptions of Australia’s colonial past and of its geopolitical future. And yet, debates over colonial war or genocide and contemporary terrorism have been conducted in more or less complete isolation. In this article I argue that our contemporary obsession with ‘security’ is premised on the perennial threat of ‘insecurity’. This is the problem of in/security, and it has played a central role in the development of Western political thought. More importantly, its formulation in Western political thought provided a powerful justification for the violence of the early decades of Australia’s colonisation during which Indigenous Australians could also be said to have been dying for security.


    African Journals Online (AJOL)


    aangetoon het, 'n huis in Kapernaum gehad en hierdie geskiedenis speel in Kapernaum of daar digby af. Jesus en sy dissipele het namelik, volgens 6:35 geland by Gennesaret, net suid van Kapernaum Die gevolgtrekking word ondersteun deur Joh. 6:17 waarvolgens die dissi pele na die spysiging op Kapernaum gevaar ...

  1. 'n Verkenning van die soorte vennootskappe in die Amerikaanse reg ...

    African Journals Online (AJOL)

    In die Amerikaanse literatuur word talle verwysings gevind na die vennootskap in mynbou ("mining partnership"), familievennootskap ("family partnership", vennootskap in vaste eiendom ("partnership in real estate") en vennootskap vir boerdery ("farming partnership"). Hierdie onderskeiding is primer gebaseer op die tipe ...

  2. Geslagsverskille in die ouditiewe ontlokte potensiaal van die brein

    Directory of Open Access Journals (Sweden)

    Anita D Stuart


    Full Text Available Gender differences in the auditory evoked potential of the brain. Based on literature indications of an association between temperament characteristics and the evoked potential of the brain, and indications of gender differences in certain temperament traits, the purpose of this study was to ascertain whether evoked responses also differentiated between the genders. A sample of 81 male and 210 female students was randomly selected. Two auditory evoked potential procedures were applied. The results indicated statistically significant differences in evoked potential responses between the genders. The results are interpreted against the background of sensory and neurological sources of the evoked potential responses and linked to the neurophysiological foundations of temperament. Opsomming: Gegrond op aanduidings in die literatuur van ’n assosiasie tussen temperamentskenmerke en die ontlokte potensiaal van die brein, sowel as aanduidings van geslagsverskille in sekere temperamentstrekke, was die doel van die huidige studie om te bepaal of ontloktepotensiaal-response ook tussen die geslagte onderskei. ’n Steekproef van 81 manlike en 210 vroulike studente is ewekansig geselekteer. Twee ouditiewe ontloktepotensiaal- prosedures is toegepas. Die resultate het op statisties beduidende verskille tussen die geslagte gedui. Die bevindinge word teen die agtergrond van die sensoriese en neurologiese oorsprong van ontloktepotensiaal–response geïnterpreteer en verbind aan die neurofisiologiese verankering van temperament.

  3. Die 'postmoderne' stempel in die Nuwe-Testamentiese hermeneutiek

    African Journals Online (AJOL)

    georiënteerde teorie en kritiek wat volgens Moore opbou tot 'n herhaling binne. Bybelnavorsing. Dit het reeds by Immanuel Kant begin. Sedert Kant is dit proble- maties cm die objek van kennis te beskou as iets wat kennis objektief in sigself bevat. Objektiwisme is prys gegee. Dialektiek het in die plek daarvan gekom. Die.

  4. duele verse sowel as die somtotaal die leser

    African Journals Online (AJOL)

    27 Jan 2006 ... selfs 'n landkaart afgedruk) terwyl dit ter- selfdertyd ver bo die lokale uitstyg. Die digter is sterk bewus van sy omgewing, geskiedenis en tradisies, maar veral van die algemene menslike kondisie wat binne hierdie referensiekader vergestalt word. Hy gebruik 'n bekende historiese slagveld as bundeltitel (en ...

  5. Die Leben Einsteins eine Reise durch die Geschichte der Physik

    CERN Document Server



    Jeder kennt die Namen Einstein, Newton oder Galilei. aber was weiss man über sie? Hier ein Porträt Einsteins anhand von sechs Meilensteinen aus der Geschichte der Physik. Einstein tritt auf als Protagonist in verschiedenen Epochen und bei verschiedenen Entdeckungen, die die Welt verändert haben.


    African Journals Online (AJOL)


    Die offerfees te Gibeon was 'n plegtigheid, waaraan geheel Israel deelgeneem het. Die duisend. "brandoffers" wat sowel Kon. as Kron. vermeld, sal wel opgevat moet word as „brandoffers en dankoffers", sodat daar vir die aanwesiges. *n groot feesmaaltyd aangerig is, vgl. I Kon. 3:15. n Sodanige maal- tyd verbind vors en ...

  7. Ruimtelike beplanning: die rol van die stads - en streeksbeplanner ...

    African Journals Online (AJOL)

    Ruimtelike beplanning: die rol van die stads - en streeksbeplanner in die saw. R Erasmus. Abstract. Since 1978 regional and town planners are employed in the SADF on a permanent basis as well as in the capacity of national service men. These men are all academically qualified and as such satisfy a need that developed ...

  8. n opinie oor die behaviouristiese siening versus die fenomenologie ...

    African Journals Online (AJOL)

    verband die eksperimente van Pavlov, Thorndike,. Skinner, Tolmann en Hull.) Fenomenologie. Die fenomenologie is 'n essensie-openbarende denkrigting. Dit impliseer'n denkende soektog na dit wat 'n besondere verskynsel of werklikheid maak juis dit wat dit is en nie iets anders nie. In die fenomenologiese antropologie ...

  9. Die invloed van die Tweede Vryheidsoorlog (1899-1902 op die Teologiese Skool Burgersdorp

    Directory of Open Access Journals (Sweden)

    P. Krüger


    Full Text Available The influence of the Second War of Independence (1899-1902 on the Theological Seminary of Burgersdorp In this article the reasons for the War are pinpointed as England’s imperialism and the underlying motif of getting hold of the riches and gold of the ZAR. At the outbreak of the War the students and lecturers of the Burgersdorp Theological Seminary, as most Boers in the Cape Colony, had to make a decisive choice: loyalty to the Government of the Cape Colony or to their fellow kinsmen in the North (and thus siding with the latter. Varying facets of the war-torn situation are touched upon in this article: the lecturers were for example accused of treason but acquitted. The outcome of the 30 students’ situation, however, differed. Those students origally from the northern Republics returned home to join their commandos. Some of these students were taken prisoners of war. Most of the Cape students showed their solidarity with their northern compatriots by joining the Ambulance Corps. Three students and two former students eventually died (one was the son of Prof. Lion Cachet. In honour of these students a monument was erected in 1906. Only one student and three former students were rebels, as far as is presently known. At a later stage three students were able to continue their studies in the Netherlands. Two of these, J.D. du Toit and F. Postma, later returned to South Africa and committed their lives to the Theological Seminary at Potchefstroom and the Potchefstroom University for CHE.

  10. Die onderrigtaak van die verpleegpraktisyn in die saalsituasie

    Directory of Open Access Journals (Sweden)

    M.E.C. Potgieter


    Full Text Available The ward sister, being the senior nurse practitioner on the ward, has an important teaching task. This teaching, although mainly directed towards the student nurse, also includes all categories of workers in the ward as well as the patient and his family. Teaching on the ward mainly takes place on an informal basis, but some methods of formal teaching can be used with excellent results.

  11. Lifetime risk of developing impaired glucose metabolism and eventual progression from prediabetes to type 2 diabetes: a prospective cohort study. (United States)

    Ligthart, Symen; van Herpt, Thijs T W; Leening, Maarten J G; Kavousi, Maryam; Hofman, Albert; Stricker, Bruno H C; van Hoek, Mandy; Sijbrands, Eric J G; Franco, Oscar H; Dehghan, Abbas


    Data are scarce for the lifetime risk of developing impaired glucose metabolism, including prediabetes, as are data for the risk of eventual progression from prediabetes to diabetes and for initiation of insulin treatment in previously untreated patients with diabetes. We aimed to calculate the lifetime risk of the full range of glucose impairments, from normoglycaemia to prediabetes, type 2 diabetes, and eventual insulin use. In this prospective population-based cohort analysis, we used data from the population-based Rotterdam Study. We identified diagnostic events by use of general practitioners' records, hospital discharge letters, pharmacy dispensing data, and serum fasting glucose measurements taken at the study centre (Rotterdam, Netherlands) visits. Normoglycaemia, prediabetes, and diabetes were defined on the basis of WHO criteria for fasting glucose (normoglycaemia: ≤6·0 mmol/L; prediabetes: >6·0 mmol/L and prediabetes to overt diabetes and from diabetes free of insulin treatment to insulin use. Additionally, we calculated years lived with healthy glucose metabolism. We used data from 10 050 participants from the Rotterdam Study. During a follow-up of up to 14·7 years (between April 1, 1997, and Jan 1, 2012), 1148 participants developed prediabetes, 828 developed diabetes, and 237 started insulin treatment. At age 45 years, the remaining lifetime risk was 48·7% (95% CI 46·2-51·3) for prediabetes, 31·3% (29·3-33·3) for diabetes, and 9·1% (7·8-10·3) for insulin use. In individuals aged 45 years, the lifetime risk to progress from prediabetes to diabetes was 74·0% (95% CI 67·6-80·5), and 49·1% (38·2-60·0) of the individuals with overt diabetes at this age started insulin treatment. The lifetime risks attenuated with advancing age, but increased with increasing BMI and waist circumference. On average, individuals with severe obesity lived 10 fewer years without glucose impairment compared with normal-weight individuals. Impaired glucose

  12. The Comfort Measures Order Set at a Tertiary Care Academic Hospital: Is There a Comparable Difference in End-of-Life Care Between Patients Dying in Acute Care When CMOS Is Utilized? (United States)

    Lau, Christine; Stilos, Kalli; Nowell, Allyson; Lau, Fanchea; Moore, Jennifer; Wynnychuk, Lesia


    Standardized protocols have been previously shown to be helpful in managing end-of-life (EOL) care in hospital. The comfort measures order set (CMOS), a standardized framework for assessing imminently dying patients' symptoms and needs, was implemented at a tertiary academic hospital. We assessed whether there were comparable differences in the care of a dying patient when the CMOS was utilized and when it was not. A retrospective chart review was completed on patients admitted under oncology and general internal medicine, who were referred to the inpatient palliative care team for "EOL care" between February 2015 and March 2016. Of 83 patients, 56 (67%) received intiation of the CMOS and 27 (33%) did not for EOL care. There was significant involvement of spiritual care with the CMOS (66%), as compared to the group without CMOS (19%), P care, which was significantly less than the number of symptom management adjustments per patient when CMOS was not used (3.3), P care and assessment across the organization is still required.

  13. Die Vier Typen von Projektmanagern

    DEFF Research Database (Denmark)

    Lund Pedersen, Carsten; Ritter, Thomas


    Bevor Sie einem Mitarbeiter die Leitung eines Projekts anvertrauen, sollten Sie sich über dessen Managementstil klar werden. Passt dieser nicht zur Art des Vorhabens, wird er scheitern. So treffen Sie die richtige Wahl....

  14. Die historiese Jesus as wondenverker

    African Journals Online (AJOL)

    Biblical Association, te wete 'The social sciences and second Testament exegesis'. John Pilch is die leier van die Society of Biblical Literature se 'Social sciences and ..... Hollenbach, P 1982. ... Stauffer, E 1982. Jesus ... London: Collins.

  15. Precision die design by the die expansion method

    CERN Document Server

    Ibhadode, A O Akii


    This book presents a new method for the design of the precision dies used in cold-forging, extrusion and drawing processes. The method is based upon die expansion, and attempts to provide a clear-cut theoretical basis for the selection of critical die dimensions for this group of precision dies when the tolerance on product diameter (or thickness) is specified. It also presents a procedure for selecting the minimum-production-cost die from among a set of design alternatives. The mathematical content of the book is relatively simple and will present no difficulty to those who have taken basic c

  16. Die Dokter-Pasient Rolverwantskap

    African Journals Online (AJOL)

    17 Aug 1974 ... en as sodanig 'n ral sped in die persoon se siektegedrag en uiteindelike patroon van hulpsoeke. SIEKEROL EN SOSIALISERING IN DIE. PASIENTROL ..... more cumulative, resulting in a more gradual social and professional maturation.' Vit die voorafgaande word dit duidelik dat Dewy se pragmatiese ...

  17. prosesseringsmetodes op die voedingswaarde van

    African Journals Online (AJOL)

    gebring is, kon geen betekenisvolle verskille tussen die drie monsters gevind word nie. Volgens Opstvedt (1976) kan ME waardes ook dien as 'n kriteria van proteien- kwaliteit, hoofsaaklik a.g.v. die verhoogde stikstofuit- skeiding in die urine wat sal plaasvind a.g.v. beskadiging van aminosure. De Groote (1968) het gevind ...


    African Journals Online (AJOL)

    wei die verdediging van die landsgrense teen 'n vyand wat die orde, gesag, vrede, stabiliteit en welvaart in Suidwes-Afrika en die Republiek van. Suid-Afrika wil vernietig. Hierdie oorlog moet nie ge'lsoleerd gesien word nie, maar in perspektief geplaas word teen die agtergrond van 'n nag groter konflik, naamlik die van die ...

  19. Die Subjektiewe en Objektiewe doelwitte van Arbeid

    Directory of Open Access Journals (Sweden)

    T. H. Veldsman


    Die artikel gee aandag aan die subjektiewe en objektiewe doelwitte van arbeid. Hul plek en funksie binne 'n voorgestelde geïntegreerde motiveringsmodel word eerstens aangedui. Vervolgens word die verwantskap tussen die twee doelwitte uitgelig, gevolg deur 'n bespreking van die aard van die objektiewe doel. Laastens word die invloed van moderne arbeid op hierdie doelwitte uitgestippel.


    African Journals Online (AJOL)


    Kierkegaard en Nietzsche, Max Weber en Dilthey, om maar enkeles te noem, en 5.) Jaspers se persoonlike beskouing oor die roe ping en die taak van die Filosofie, sy aanvoeling van die filosofiese problematiek en sy grondhouding teenoor die eksistensiële verbonden- hede. Die woord van Fichte, naamlik dat die Filosofie ...

  1. Quasi-experimental evaluation of a multifaceted intervention to improve quality of end-of-life care and quality of dying for patients with advanced dementia in long-term care institutions. (United States)

    Verreault, René; Arcand, Marcel; Misson, Lucie; Durand, Pierre J; Kroger, Edeltraut; Aubin, Michèle; Savoie, Maryse; Hadjistavropoulos, Thomas; Kaasalainen, Sharon; Bédard, Annick; Grégoire, Annie; Carmichael, Pierre-Hughes


    Improvement in the quality of end-of-life care for advanced dementia is increasingly recognized as a priority in palliative care. To evaluate the impact of a multidimensional intervention to improve quality of care and quality of dying in advanced dementia in long-term care facilities. Quasi-experimental study with the intervention taking place in two long-term care facilities versus usual care in two others over a 1-year period. The intervention had five components: (1) training program to physicians and nursing staff, (2) clinical monitoring of pain using an observational pain scale, (3) implementation of a regular mouth care routine, (4) early and systematic communication with families about end-of-life care issues with provision of an information booklet, and (5) involvement of a nurse facilitator to implement and monitor the intervention. Quality of care was assessed with the Family Perception of Care Scale. The Symptom Management for End-of-Life Care in Dementia and the Comfort Assessment in Dying scales were used to assess the quality of dying. A total of 193 residents with advanced dementia and their close family members were included (97 in the intervention group and 96 in the usual care group). The Family Perception of Care score was significantly higher in the intervention group than in the usual care group (157.3 vs 149.1; p = 0.04). The Comfort Assessment and Symptom Management scores were also significantly higher in the intervention group. Our multidimensional intervention in long-term care facilities for patients with terminal dementia resulted in improved quality of care and quality of dying when compared to usual care.

  2. Dying with dignity. (United States)

    Madan, T N


    Death is a theme of central importance in all cultures, but the manner in which it is interpreted varies from society to society. Even so, traditional cultures, including Christian, Hindu and Jain religious traditions, exhibited a positive attitude to death and did not look upon it in a dualistic framework of good vs bad, or desirable vs undesirable. Nor was pessimism the dominant mood in their thinking about death itself. A fundamental paradigm shift occurred in the West in the eighteenth century when death was desacralized and transformed into a secular event amenable to human manipulation. From those early beginnings, dying and death have been thoroughly medicalized and brought under the purview of high technology in the twentieth century. Once death is seen as a problem for professional management, the hospital displaces the home, and specialists with different kinds and degrees of expertise take over from the family. Everyday speech and the religious idiom yield place to medical jargon. The subject (an ageing, sick or dying person) becomes the object of this make-believe yet real world. As the object of others' professional control, he or she loses the freedom of self-assessment, expression and choice. Or, he or she may be expected to choose when no longer able to do so. Thus, not only freedom but dignity also is lost, and lawyers join doctors in crisis manipulation and perpetuation. Although the modern medical culture has originated in the West, it has gradually spread to all parts of the world, subjugating other kinds of medical knowledge and other attitudes to dying and death.(ABSTRACT TRUNCATED AT 250 WORDS)

  3. Sal die ‘ewolusie’ vanaf biologie na lewenswetenskappe ‘uitsterwing’ van die vakgebied voorkom?

    Directory of Open Access Journals (Sweden)

    Johanna G. Ferreira


    Full Text Available In hierdie artikel word die wysiging van die skoolvak van ‘biologie’ na ‘lewenswetenskappe’ bespreek, asook die gepaardgaande en verwagte implikasies van die verandering. Die vraag word gestel of die beoogde wysiging wel noemenswaardig is en of dit enigsins ‘n verskil aan die dalende belangstelling in die lewenswetenskappe op tersiêre vlak sal maak. Die wysigings in die nuwe kurrikula verhoog die relevansie van die vakinhoud vir leerders en vir die gemeenskap, maar sekere kwessies kry nie aandag nie. Voorstelle word gemaak om die kurrikulum te wysig en onderrigmetodes aan te pas om die nodige vaardighede by leerders te vestig.

  4. enkele fasette van die problematiek van die akademikus by die skryf

    African Journals Online (AJOL)

    Om verskeie redes het dit van die allergrootste belong geword dot 'n his- tories korrekte, wetenskaplike weerga- we van bogenoemde gebeure opge- teken moet word. Die sluier, in sommige gevalle am logiese redes toegepas, moes eenvoudig gelig word am gebeure wat die gewone man op stroot in Suid-Afrika dikwels ...

  5. Die Defects and Die Corrections in Metal Extrusion

    Directory of Open Access Journals (Sweden)

    Sayyad Zahid Qamar


    Full Text Available Extrusion is a very popular and multi-faceted manufacturing process. A large number of products for the automotive, aerospace, and construction sectors are produced through aluminum extrusion. Many defects in the extruded products occur because of the conditions of the dies and tooling. The problems in dies can be due to material issues, design and manufacturing, or severe usage. They can be avoided by maintaining the billet quality, by controlling the extrusion process parameters, and through routine maintenance. Die problems that occur on a day-to-day basis are mostly repairable and are rectified through various types of die correction operations. These defects and repair operations have not been reported in detail in the published literature. The current paper presents an in-depth description of repairable die defects and related die correction operations in metal extrusion. All major die defects are defined and classified, and their causes, preventive measures, and die correction operations are described. A brief frequency-based statistical study of die defects is also carried out to identify the most frequent die corrections. This work can be of direct benefit to plant engineers and operators and to researchers and academics in the field of metal extrusion.

  6. Die hermeneutiek van gereformeerde kerkreg

    Directory of Open Access Journals (Sweden)

    Andries le Roux du Plooy


    Full Text Available Die artikel het op die belangrikheid en noodsaaklikheid van ‘n hermeneutiek vir die gereformeerde kerkreg gefokus. Die kerkregtelike dokument wat besonderlik ter sake was, is die kerkorde van die Gereformeerde kerke in Suid-Afrika, met sy besondere band met die Dordtse kerkorde van 1618 en 1619. Agtereenvolgens is aandag gegee aan die volgende aspekte soos (1 die eiesoortige aard van ‘n kerkorde as ‘n teologiese dokument en teks, in onderskeiding van regsdokumente; (2 die aard van die hermeneutiek van kerkreg; (3 enkele teorieë oor die interpretasie of uitleg van tekste, veral regstekste en (4 normatiewe vooronderstellings en reëls vir die interpretasie en verstaan van die teks en artikels van die kerkorde asook besluite van kerklike vergaderinge. Die gevolgtrekking was dat weinig indringende navorsing gedoen is oor die saak van hermeneutiek vir kerkreg, hoewel dit noodsaaklik is. Duidelike hermeneutiese reëls is gesuggereer en verduidelik, wat sou kon meehelp dat kerke en kerklike vergaderinge die artikels van die kerkorde asook besluite en reglemente wat daarop berus het, kan interpreteer en toepas. The hermeneutics of reformed church polity. The article focused on the importance and urgency of a design for reformed hermeneutics on church polity. The Church Order referred to in the article is the Church Order of the Reformed Churches in South Africa, which are closely related to the Church Order of Dordt of 1618 and 1619. The following aspects received attention namely (1  the unique character of a Church Order, in comparison to and distinguished from legal documents and statutes; (2 the character and nature of hermeneutics of church polity; (3 theories of interpretation in the common law tradition and their relevance to church polity and (4 normative presuppositions and marks for the interpretation and understanding of the text and articles of the Church Order, as well as the resolutions of church assemblies. It was found that

  7. Die verband tussen lokus van beheer en die werks prestasie van swart bemarkers in die lewensversekeringsbedryf

    Directory of Open Access Journals (Sweden)

    E. L. Coetzer


    Full Text Available The relationship between locus of control and the work performance of black marketers in the life assurance industry. The aim of the study was to establish the relationship between locus of control and the work performance of black marketers in the life assurance industry. These constructs were selected by virtue of the lack of empirical research regarding the assumed relationship between them. The Locus of Control Scale of Schepers (1995 was used for measuring locus of control. Work performance was measured by the commission earned per month by the marketer, the number of policies generated by the marketer, as well as the percentage of lapsed policies. The relevant measurements were obtained in respect of a sample of 149 black marketing personnel. The results indicated a modest but statistically significant relationship between external locus of control and the work performance of black marketers. Opsomming Die doel van die studie was om die verband tussen lokus van beheer en die werksprestasie van swart bemarkers in die lewensversekeringsbedryf te bepaal. Hierdie konstrukte is gekies op grond van die gebrek aan empiriese navorsing rakende die veronderstelde verband tussen genoemde konstrukte. Die Lokus van Beheer-vraelys van Schepers (1995 is in die meting van lokus van beheer gebruik. Werksprestasie is aan die hand van kommissie per maand verdien, aantal polisse gegenereer deur 'n bemarker en die persentasie vervalde polisse, gemeet. Die tersaaklike metinge is verkry ten opsigte van 'n steekproef van 149 swart bemarkers. Die resultate toon 'n klein, dog statisties beduidende verband tussen eksterne lokus van beheer en die werksprestasie van swart bemarkers in die lewensversekeringsbedryf.

  8. Is die ortodoksie se verstaan van die sondeval belemmerend vir die gesprek tussen teologie en natuurwetenskap?

    Directory of Open Access Journals (Sweden)

    Johan Buitendag


    Full Text Available In hierdie artikel is betoog dat die Gereformeerde Ortodoksie se begrip van die sondeval ’n  belemmering  was  vir  die  gesprek  tussen  teologie  en  natuurwetenskap.  Die  rede hiervoor was dat dit ten eerste ’n bepaalde verstaan van liniêre tyd nahou en ten tweede dat dit ’n bonatuurlike ingryp veronderstel het. Albei hierdie aspekte het die debat onnodig problematiseer. Die argument is ontwikkel deur eerstens die probleem te definieer, gevolg deur ’n uiteensetting van die standpunte van Augustinus en Calvyn onderskeidelik oor die sondeval. As ’n heuristiese sleutel is die konsepte van infralapsarisme en supralapsarisme aangewend om die tema te ontleed. Die artikel is afgesluit met die oortuiging dat die imago Dei ’n beliggaamde menslike persoon is wat biologies in die geskiedenis in terme van selfbewussyn en morele verantwoordelikheid ontluik het. Is the Orthodoxy’s notion of the Fall inhibitory for the dialogue between theology and science? In this article it was argued that the Reformed Orthodoxy’s interpretation of the Fall had become an impediment in the dialogue between theology and science. The reason was that it assumed firstly a specific understanding of linear time and secondly a metaphysical intervention. Both events were unnecessarily problematising the debate. The argument was deployed by stating the problem, followed by an exposition of the views of Augustine and Calvin on the Fall. As a heuristic key, the concepts of infralapsarism and supralapsarism were applied respectively to analyse the topic. The article concluded with the conviction that the imago Dei is an embodied human person that had biologically emerged in history as a center of self-awareness, and moral responsibility.

  9. Clinical medical education in rural and underserved areas and eventual practice outcomes: A systematic review and meta-analysis. (United States)

    Raymond Guilbault, Ryan William; Vinson, Joseph Alexander


    Undergraduate medical students are enrolled in clinical education programs in rural and underserved urban areas to increase the likelihood that they will eventually practice in those areas and train in a primary care specialty to best serve those patient populations. MEDLINE and Cochrane Library online databases were searched to identify articles that provide a detailed description of the exposure and outcome of interest. A qualitative review of articles reporting outcome data without comparison or control groups was completed using the Medical Education Research Study Quality Instrument (MERSQI). A meta-analysis of articles reporting outcome data with comparison or control groups was completed with statistical and graphical summary estimates. Seven hundred and nine articles were retrieved from the initial search and reviewed based on inclusion and exclusion criteria. Of those, ten articles were identified for qualitative analysis and five articles included control groups and thus were included in the quantitative analysis. Results indicated that medical students with clinical training in underserved areas are almost three times as likely to practice in underserved areas than students who do not train in those areas (relative risk [RR] = 2.94; 95% confidence interval [CI]: 2.17, 4.00). Furthermore, medical students training in underserved areas are about four times as likely to practice primary care in underserved areas than students who do not train in those locations (RR = 4.35; 95% CI: 1.56, 12.10). These estimates may help guide medical school administrators and policymakers to expand underserved clinical training programs to help relieve some of the problems associated with access to medical care among underserved populations.

  10. Sedimentêre omgewings van die Inhaca-eilandstelsel met spesiale verwysing na die petrografiese en geochemiese eienskappe van die sedimente spesiale verwysing na die petrografiese en geochemiese eienskappe van die sedimente

    Directory of Open Access Journals (Sweden)

    Marieke Peché


    Full Text Available Die Inhaca-eilandstelsel is geleë langs die suidooskus van Mosambiek. Die oostekant van die stelsel grens aan die Indiese Oseaan en die westekant aan die Baai van Maputo. Hierdie eilandstelsel bestaan uit Inhaca- en Portugese eiland, asook ’n groep sandbanke wat van die noordlike punt van Inhaca na Portugese eiland strek. Die doel van hierdie studie is om die verskillende moderne en oer-sedimentêre omgewings op die eilandstelsel te identifiseer en te beskryf, die invloed van getye en golfaksie op die moderne sedimentêre omgewing vas te stel en die geochemiese en petrografiese samestelling van die geologiese eenhede te bepaal.

  11. [Right to die with dignity?]. (United States)

    Ruiz, Alvaro


    The right to die with dignity is an ill-defined concept, with multiple, often inappropriate, interpretations. The current proposition is that the physician take full responsibility for protecting the patients rights, for ensuring a rational use of resources and for overseeing the decision-making process such that the information is adequate and the steps proportioned. This responsibility extends not only to the health status of the patient situation, to the patients prognosis, and to his/her expectations and wishes, but also to the benefits foreseen and to the cost-benefit ratio. Emphasis is placed on two aspects of this relationship. First, dignity can be interpreted in many ways and sometimes, in the name of dignity, the patient is exposed (or exposes him/herself) to suffering, pain and complications that can be avoided. Second, when no reasonable probability of survival is present and a better quality of life is impossible, efforts are better redirected to offering a better quality of death.

  12. Die vangnet van die woord: forensies-linguistiese getuienis in 'n ...

    African Journals Online (AJOL)

    Een van die redes daarvoor is waarskynlik die gepaardgaande sleurwerk verbonde aan die verwerking van die betrokke taaldata — iets wat egter deur die onlangse meteoriese vooruitgang in tegnologiese tegnieke op die agtergrond geskuif is en nuwe moontlikhede na vore laat kom het. In die lig van die kompleksiteit van ...

  13. het om die Woord van God aan die gemeente te bedien. A. D. P ont ...

    African Journals Online (AJOL)


    Sizoo vertel met die vlotheid van die ervare skrywer en die ver antwoordelikheid van die wetenskaplike ... Maar in stiptelike trou aan die feitelikheid, verlaat die skrywer hom uitsluitlik op die outentieke bronne om ... de leser; in sy rykdom van gegewens en wetenskaplike betroubaarheid kan dit met vrug gelees word deur die ...

  14. Die invloed van herbivorie en vuur op die oorlewing van sekere meerjarige kruide langs die Sabierivier, Kruger Nasionale Park

    Directory of Open Access Journals (Sweden)

    H. Myburgh


    Full Text Available Die groot vloede wat in die jaar 2000 in die Kruger Nasionale Park plaasgevind het, het dierivieroewerplantegroei versteur. Dit het die geleentheid gebied om heinings op te rig langsdie Sabierivier om herbivore uit sekere gebiede uit te sluit en sodoende die herstel van die rivieroewerekosisteme te monitor.

  15. Die heelal en sy onstaan (II

    Directory of Open Access Journals (Sweden)

    D. J. Van Rooy


    Full Text Available Ons kennis en wetenskap van die hemelliggame word volkome bepaal deur die lig wat ons van hulle ontvang, d.w.s. as ons die feite wat die Bybel daaromtrent meedeel, buite rekening laat.

  16. Versoening tussen leerders: Is parallelmediumskole die antwoord op die rassismeprobleem?


    Du Plessis, Elize; Marais, Petro


    Die Suid-Afrikaanse Grondwet stel dit duidelik dat enige vorm van diskriminasie nie toegelaat mag word nie. In ons skole beteken dit dat elke leerder ʼn reg het op goeie opvoeding en ʼn veilige skoolomgewing. Die fokus van hierdie navorsing is gerig op bestaande parallelmediumskole. Die uiteindelike vraagstuk is dus hoe multikulturele onderwys bevorder word en hoe rassisme aangespreek kan word? As teoretiese raamwerk is Kohlsberg se kognitiewe ontwikkelingsbenadering en Whitehouse se univerele ...

  17. Die ontmaskering van die bose: Eksegetiese perspektiewe op ...

    African Journals Online (AJOL)


    2 Yarbro Collins (1983) bied tans nog die beste agtergrond vir 'n besinning oor geweld in ..... John's grammatical howlers are intentionally designed to alert listerners ..... 26 In die Nuwe Testament word Paul se snydende opmerking teenoor die Korintiërs as ..... rnt g0r`m nh8 ldfhrs`}m du sg}u fg}u + n2sh d/m sg>}} e`ql`jdh.

  18. Accurate defect die placement and nuisance defect reduction for reticle die-to-die inspections (United States)

    Wen, Vincent; Huang, L. R.; Lin, C. J.; Tseng, Y. N.; Huang, W. H.; Tuo, Laurent C.; Wylie, Mark; Chen, Ellison; Wang, Elvik; Glasser, Joshua; Kelkar, Amrish; Wu, David


    Die-to-die reticle inspections are among the simplest and most sensitive reticle inspections because of the use of an identical-design neighboring-die for the reference image. However, this inspection mode can have two key disadvantages: (1) The location of the defect is indeterminate because it is unclear to the inspector whether the test or reference image is defective; and (2) nuisance and false defects from mask manufacturing noise and tool optical variation can limit the usable sensitivity. The use of a new sequencing approach for a die-to-die inspection can resolve these issues without any additional scan time, without sacrifice in sensitivity requirement, and with a manageable increase in computation load. In this paper we explore another approach for die-to-die inspections using a new method of defect processing and sequencing. Utilizing die-to-die double arbitration during defect detection has been proven through extensive testing to generate accurate placement of the defect in the correct die to ensure efficient defect disposition at the AIMS step. The use of this method maintained the required inspection sensitivity for mask quality as verified with programmed-defectmask qualification and then further validated with production masks comparing the current inspection approach to the new method. Furthermore, this approach can significantly reduce the total number of defects that need to be reviewed by essentially eliminating the nuisance and false defects that can result from a die-to-die inspection. This "double-win" will significantly reduce the effort in classifying a die-to-die inspection result and will lead to improved cycle times.

  19. Die pastorale sielkundige as diakonale pastor

    Directory of Open Access Journals (Sweden)

    A. J. Smuts


    Full Text Available In die bedieningspatroon van die Ned. Geref. Kerk het die pastorale sielkundige die afgelope aantal jare steeds meer op die voorgrond begin tree. Hy is egter 'n problematiese figuur, wie se identiteit van meer as een kant onder bespreking is. In ander lande, selfs in die VSA waar die kerk veel gebruik maak van die sielkunde, is dit moeilik om 'n presiese parallel vir hom te vind. Sowel binne as buite die kerk word hy deur sommige bevraagteken. Daarom is dit noodsaaklik om vanuit die teologie te kyk na die werk wat hy doen.

  20. Digilanid C by die behandeling van hartlyers

    NARCIS (Netherlands)

    Snyman, Hendrik Willem


    In die voorafgaande word 'n literatuur studie oor die ontwikkeling en huidige stand van die chemie en farmakologie van die Digitalis purpurea en Digitalis lanata gegee, waarin spesiaal gelet word op die chemiese samestelling en farmakologiese aktiwiteit van die Digitalis lanata glikoside. Daarna


    African Journals Online (AJOL)

    In 1933 belas Rykskanselier. Hitler vir. Goering, Minister van Lugvaart, in die geheim met die skepping van die Luftwaffe. Die basis in Rusland is gesluit en toekomstige vlieeniers is nou in die geheim na Italie waar hulle elke aspek van moderne oorlog- voering oefen en die Blitzkrieg-gedagte, deur op ondersteuning van 'n.


    African Journals Online (AJOL)

    rang. In Assiries beteken die woord “hoof-eunug”. Soos reeds vermeld (by 2), vorm die eunug 'n belangrike deel van die Assiriese burokrasie. Dokumente dui aan ... rang in die Babiloniese weermag, en so 'n amptenaar het saam met die rabsag ..... baie laat, in die inter-testamentêre periode, gebruik is vir 'n gekastreerde.

  3. Understanding the Problems of Death and Dying: A Health Professionals' Attitude Survey. (United States)

    Green, Joseph S.; And Others


    Attitudes of health practitioners and others toward death and dying and their emotional reactions to dying patients were surveyed both before and after a Veterans Administration workshop. Some attitude changes were noted, with implications for future workshops. (MF)

  4. Die Transition zur pflegenden Tochter

    Directory of Open Access Journals (Sweden)

    Dagmar Dräger


    Full Text Available Das Buch aus der Reihe „Studien zur Gesundheits- und Pflegewissenschaft“ beschreibt den theoretischen Hintergrund, das methodische Vorgehen und die Ergebnisse einer biografischen Untersuchung, die sich dem Übergang von der Tochter zur pflegenden Tochter widmete. Grundlage der Publikation ist die Dissertation (2002 der Autorin. Mit der Berücksichtigung biographischer und familiärer Hintergründe wird eine neue Perspektive in der Forschung zu pflegenden Angehörigen eingenommen.

  5. Maintaining Low Voiding Solder Die Attach for Power Die While Minimizing Die Tilt

    Energy Technology Data Exchange (ETDEWEB)

    Hamm, Randy; Peterson, Kenneth A.


    This paper addresses work to minimize voiding and die tilt in solder attachment of a large power die, measuring 9.0 mm X 6.5 mm X 0.1 mm (0.354” x 0.256” x 0.004”), to a heat spreader. As demands for larger high power die continue, minimizing voiding and die tilt is of interest for improved die functionality, yield, manufacturability, and reliability. High-power die generate considerable heat, which is important to dissipate effectively through control of voiding under high thermal load areas of the die while maintaining a consistent bondline (minimizing die tilt). Voiding was measured using acoustic imaging and die tilt was measured using two different optical measurement systems. 80Au-20Sn solder reflow was achieved using a batch vacuum solder system with optimized fixturing. Minimizing die tilt proved to be the more difficult of the two product requirements to meet. Process development variables included tooling, weight and solder preform thickness.

  6. Neurokognitiewe integrasie en die leerproses

    Directory of Open Access Journals (Sweden)

    Du Preez, Johan J.


    Full Text Available The purpose of this article, "Neuro-cognitive integration and the learning process'; is to find principles and strategies for the development of brain potential and the optimal integration of subject matter. Eight neuro-cognitive systems are identified and their importance to the integration of subject matter is emphasized. These systems are cortical energy, coding, planning and controlling, as well as the verbal sequential, non-verbal holistic, physical-motor, social effective and the subconscious. The relevant principles and strategies can serve as basis for mainstream and special education, guidance as well as psychotherapy. Die doe! met hierdie artikel is om beginsels en strategiee te vind om breinpotensiaal te ontsluit en leerstof optimaal te integreer. Aan die hand van 'n neurokognitiewe model word 'n aantal beginsels en strategiee bespreek en die verband met die leerproses word aangetoon. Agt neurokognitiewe sisteme is gei'dentifiseer en die belangrike rot wat dit speel ten opsigte van die integrasie van leerstof word beklemtoon. Genoemde sisteme sluit die volgende in: kortikale energie, kodering, beplanning en kontrolering, asook die verbaal-sekwensiele, nieverbaal-holistiese, fisiek-motoriese, sosio-affektiewe en die subbewuste. Genoemde beginsels en strategiee kan oak dien as grondslag vir hoofstroomonderwys, spesialiseringsonderwys, voorligting sowel as psigoterapie.

  7. Correlation of Admission Metrics with Eventual Success in Mathematics Academic Performance of Freshmen in AMAIUB's Business Curricula (United States)

    Calucag, Lina S.; Talisic, Geraldo C.; Caday, Aileen B.


    This is a correlational study research design, which aimed to determine the correlation of admission metrics with eventual success in mathematics academic performance of the admitted 177 first year students of Bachelor of Science in Business Informatics and 59 first year students of Bachelor of Science in International Studies. Using Pearson's…

  8. Numerical optimization of die geometry in open die forging

    DEFF Research Database (Denmark)

    Christiansen, Peter; Hattel, Jesper Henri; Bay, Niels


    This paper deals with numerical optimization of open die forging of large metallic ingots made by casting implying risk of defects, e.g. central pores. Different material hardening properties and die geometries are combined in order to investigate, which geometry gives rise to maximum closure...

  9. die geskiedenis van die saw gedenkteken te fort klapperkop militere ...

    African Journals Online (AJOL)

    As gevolg van enige optrede, op enige plek, te enige tyd, deur enige vyand van die RSA of deur enige terroris(te), insurgent(e) of ander persoon of persone wat die RSA en sy volkere kwaadgesind is. h. Binne twee jaar (vyfhondred-en-dertig dae) nadat hy/sy met 'n ongeskiktheids- pensioen uit diens getree het agv siekte,.

  10. Die adversatiewe stelsel van bewyslewering en die beste belang ...

    African Journals Online (AJOL)

    MJM Venter

    weeg. Hierdie vraag word teen die agtergrond daarvan beoordeel dat veral dispute ..... restructuring family into the highly polarized positions of court-based dispute resolution.16. Talle alternatiewe om tekortkominge in die adversatiewe proses te ..... De Jong M "Mediation and Other Appropriate Forms of Alternative Dispute.

  11. Die teologiese debat: Die waarde of betekenis daarvan

    African Journals Online (AJOL)

    Ego vero hoc libro non contuli sed asservi et assero, ac penes nullum vo- lo esse iudicium, sed omnibus suadeo, ut praestent obsequium. (M Luther, De servo arbitrio, 1525). 1. INLEIDING. In ons dae is dit hoe mode om oor alles debat te voer. Een van die towerwoorde van ons tyd, veral op die politiek-staatkundige terrein, ...

  12. Die konteks vir die keuse van geriefsvoedsel van bepaalde ...

    African Journals Online (AJOL)


    70. Die konteks vir die keuse van geriefsvoedsel van bepaalde beroepsvroue *. Martha Kok en Priscilla Botha. ABSTRACT. The purpose of this research is to understand and describe the context in which career women choose, purchase and use convenience food (CF). A person is rarely isolated from or unaffected by.

  13. Die vlugtige taal van vergeet: Die metafoor by Breyten Breytenbach ...

    African Journals Online (AJOL)

    From his first book of poetry, die ysterkoei moet sweet (“the iron cow must sweat”, 1964), till his most recent one, die windvanger (“the windcatcher”, 2007), metaphor has been a central means towards the creation of meaning for Breytenbach. This article will investigate the use of metaphor particularly in this recent book.

  14. Die Nasionale Pparke van die Republiek van Suid-Afrika die verlede en die hede

    Directory of Open Access Journals (Sweden)

    A.M. Brynard


    Full Text Available This paper deals mainly with the past and present status of nature conservation in the Republic of South Africa. It is pointed out that the nature conservation history of the Republic of South Africa commenced as early as 1656. In 1897 the first areas for the conservation of wild animals were set aside. These were the Hluhluwe and Umfolozi Game Reserves. Shortly after- wards, in 1898, the Sabi Game Reserve was established mainly through the efforts of President Paul Kruger. Col James Stevenson-Hamilton was appointed the first Warden of the Sabi Game Reserve and through his continued endeavours and perse-verance this game reserve, with certain additions, was eventually proclaimed as the first national park in the RSA in 1926. The first National Parks Board of Trustees, instituted according to the National Parks Act of 1926 commenced with its duties on the 16th September, 1926. The National Parks Act made provision for the establishment of other National Parks. Since 1931 eight National Parks were estab- lished. A short description of the history and most important features of each of these is given.

  15. Is tamoxifen associated with an increased risk for thromboembolic complications in patients undergoing microvascular breast reconstruction? [Ist die Einnahme von Tamoxifen zum Zeitpunkt der mikrovaskulären Brustrekonstruktion mit einer erhöhten Rate an thrombembolischen Komplikationen assoziiert?

    Directory of Open Access Journals (Sweden)

    Krämer, Robert


    Full Text Available [english] Introduction: Tamoxifen is associated with a twofold increased risk of thromboembolic events. Third generation aromatase inhibitors (AIs, such as letrozole, anastrozole, and exemestane have therefore replaced tamoxifen in the adjuvant therapy of hormone receptor-positive breast cancer. A retrospective review was performed in patients who underwent delayed microvascular breast reconstruction and received tamoxifen at the time of surgery in order to assess the risk of both minor and major flap complications including thromboembolic events.Patients and methods: Twenty-nine patients who underwent delayed microsurgical breast reconstruction with autologous tissue between 2006 and 2012 were included in the study. The overall complication rates were compared between patients who did versus those who did not receive tamoxifen at the time of microsurgical breast reconstruction. Results: Breast reconstruction was performed with a DIEP flap in and with a TRAM flap in 4 patients. Overall, the complication rate was 37.9% (n=11 consisting of 5 major (including one total flap loss and 6 minor complications. In patients receiving tamoxifen (n=5, we observed one minor complication and one major complication with a total flap loss due to thrombus formation at the anastomosis site. In one patient pulmonary embolism occurred without association to tamoxifen. The number of thromboembolic events was equivalent in both groups (p=0.642. No increase of major (p=0.858 or minor (p=0.967 complications in the tamoxifen group could be observed. Taking the overall complication rate into account there was no statistically difference between the two groups (p=0.917.Conclusion: In our study we could not observe an increased risk for thromobembolic events in patients receiving tamoxifen while undergoing autologous microvascular breast reconstruction.[german] Aromatasehemmer der dritten Generation haben mittlerweile Tamoxifen in der neoadjuvanten und adjuvanten Therapie

  16. Pylstertmotte (Lepidoptera: Sphingidae van die Nasionale Krugerwildtuin

    Directory of Open Access Journals (Sweden)

    M. A. van den Berg


    Full Text Available 'n Totaal van 42 spesies van pylstertmotte is in die Nasionale Krugerwildtuin versamel. Die bekendste hiervan is die patatrusper (Herse convolvuli (L en die dood-skedelmot (Acherontia atropos (L. Die volgende spesies wat versamel is, se voorkoms is nog nie voorheen vir die Republiek van Suid-Afrika aangemeld nie nl. Pemba flavillacea (Walk., Praedora plagiata (R. &J., Leptoclanis basalis (Walk., Polyptychus calcareus (R. &J., Polyptychus compar (R. &J., Nephele aequivalens (Walk., Nephele peneus (Cram., Hippotion roseipennis (Butler en Xenosphingia jansei (Jord.. Die verspreiding van Oligographa juniperi (Bsd. wat langs die kusgebiede van Natal en die Oos-Kaap aangetrefword, is op verskeie plekke in die Krugerwildtuin versamel.

  17. Statues Also Die

    Directory of Open Access Journals (Sweden)

    Pierre-Philippe Fraiture


    Full Text Available “African thinking,” “African thought,” and “African philosophy.” These phrases are often used indiscriminately to refer to intellectual activities in and/or about Africa. This large field, which sits at the crossroads between analytic philosophy, continental thought, political philosophy and even linguistics is apparently limitless in its ability to submit the object “Africa” to a multiplicity of disciplinary approaches. This absence of limits has far-reaching historical origins. Indeed it needs to be understood as a legacy of the period leading to African independence and to the context in which African philosophy emerged not so much as a discipline as a point of departure to think colonial strictures and the constraints of colonial modes of thinking. That the first (self-appointed exponents of African philosophy were Westerners speaks volumes. Placide Tempels but also some of his predecessors such as Paul Radin (Primitive Man as Philosopher, 1927 and Vernon Brelsford (Primitive Philosophy, 1935 were the first scholars to envisage this extension of philosophy into the realm of the African “primitive.” The material explored in this article – Statues Also Die (Marker, Resnais, and Cloquet, Bantu Philosophy (Tempels, The Cultural Unity of Negro Africa (Cheikh Anta Diop, and It For Others (Duncan Campbell - resonates with this initial gesture but also with the ambition on part of African philosophers such as VY Mudimbe to challenge the limits of a discipline shaped by late colonialism and then subsequently recaptured by ethnophilosophers. Statues Also Die is thus used here as a text to appraise the limitations of African philosophy at an early stage.  The term “stage,” however, is purely arbitrary and the work of African philosophers has since the 1950s often been absorbed by an effort to retrieve African philosophizing practices before, or away from, the colonial matrix. This activity has gained momentum and has been

  18. Die faktore gemeenskaplik aan die selfondersoekvraelys van Holland en die nuwe Suid-Afrikaanse beroepsbelangstellingsvraelys

    Directory of Open Access Journals (Sweden)

    C. Swanevelder


    Full Text Available The factors common to the Self Directed Search of Holland (SDS and the new South African Vocational Interest Inventory (SAVII. The new South African Vocational Interest Inventory was locally developed with the purpose to create a single vocational interest inventory for all population groups in the RSA. In this study the common factors underlying the SDS and the SAVII were determined with the aid of interbattery factor analysis. The results indicate that there are six common factors underlying the two instruments for both the standard nine boys and girls, and that these factors agree with the six factors built into the SDS by Holland. Opsomming Die nuwe Suid-Afrikaanse Beroepsbelangstellingsvraelys (SABBV is plaaslik ontwikkel met die doel om 'n enkele beroepsbelangstellingsvraelys vir alle bevolkingsgroepe binne die RSA, daar te stel. In hierdie studie is daar ondersoek ingestel na die gemeenskaplike faktore onderliggend aan die SABBV en die Selfondersoekvraelys (SOV van Holland met behulp van 'n interbatteryfaktorontleding. Daar is bevind dat daar ses gemeenskaplike faktore onderliggend aan die twee instrumente is vir sowel standerd nege seuns as dogters, en dat hierdie faktore ooreenstem met die ses faktore wat deur Holland in die SOV ingebou is.

  19. Die Parlamentswahlen 2008 in Malaysia

    DEFF Research Database (Denmark)

    Reher, Stefanie; Knirsch, Thomas


    aus diversen Parteien bestehende Oppositionsbündnis erfuhr überraschend eine klare Stärkung. Während die aus der UMNO und 13 weiteren Koalitionären bestehende BN unter dem Motto „Sicherheit, Frieden, Wohlstand” für Premier Badawi warb, führten die Oppositionsparteien DAP, PAS und PRK – letztere unter...

  20. In diens van die Kompanjie

    African Journals Online (AJOL)

    was ook siektes WQl Jit onvoldoende of ondoel- treffende voeding, eentonige kos en ontoerei- kende geneesmiddels voortgespruit het, terwyl behoorlike versorging dikwels ontbreek he!. Doodsoorsake tydens die seereis het voartge- vloei uit ongelukke aan boord, beperkte ruimte vir die bemanning en geringe vars lug, ...

  1. Die Mythen von der Globalisierung

    DEFF Research Database (Denmark)

    Nell, Phillip; Schmitt, Jan; Decreton, Benoit


    Der Wissensstand über den Grad und die Art der Globalisierung ist viel niedriger als angenommen. Daraus entstehen Fehleinschätzungen.......Der Wissensstand über den Grad und die Art der Globalisierung ist viel niedriger als angenommen. Daraus entstehen Fehleinschätzungen....

  2. n hoofstuk in die (outo)biografie van die predikant (pastor?) 1 ...

    African Journals Online (AJOL)

    biografie van die dominee (pastor?), spreek om verskeie redes boekdele. Die gebruik van die onbepaalde lidwoord is eerstens 'n bevestiging dat die artikel slegs 'n verdere bydrae (hoofstuk) tot die bestaande en steeds voortgaande gesprek (boek) oor die biografie van die dominee is (Heitink 2001). Tweedens plaas ek ...

  3. die krag van simbole en rites in die liturgie 1. probleemstelling

    African Journals Online (AJOL)

    uitroepe vervang met die drie keer Kyrie eleison, die drie maal Christe eleison en die drie keer Kyrie eleison-uitroepe (Albrecht 1989:43). Op die lang duur het die uitroep dus heeltemal losgeraak van die gebede en het dit 'n selfstandige liturgiese element geword (Van Rongen. 1990:35). Die Reformasie met sy nadruk op ...

  4. Vanaf die Fermat-punte na die De Villiers-punte van ’n driehoek

    Directory of Open Access Journals (Sweden)

    Michael de Villiers


    Full Text Available Hierdie artikel beskryf die ontdekking van die sogenaamde De Villiers-punte van ’n driehoek die bewyse wat betrokke is, en trek die historiese oorsprong terug na die Fermat-punte van ’n driehoek, die swaartepunt van ’n driehoek, en ’n nuttige veralgemening van die Fermat-punte van ’n driehoek.

  5. Montessori-skole: die ander kant

    Directory of Open Access Journals (Sweden)

    Monica Viljoen


    Full Text Available Na aanleiding van die artikel “Die invloed van die New Age-beweging op die onderwysagenda van die toekoms” deur Lien van Niekerk en Corinne Meier van die Departement Historiese Opvoedkunde van Unisa (vgl. Koers, 59 (1 1994:69-84 wil ek graag ’n ander sy van Montessori-skole onder die aandag van Koers lesers bring.

  6. Mediamonitering in die bestuur van korporatiewe beeld



    M.Comm. Die waarde van hierdie ondersoek hou verband met die bemarking van 'n onderneming en die handhawing van 'n mededingende voordeel deur die projektering van 'n positiewe beeld (Anon., 1995a:92; Bateman & Zeithaml, 1993:75; Caminiti, 1992:50; Kotler & Armstrong, 1991:240). Hierdie aspek neem toe in belangrikheid soos wat die besigheidsmilieu in Suid-Afrika verander, veral wat betref die toetrede van buitelandse maatskappye tot die Suid-Afrikaanse mark.

  7. Filosofiese tendense in die wordinggeskiedenis van ons verstaan van die fisiese natuur

    Directory of Open Access Journals (Sweden)

    D. F. M. Strauss


    Full Text Available Die ontstaan van ’n lang tradisie van natuurwetenskaplike denke is in antieke Griekeland te vind – die bakermat van die Westerse beskawing en die bron van geartikuleerde rasionele besinning. Die vroegste fases van die Griekse kultuur het reeds geboorte geskenk aan ’n teoretiese nadenke oor die heelal. Die Pythagoreërs is veral bekend vir hul klem op die verklaringskrag van getalsverhoudinge. In hul tese dat “alles getal is” het hulle egter slegs rasionale getalle (breuke erken en gevolglik uiteindelik vasgeloop in die ontdekking van irrasionale getalle wat tot die geometrisering van die Griekse wiskunde gelei het en tegelyk die bedding gevorm het van waaruit ’n magtige tradisie van ruimte-metafisika gegroei het wat die hele middeleeuse tydperk omspan het. Die vermeende statiese syn is in die mees ekstreme geval – die skool van Parmenides en die argumente van Zeno teen veelheid en beweging – tot in die uiteindelike antinomiese konsekwensies daarvan deurdink. Dit was egter eers die vroeg-moderne tyd – die voorgangers en nakomelinge van Galilei – wat naas getal en ruimte ’n waardering ontwikkel het vir die verklaringskrag van beweging (vergelyk die klassieke meganistiese wêreldbeeld van die heelal as ’n meganisme van stofdeeltjies in beweging. Maar ook hierdie meganistiese reduksie (waardeur alle fisiese verskynsels herlei is tot die beweging van al of niegelade massapunte sou uiteindelik misluk omdat dit nie van die onomkeerbaarheid van fisiese prosesse rekenskap kon gee nie. Gevolglik beliggaam eers die fisika van die 20ste eeu ’n erkenning van die deurslaggewend-stempelende rol van energie-werking (dus van die fisiese aspek in die aard van stoflike dinge en prosesse. Die artikel word afgesluit met ’n vlugtige verduideliking van die implikasies van die voorafgaande argumentasie vir ’n benadering van die misterie van die bestaan van materie.

  8. Die uitdaging van die ateïsme en antiteïsme: ’n Teologiese gesprek met Armando Pellencin oor sy boek Ateïsme: die saak teen God (1 & 2

    Directory of Open Access Journals (Sweden)

    J.H. van Wyk


    Full Text Available In hierdie artikel beskryf die outeur hoedat hy onverwags in 2007 in ’n debat met die ateïs Armando Pellencin betrokke geraak het en hoedat dit uiteindelik gelei het tot die skryf van hierdie artikel oor ateïsme. Nadat hy in ’n kort intermezzo ’n oorsig oor die opkoms van ateïsme gebied het, lewer die outeur daarna ’n uiteensetting van die standpunte van Pellencin. In die volgende hoofdeel van die artikel argumenteer die outeur dat Pellencin – asook ander ateïste – nie afdoende en bevredigende antwoorde kan gee op die vyf fundamentele lewensvrae nie. Hierdie fundamentele lewensvrae is die volgende: Hoe verwerf ’n mens kennis (waarheid?; Waar kom alles vandaan?; Waar gaan alles heen?; Wat is die sin van die lewe?; Hoe kan ’n mens tussen goed en kwaad onderskei? Die outeur konkludeer dat ateïsme, as geloofskeuse en lewens- en wêreldbeskouing faal vanweë die inherente tekortkomings wat aan die reduksionisiese benadering van naturalisme, rasionalisme, positivisme en sciëntisme verbonde is. In this article the author describes how, in 2007, he got involved in an unexpected discourse with the atheist Armando Pellencin and how it eventually lead to the writing of this article on atheism. After a short intermezzo in which an overview of the rise of atheism is presented, the views of Pellencin are expounded. In the main part of the article the author argues that Pellencin and other atheists fail to supply decisive and satisfactory answers to the five fundamental questions in life. This fundamental questions are the following: How do we achieve knowledge (truth?; Where does everything come from?; Where is everything going to?; What is the meaning of life?; How should we discern between good and evil? The author concludes that atheism, as a matter of faith, fails as a life and worldview, because of the deficiencies inherent in a reductionist approach such as naturalism, rationalism, positivism and scientism.

  9. Die identifisering van maatstawwe vir die navorsingsprestasie van akademici

    Directory of Open Access Journals (Sweden)

    H. A. Labuschagne


    Full Text Available Identification of criteria for academic research performance. At South African universities, the achievement of objectives is usually measured in terms of so-called "process criteria" (e.g. pass rates, instead of performance criteria which reflect the quality of academic personnel. Stimulated by the need to identify valid indices of research performance, as a component of academic performance, this study investigated the dimensionality of several criteria, identified from empirical and literature studies. It was found that various valid criteria could be represented by six constructs, viz.: the stature of the researcher as scientist; scientific contributions; enhancement of own profession; community development; participation in research projects; and giving advice to persons or institutions outside the university. Opsomming By Suid-Afrikaanse universiteite word doelwitbereiking gewoonlik aan die hand van sogenaamde "prosesmaat-stawwe" (bv. slaagsyfers in plaas van prestasiemaatstawwe wat die gehalte van akademiese personeel weerspieel, gemeet. Na aanleiding van 'n behoefte aan die identifisering van geldige rigtingwysers vir navorsingsprestasie as 'n komponent van akademiese prestasie, is daar ondersoek ingestel na die dimensionaliteit van verskillende maatstawwe wat vooraf deur middel van empiriese- en literatuurstudies geidentifiseer is. Daar is gevind dat verskeie geldige maatstawwe deur ses konstrukte verteenwoordig word, te wete: die statuur van die navorser as wetenskaplike, wetenskaplike bydraes, uitbouing van eie professie, gemeenskapsontwikkeling, deelname aan navorsingsprojekte en advieslewering aan persone of instellings buite die Universiteit.

  10. Measurement of thyrotropin receptor antibodies (TRAK) with a second generation assay in patients with Graves' disease; Die Bestimmung von Thyreotropin-Rezeptor-Antikoerpern (TRAK) mit einem Assay der zweiten Generation bei Patienten mit Morbus Basedow

    Energy Technology Data Exchange (ETDEWEB)

    Zoephel, K.; Wunderlich, G.; Franke, W.G. [Klinik und Poliklinik fuer Nuklearmedizin, Technische Univ. Dresden (Germany); Koch, R. [Inst. fuer Medizinische Informatik und Biometrie, Technische Univ. Dresden (Germany)


    Aim: The detection of TSH-receptor-antibodies (TRAb) in patients (pts) with Graves' disease (GD) is routinely used in nuclear medicine laboratories. It is performed by commercial, porcine radioreceptorassays (RRA) measuring TSH binding inhibitory activity. A second generation assay using the human, recombinant TSH-receptor was developed during the last years. The manufacturer composed this new assay as a coated tube RRA (CT RRA) and claimed a higher sensitivity for GD. Methods: TRAb was measured in 207 pts with various thyroid disorders and 205 healthy controls using the new coated tube RRA (Fa. B.R.A.H.M.S. Diagnostica GmbH, Berlin, Germany) as well as a conventional RRA (Fa. Medipan Diagnostica GmbH, Selchow, Germany): 60 pts suffering from GD showing a relapse after anti-thyroid drug treatment and before radioiodine therapy, 109 pts with disseminated autonomia (DA) and 38 pts suffering from Hashimoto's thyroiditis. A ROC-analysis was performed to find the optimal decision threshold level for positivity. Results: We found 42/60 TRAb-positive pts with GD in the established RRA (threshold 6 U/L) and 52/60 in the CT RRA, respectively. The sensitivity increased from 70% (RRA) to 86,7% (CT RRA). The CT RRA found 2 false positives (one Hashimoto's and one healthy control) and the RRA detected 3 Hashimoto's and 2 healthy controls as false positive. Conclusion: The increased sensitivity of CT RRA for GD provides an advantage compared to conventional RRA, especially in GD-patients relapsing afte antithyroid drug treatment. Functional sensitivity and Interassayvariation of CT RRA are very precisely compared to conventional RRA. Handling of the new assay is also improved. (orig.) [German] Ziel: Die Bestimmung der TSH-Rezeptorantikoerper (TRAK) bei Patienten mit Morbus Basedow ist fester Bestandteil der nuklearmedizinischen In-vitro-Diagnostik. Seit kurzem ist die Bestimmung mit einem TRAK-Assay moeglich, bei dem im Gegensatz zu den herkoemmlichen

  11. Die toepassing van die K3-model op die televisieteks Colour TV

    African Journals Online (AJOL)

    “OIL's approach to investigating the coloured market took place in the form of ethnographic research which ... communication strategies” (Botha 2010: 14). ... Op grond van die waarnemings, onderhoude en vraelyste het OIL tot die volgende ..... hold onto your nearest and dearest because this is going to be a kwaai mix bag.

  12. Die kliniese kindersielkundige as diagnostikus1

    Directory of Open Access Journals (Sweden)

    D. J. W. Strümpfer


    Full Text Available Die benaming „Kliniese Kindersielkunde” is nog onbekend en gevolglik betreklik onbemind. Dit is in 1951 die eerste keer gebruik. Die werk van die Kliniese Kindersielkunde is egter so oud as die werk van die algemene Kliniese Sielkunde, waarvan die geskiedenis gewoonlik teruggevoer word tot die begin van sielkundige toetsing vroeg in die tagtigerjare. Tot ’n aansienlike mate is hierdie vroeë werk op kinders uitgevoer, bv. dié van Galton en later die van Binet en Simon. Witmer het in 1896 die eerste sielkundige kliniek geopen en het ook die term „Kliniese Sielkunde” ingevoer; die meerderheid van sy pasiënte was egter ook kinders. Tot voor die Tweede Wêreldoorlog was klinies-sielkundige werk hoofsaaklik op kinders toegespits. Sedertdien het die kliniese sielkundige tot ’n belangrike mate toegetree tot die gebied van die diagnose en terapie van psigiese afwykings by volwassenes, tot so ’n mate dat in die gedagtes en geskrifte van baie werkers die terrein van die Kliniese Sielkunde byna tot werk met volwassenes beperk word.

  13. James Henry Greathead en die Londense Moltrein

    Directory of Open Access Journals (Sweden)

    Laurence Wright


    Full Text Available Die artikel ondersoek die oorsprong en vroeë geskiedenis van die toestel genaamd die ‘Greathead Skild’, ‘n belangrike nuwigheid in Viktoriaanse ingenieurwetenskap, wat van deurslaggewende belang was in die konstruksie van die Londense Moltrein. Die doel is om die basis te ontleed waarop, baie jare later, ‘n Suid-Afrikaanse ingenieur wye openbare erkenning in die vorm van ‘n standbeeld vir die ‘ontwerp’ van die Skild geniet het. Uit die perspektief van kulturele studies beskou, hoe moet ons uitvinding verstaan, gegewe dat ander briljante ingenieurs ook betrokke was? Hierdie vraag word ontleed met die gebruik van die konsep ‘extelligence’ (Stewart and Cohen 1997, in samehang met ander kontemporêre en geskiedkundige weergawes, insluitend Greathead se eie rekord van sy prestasies in die verrigtinge van die Instituut van Siviele Ingenieurs en voorgelê in The City and South London Railway (1896, onder redaksie van James Forrest. Hierdie artikel is die eerste keer as referaat aangebied by die konferensie oor ‘Nuuthede en Innovasie in die Negentiende Eeu’ aan die Noordwes-Universiteit, Mei 2016.


    African Journals Online (AJOL)

    P.J. Strauss. DIE NAAM “NEDERDUITSE. GEREFORMEERDE KERK”. ABSTRACT. An investigation into the name of the Dutch Reformed Church (DRC) reveals that it is a reformed church in the ... P.J. Strauss, Fakulteit Teologie, Universiteit van die Vrystaat, Suid‑Afrika. ..... Dit is so omdat die staat en sy howe die reg in die ...

  15. Abstraksie en veralgemening in die Wiskunde

    Directory of Open Access Journals (Sweden)

    B.C. Strydom


    Full Text Available Wanneer ek tot u spreek oor abstraksie en veralgemening in die Wiskunde, wil ek u aandag vestig op die belangrikheid daarvaan vir die Wiskunde, maar u terselfdertyd daarop wys dat die wiskundige hom nie langs hierdie weg heeltemal van die werklikheid kan losmaak nie.

  16. Die Dankesrede bei der Preisverleihung

    Directory of Open Access Journals (Sweden)

    Elenmari Pletikos Olof


    Full Text Available Festliche Preisverleihungen sind Gelegenheiten, bei denen von den Preisträgerneine kurze Rede erwartet wird. Obwohl die Dankesrede eine kleinere Randgattung innerhalb des epideiktischen Genres ist, steht sie im Mittelpunkt des Ereignisses. Rhetorikhandbücher geben zahlreiche Ratschläge, wie eine gute Festrede vorbereitet werden soll, um zu unterhalten, zu bewegen und zu belehren. Ziel dieser Untersuchung ist es festzustellen, welche Eigenschaften der Dankesrede die Zuhörer als erwünscht oder unerwünscht wahrnehmen und welche Charakteristika am meisten zur Qualität festlicher Dankesreden beitragen. Das Korpus der gesprochenen Texte bilden 30 Dankesreden anlässlich kroatischer Preisverleihungen in den Bereichen Schauspiel, Sport, Musik, Fernsehen, Literatur und Wirtschaft. Die Audio-Aufnahmen der Dankesreden wurden einer Gruppe von Hörern zur Bewertung in folgenden Kategorien vorgelegt: interessant, geistreich, hoher Sprachstil, feierlich, emotiv, persönlich, originell, bescheiden, vorbereitet und spontan. Zusätzlich wurde zu jeder Rede die offene Frage gestellt, was dem Zuhörer an der Rede gefallen oder nicht gefallen habe. Die Resultate der Perzeptionsanalye lassen erkennen, dass die Interessantheit einer Rede mit der Eigenschaft des Geistreichen, des Originellen, des Emotionalen und des Persönlichen in Verbindung gebracht wird und die Eigenschaft des Festlichen im Wesentlichen nur mit dem hohen Sprachstil und der Vorbereitetheit des Textes korreliert. Einige Eigenschaften können sowohl erwünscht als auch unerwünscht sein, z. B. Dialekt, Persönliches und Kürze. Die besten Dankesreden haben Eigenschaften, die im Grunde schwer miteinander zu verbinden sind: Einerseits soll der Text vorbereitet sein (hoher Stil, Wortwahl, Figuren, Originalität der Geschichte, Humor, andererseits wird bei der Ausführung Spontaneität (Aufrichtigkeit, Emotionalität, Persönlichkeit erwartet.

  17. Relating cause of death with place of care and healthcare costs in the last year of life for patients who died from cancer, chronic obstructive pulmonary disease, heart failure and dementia: A descriptive study using registry data. (United States)

    van der Plas, Annicka Gm; Oosterveld-Vlug, Mariska G; Pasman, H Roeline W; Onwuteaka-Philipsen, Bregje D


    The four main diagnostic groups for palliative care provision are cancer, chronic obstructive pulmonary disease, heart failure and dementia. But comparisons of costs and care in the last year of life are mainly directed at cancer versus non-cancer or within cancer patients. Our aim is to compare the care and expenditures in their last year of life for Dutch patients with cancer, chronic obstructive pulmonary disease, heart failure or dementia. Data from insurance company Achmea (2009-2010) were linked to information on long-term care at home or in an institution, the National Hospital Registration and Causes of Death-Registry from Statistics Netherlands. For patients who died of cancer ( n = 8658), chronic obstructive pulmonary disease ( n = 1637), heart failure ( n = 1505) or dementia ( n = 3586), frequencies and means were calculated, Lorenz curves were drawn up and logistic regression was used to compare patients with high versus low expenditures. For decedents with cancer and chronic obstructive pulmonary disease, the highest costs were for hospital admissions. For decedents with heart failure, the highest costs were for the care home (last 360 days) and hospital admissions (last 30 days). For decedents with dementia, the highest costs were for the nursing home. Patients with dementia had the highest expenditures due to nursing home care. The number of dementia patients will double by the year 2030, resulting in even higher economic burdens than presently. Policy regarding patients with chronic conditions should be informed by research on expenditures within the context of preferences and needs of patients and carers.


    African Journals Online (AJOL)


    So ver terug as die vroeë twintigste eeu het die Appèlhof in Cassiem v Standard. Bank of SA Ltd,1 .... 838; Capital Building Society v De Jager 1963 3 SA 381 (T); Smit v Walles 1985 2 SA 189 (T). 196-198. 18 ...... moeilik kon regverdig.97. Ons howe het tot op hede gehuiwer om 'n algemene plig van goeie trou ten aansien.

  19. Quantenfische die Stringtheorie und die Suche nach Weltformel

    CERN Document Server

    Lüst, Dieter


    Lässt sich das Verhalten aller Dinge, von den kleinsten Teilchen bis zum Universum, einheitlich beschreiben? Der heißeste Kandidat für die Entwicklung einer Weltformel, die alle physikalischen Phänomene erklären kann, ist die Stringtheorie. Sollte sie sich als richtig erweisen, so würde das unser Verständnis über den Ursprung der Naturgesetze dramatisch verändern. Denn das von uns beobachtete Universum wäre dann vermutlich eine winzige Blase in einem viel größeren Gebilde, dem Multiversum. Um die Stringtheorie und die Idee des Multiversums plausibel zu machen, greift der international bekannte theoretische Physiker Dieter Lüst auf ein Modell zurück: das Leben von Fischen in einem Teich. Eines Tages gelingt es den Fischen, die kleinsten Teilchen zu identifizieren, aus denen alles im Fischteich besteht - eingeschlossen sie selbst. Sie nennen diese Urbausteine Quantenfische, da ihr Verhalten nahelegt, dass sie auch eine Art von Lebewesen sind. Doch der ersten folgt eine weitere Entdeckung der Fisch...

  20. Die rol van persoonlikheidstrekke in die weerstand teen stres

    Directory of Open Access Journals (Sweden)

    Sonja V. R. van Oudtshoorn


    Full Text Available The role of personality characteristics in resistance to stress: A study was conducted to establish whether certain personality characteristics contribute to resistance to stress. Rescue brigadesmen, performing dangerous rescue operations in the goldmining industry, served as basis for the study. The sample consisted of 63 current, 56 ex- and 50 non-brigadesmen. Results indicate that brigadesmen, on the basis of their personality structure, are better equipped to cope with stress. Scores on the 16PF show that they have a lower level of interpersonal anxiety (Factor Q4 and that they are more practical (Factor I, emotionally stable (Factor C, and conscientious (Factor G. These findings support existing knowledge of the 16PF. Opsomming Ten einde vas te stel ofdaar sekere persoonlikheidstrekke bestaan wat bydra tot weerstand teen stres, is 'n studie uitgevoer met reddingspanlede, wat lewensgevaarlike reddingsdiens in die goudmynbedryf verrig, as ondersoekgroep. Die streekproefhet uit 63 huidige, 56 oud-reddingspanlede en 50 amptenare, wat nog nooit aan die span behoort het nie, bestaan. Dit blyk dat reddingspanlede, op grond van hulle persoonlikheidstruktuur, beter toegerus is om stres te hanteer. Tellings op die 16PF toon dat hulle oor 'n laervlakvan interpersoonlike angs beskik, (Faktor Q4, dat hulle meer prakties (Faktor I, emosioneel stabiel (Faktor C en konsensieus is (Faktor G. Hierdie bevindinge sluit aan by die reeds bestaande kennis oor die 16PF.

  1. Dying with dignity: a concept analysis. (United States)

    Hemati, Zeinab; Ashouri, Elaheh; AllahBakhshian, Maryam; Pourfarzad, Zahra; Shirani, Farimah; Safazadeh, Shima; Ziyaei, Marziyeh; Varzeshnejad, Maryam; Hashemi, Maryam; Taleghani, Fariba


    This article is a report of an analysis of the concept of dying with dignity. Dignity is an important component of providing care for dying patients and their families. Nevertheless, given that this concept is poorly defined, concept analysis is one of the best ways to define and clarify the concept of death with dignity with the aim to enhance its application in clinical practice, research and education. A search of multiple nursing and social sciences databases was undertaken, including Academic Search Complete, Science Direct, ProQuest, Scopus, Medline, PubMed, EBSCO, Ovid, Noormage, Cinahl, Magiran, PsycINFO and SID. After an extensive review of the literature from 1998-2014, about 14 related articles were included in the study. Based on these articles, the applications, attributes and experimental results of and references to death with dignity were recorded. Based on this analysis, the most important attributes of this concept included respect for privacy, respect, spiritual peace and hope. The antecedents of this concept included consideration of moral values during caregiving, preservation of human dignity as a patient right and professional ethics, and belief in the dignity of self and others, consideration of culture in providing end-of-life care. The consequences of this concept included a sense of peace in the patient and their family, peaceful death and provision of patient privacy and comfort. The concept of patient dignity has been referred to in many contexts. However, considering the dignity of dying patients commensurate with their culture is the most important component of care provided by nurses to facilitate a peaceful death. Respecting the dignity of the patient results in the reduction of her/his suffering and prepares her/him for a comfortable death. © 2016 John Wiley & Sons Ltd.

  2. Die Bibliothek ohne Bibliothekar? Zur Situation der Patientenbüchereien in Wien / The Library without a Librarian? The Situation of the Patient Libraries in Vienna

    Directory of Open Access Journals (Sweden)

    Jany, Elke


    Full Text Available Libraries for patients fulfil apart from health-specific tasks politico-cultural functions too. However, substantial savings in the health service sector affect also these institutions vital for the recovery of patients. The present work offers an overview on the libraries in the Viennese hospitals with respect to new tasks and challenges that librarians must face; and it demonstrates the different conditions for private as well as public hospitals.

  3. A medical oncologist's perspective on communication skills and burnout syndrome with psycho-oncological approach (to die with each patient one more time: the fate of the oncologists). (United States)

    Tanriverdi, Ozgur


    The increasing incidence of cancer is at the same time one of the leading causes of death all over the world. Many clinical studies show that the psychological disorders are more frequent in cancer patients than the normal population. That is the reason why "psycho-oncology" is getting popular each day. On the other hand, clinical studies about psychological status of the oncologists who are in contact with cancer patients ceaselessly and who are mostly responsible to give the "bad news" to the cancer patients are very limited. In fact, if the clinical studies which show that the frequency of depression and burnout syndrome are increasing among physicians are taken into consideration, one can say that psycho-oncology must cover all the medical personnel who are dealing with cancer patients. It is determined that the rate of depression and burnout syndrome is high among oncologists when referred to the literature. Several solutions are proposed for the psychological conditions of the oncologists and other related personnel who empathize with the patients and deliver "bad news" and also try to adopt ideal "patient-physician" communication model. The knowledge on the psychological conditions of oncology professionals and their behaviour and the results of the clinical studies on this subject will be discussed and the personal opinion will also be presented in this paper.

  4. Engaging Terminally Ill Patients in End of Life Talk: How Experienced Palliative Medicine Doctors Navigate the Dilemma of Promoting Discussions about Dying. (United States)

    Pino, Marco; Parry, Ruth; Land, Victoria; Faull, Christina; Feathers, Luke; Seymour, Jane


    To examine how palliative medicine doctors engage patients in end-of-life (hereon, EoL) talk. To examine whether the practice of "eliciting and responding to cues", which has been widely advocated in the EoL care literature, promotes EoL talk. Conversation analysis of video- and audio-recorded consultations. Unselected terminally ill patients and their companions in consultation with experienced palliative medicine doctors. Outpatient clinic, day therapy clinic, and inpatient unit of a single English hospice. Doctors most commonly promoted EoL talk through open elaboration solicitations; these created opportunities for patients to introduce-then later further articulate-EoL considerations in such a way that doctors did not overtly ask about EoL matters. Importantly, the wording of elaboration solicitations avoided assuming that patients had EoL concerns. If a patient responded to open elaboration solicitations without introducing EoL considerations, doctors sometimes pursued EoL talk by switching to a less participatory and more presumptive type of solicitation, which suggested the patient might have EoL concerns. These more overt solicitations were used only later in consultations, which indicates that doctors give precedence to patients volunteering EoL considerations, and offer them opportunities to take the lead in initiating EoL talk. There is evidence that doctors treat elaboration of patients' talk as a resource for engaging them in EoL conversations. However, there are limitations associated with labelling that talk as "cues" as is common in EoL communication contexts. We examine these limitations and propose "possible EoL considerations" as a descriptively more accurate term. Through communicating-via open elaboration solicitations-in ways that create opportunities for patients to volunteer EoL considerations, doctors navigate a core dilemma in promoting EoL talk: giving patients opportunities to choose whether to engage in conversations about EoL whilst

  5. Computer-assisted analysis and scientific evaluation of patients with cerebral angiomas. Die computerunterstuetzte Analyse und wissenschaftliche Auswertung von Patienten mit zerebralen Angiomen

    Energy Technology Data Exchange (ETDEWEB)

    Killer, M


    The treatment of cerebral arterio-venous malformations currently consists of a combination of different techniques, such as surgical extirpation, endovascular embolization and radiosurgery. Depending on the patient's anamnesis and pathomorphology the objective of the treatment is either a total elimination of the AVM or an improvement of the symptoms. In order to capture the large quantities of data accumulated during the variously combined methods as well as from manifold medical examinations before and during the treatment, a data capture program is presented. This program, developed on the basis of the File Maker 2.0 by Claris, allows the registration of data obtained in preliminary examinations, therapies and follow-ups. The database thus created, allows for a simple and fast registration of all the important parameters pertaining to the current treatment of AVM. The analysis of the data, when related to a particular patient, facilitates determining the further course of action and treatment of this patient. Furthermore the statistical analysis of different relationships of AVM-parameters permits to gain important feedback about the efficacy of the selected strategies of treatment. In this thesis, the data of 143 patients, who underwent treatment for cerebral AVM at the Department of Neurosurgery of the University of Vienna between March 1985 and October 1992 was evaluated. Of these patients 47% were female and 53% male, their mean age being 35.6 years.

  6. Nuwe patogene in die voedselbedryf

    Directory of Open Access Journals (Sweden)

    M. M. Ehlers


    Full Text Available ’n “Nuwe generasie” voedselpatogene het die afgelope jare hul verskyning gemaak en kan 'n ernstige gevaar vir die voedselbedryf inhou. Hierdie organismes is uiters aanpasbaar en bestaande voedselprosesseringstegnieke, veral die verkoeling van voedsel, is nie altyd volkome effektief om hul groei te voorkom nie. Clostridium botulinum tipe E, enterotoksigeniese Eschsrichia coli. Listeria monocytogenes en Aeromonas hydrophila is in staat om in voedsel by 5 °C te groei. Campylobacter jejuni en Brucella kan weer by 5 °C oorleef en 'n derde groep organismes, naamlik Salmonella, Staphylococcus aureus, Vibrio parahaemolyticus en Vibrio vulnificus kan by temperature tussen 5 °C en 12 °C groei en hul teenwoordigheid is ’n aanduiding dat die koueketting verbreek is.

  7. Die Last mit der Lust

    Directory of Open Access Journals (Sweden)

    Lutz Sauerteig


    Full Text Available Robert Jütte legt mit Lust ohne Last eine umfassende, allgemeinverständliche und spannend zu lesende Geschichte der Empfängnisverhütung von der Antike bis in die unmittelbare Gegenwart vor.

  8. pastorale begeleiding aan die persoon met dissosiatiewe ...

    African Journals Online (AJOL)

    psychological or pastoral by nature. Effective assistance to the person ... INLEIDING. Volgens die kriteria in die DSM-IV2 (Diagnostic and statistical manual of mental disorders, 4th edition) van die APA (American Psychiatric. Association 1995) ...

  9. Comparison of informal caregiver and named nurse assessment of symptoms in elderly patients dying in hospital using the palliative outcome scale. (United States)

    Dawber, Rebecca; Armour, Kathy; Ferry, Peter; Mukherjee, Bhaskar; Carter, Christopher; Meystre, Chantal


    A prospective study of symptom assessments made by a healthcare professional (HCP; named nurse) and an informal caregiver (ICG) compared with that of the patient with a terminal diagnosis. To look at the validity of HCP and ICG as proxies, which symptoms they can reliably assess, and to determine who is the better proxy between HCP and ICG. A total of 50 triads of patient (>65 years) in the terminal phase, ICG and named nurse on medical wards of an acute general hospital. Assessments were made using the patient and caregiver versions of the palliative outcome scale (POS), all taken within a 24 h period. Agreement between patient-rated, ICG-rated and HCP-rated POS and POS for symptoms (POS-S) was measured using weighted-κ statistics. Demographic and clinical data on each group of participants were collected. ICG assessments have higher agreement with those of the patient than HCP. Better agreement in both groups was found for physical symptoms, and best agreement was for pain. The worst agreements were for psychological symptoms, such as anxiety and depression, and for satisfaction with information given. Psychological symptoms are overestimated by both ICG and HCP. ICGs are more reliable proxies than HCPs. A trend for overestimation of symptoms was found in both groups which may lead to undervaluation of the quality of life by proxy and overtreatment of symptoms. This highlights the need to always use the patient report when possible, and to be aware of the potential flaws in proxy assessment. Reasons for overestimation by proxies deserve further research. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  10. Engaging Terminally Ill Patients in End of Life Talk: How Experienced Palliative Medicine Doctors Navigate the Dilemma of Promoting Discussions about Dying


    Pino, Marco; Parry, Ruth; Land, Victoria; Faull, Christina; Feathers, Luke; Seymour, Jane


    Objective\\ud To examine how palliative medicine doctors engage patients in end-of-life (hereon, EoL)\\ud talk. To examine whether the practice of “eliciting and responding to cues”, which has been\\ud widely advocated in the EoL care literature, promotes EoL talk.\\ud Design\\ud Conversation analysis of video- and audio-recorded consultations.\\ud Participants\\ud Unselected terminally ill patients and their companions in consultation with experienced palliative\\ud medicine doctors.\\ud Setting\\ud O...

  11. The efficient ones; Die Leistungsfaehigen

    Energy Technology Data Exchange (ETDEWEB)



    The increase of output of a solar system where vacuum tube collectors replace flatbed collectors is difficult to calculate exactly. The formula for the calculation of efficiency is the basis of such calculations. Due to evacuation and better insulation the heat loss of vacuum tube collectors is smaller than that of flatbed collectors. This is also evident in the fact that the efficiency curve decreases less steeply as the temperature difference increases. Efficiency remains relatively high. Up to now vacuum tube collectors have been a niche product but more and more companies now sell these efficient collectors.(orig.). [German] Wie stark sich die Leistung der Solaranlage verbessert, wenn man Vakuumroehrenkollektoren (VRK) statt Flachkollektoren einsetzt, laesst sich nur schwer berechnen. Grundlage ist stets die Wirkungsgradformel. Aufgrund der Evakuierung und dadurch besseren Isolierung weisen die VRK deutlich geringere Waermeverluste auf als Flachkollektoren. Dies drueckt sich auch dadurch aus, dass die Wirkungsgradkurve mit wachsender Temperaturdifferenz {delta}{theta} deutlich flacher abfaellt. Der Wirkungsgrad bleibt relativ hoch. Als Hightech-Produkt hatte der Vakuumroehrenkollektor bisher eine typische Marktnische besetzt. Doch immer mehr Anbieter entscheiden sich fuer die Vermarktung dieser leistungsfaehigen Kollektoren. (orig.)

  12. Reparation of damaged forging dies

    Directory of Open Access Journals (Sweden)

    Vukić Lazić


    Full Text Available The forging dies are in exploitation exposed to elevated temperatures and variable impact loads, both compressive and shear. Steels for manufacturing of these tools must endure those loads while maintaining mechanical properties and being resistant to wear and thermal fatigue. For those reasons, the alloyed steels are used for making the forging dies, though they have less weldability, because alloying increases proneness to hardening. Any reparatory hard facing (HF of the damaged dies would require the specially adjusted technology to the particular piece. In this paper reparatory hard facing of dies used for forging pieces in the automobile industry is considered. Prior to reparatory hard facing of the real tools, numerous experimental hard facings on models were performed. All the model hard facings were done on the same steels which were used for production of the real forging dies. To define the optimal hard facing technology one needs to derive the optimal combination of the adequate heat treatment(s, to select the proper filler metals and the welding procedure. The established optimal HF technology was applied to real forging dies whose service life was further monitored in conditions of exploitation

  13. Cost analysis of medical assistance in dying in Canada. (United States)

    Trachtenberg, Aaron J; Manns, Braden


    The legalization of medical assistance in dying will affect health care spending in Canada. Our aim was to determine the potential costs and savings associated with the implementation of medical assistance in dying. Using published data from the Netherlands and Belgium, where medically assisted death is legal, we estimated that medical assistance in dying will account for 1%-4% of all deaths; 80% of patients will have cancer; 50% of patients will be aged 60-80 years; 55% will be men; 60% of patients will have their lives shortened by 1 month; and 40% of patients will have their lives shortened by 1 week. We combined current mortality data for the Canadian population with recent end-of-life cost data to calculate a predicted range of savings associated with the implementation of medical assistance in dying. We also estimated the direct costs associated with offering medically assisted death, including physician consultations and drug costs. Medical assistance in dying could reduce annual health care spending across Canada by between $34.7 million and $138.8 million, exceeding the $1.5-$14.8 million in direct costs associated with its implementation. In sensitivity analyses, we noted that even if the potential savings are overestimated and costs underestimated, the implementation of mdedical assistance in dying will likely remain at least cost neutral. Providing medical assistance in dying in Canada should not result in any excess financial burden to the health care system, and could result in substantial savings. Additional data on patients who choose medical assistance in dying in Canada should be collected to enable more precise estimates of the impact of medically assisted death on health care spending and to enable further economic evaluation. © 2017 Canadian Medical Association or its licensors.

  14. Uitdagings in die onderrig van evolusie in die lewenswetenskappeklaskamer

    Directory of Open Access Journals (Sweden)

    Josef J. de Beer


    Full Text Available In hierdie artikel skryf die outeurs oor navorsing wat hulle gedoen het oor onderwysers se siening van die onderrig van evolusie, wat in 2008 as ’n tema in lewenswetenskappe in Suid-Afrikaanse skole ingesluit is. Hierdie vernuwing in die kurrikulum is met gemengde reaksies begroet. Terwyl sommige onderwysers dit met entoesiasme onderrig, is baie gekant teen die onderrig van evolusie. Die artikel is gebaseer op ’n navorsingsprojek waarby 255 onderwysers betrek is. Vraelyste is gebruik om kwalitatiewe data, wat vir diskoers ontleed is, in te samel. Die diskoers van die onderwysers het getoon dat ’n groot getal van hulle nie hul onderrigopdrag kan versoen met hul geloof nie en konsepte oor evolusie as ‘feite’ verduidelik, maar seker maak dat evolusie as ’n teorie gediskrediteer word. Dit het verreikende implikasies vir sowel onderwyseropleiding as kurrikulumontwikkeling. Konseptuele veranderingsteorie word as ’n lens gebruik om na hierdie problematiek te kyk. Challenges in the teaching of evolution in the life sciences classroom. In this article the authors report on research that was conducted about teachers’ views on evolution, which was introduced as a theme in the school life sciences curriculum in 2008. This innovation in the curriculum has been met with mixed reactions. Whereas some teachers embrace this new theme, many teachers are opposed to the teaching of evolution. The article reports on an inquiry that was conducted amongst 255 teachers and in which survey questionnaires were used to collect qualitative data, which was analysed for its discourse. The discourse of the teachers shows that many of them cannot reconcile their religious faith with their teaching and that they may teach the ‘facts’ of evolution, but make sure that they discredit evolution as a theory. This raises serious concerns about teacher education and curriculum development. The authors examine these issues through the lens of conceptual change

  15. die kasteel••de goede hoop" (1921.1923): die verhaal van in ...

    African Journals Online (AJOL)

    3. TWEE. KOMITEE-VERGADERINGS. BESLUITE a. Doel en samestelling van die komitee. Op 12 Desember 1921 stuur die Sekretans yap Verdediging uitnodigings aan sekere amptelike instansies en ander behingstd1endes waarin hy die redes vir die wenslikheid van 'n komitee en die werksaamhede uitecnsit en die ge-.

  16. Chrístologie: Die historiese Jesus en die kerugmatiese Christus by ...

    African Journals Online (AJOL)

    dige Here van sy kerk. Die Christelike teologie en die kerk het dus nie 'n ander oprsprong as wat die Christologiese belydenis van die oer-Christendom het nie, naamlik die paasgebeure. Schmithals (1972b:77) wil kerk en teologie aanmoedig om hierdie oorsprong in gedagte te hou en om goed te besef dat die Christus-.

  17. PROF DR FELIX V. lATEGAN: Die Boer se Roer. Die Groot ...

    African Journals Online (AJOL)

    PROF DR FELIX V. lATEGAN: Die Boer se. Roer. Die Groot Geweerboek van Suid-. Afrika. Tafelberg. Uitgewers. Kaapstad, pp. 209, bibliografie, register. Sonder die Boer en sy roer is die geskiede:lis van ons land feitlik ondenkbc:wr en dit is clan ook vo/kome juis gesien dat die skrywer van hierdie baanbrekerswerk die ...

  18. Die Energiesicherheit Europas in Bezug auf Erdgas und die Auswirkungen einer Kartellbildung im Gassektor


    Krämer, Luis-Martín


    Die Dissertation untersucht die aktuelle Sicherheit der europaeischen Erdgasversorgung. Sie beruecksichtigt zudem die moeglichen Auswirkungen einer Kartellbildung auf die europaeische Gasversorgungssicherheit. Die Arbeit besteht aus einer detaillierten empirischen Studie und darauf aufbauender Szenarioanalyse. Hierzu wird auf den Interdependenzansatz von Robert O. Keohane und Joseph Nye zurueckgegriffen. Zur Darstellung des komplexen Themenbereichs wird auf die Darstellungspraxis der Dichten ...

  19. Paulus as vredemaker. Oor die resepsie van die Brief aan Filemon ...

    African Journals Online (AJOL)

    7 Jul 2015 ... Inleiding. Die woord 'vrede' kom net een maal in die Filemonbrief voor, en wel in die aanhef van die brief. Kommentatore merk egter gereeld op dat 'n mens nie daaruit moet aflei dat dié begrip onbelangrik vir die verstaan van die brief is nie. Om een voorbeeld te noem: Barth en Blanke. (2002) skryf as volg:.

  20. Die berekening van vloeiing in ’n roterende annulus deur die metode van kunsmatige saamdrukbaarheid

    Directory of Open Access Journals (Sweden)

    H. Grobler


    Full Text Available Die vloeiing van ’n onsaamdrukbare, viskeuse vloeier word ondersoek aan die hand van die numeriese oplossing van die gediskretiseerde Navier-Stokes- en kontinuiteitsbeheervergelykings. In die besonder word vloeiing in ’n annulus bestaande uit twee koaksiale silinders wat elk ten opsigte van die ander kan roteer, en met ’n voorgeskrewe drukval oor die lengte van die silinder, beskou. Die oplossings word bereken deur die toepassing van Chorin se metode van kunsmatige saamdrukbaarheid, waarin die tydonafhanklike beheervergelykings getransformeer word na tydafhanklike hulpvergelykings deur die invoering van ’n kunsmatige toestandsvergelyking. Die oplossing van die hulpvergelykings konvergeer na ’n stasionêre oplossing, wat ooreenstem met die oplossing van die oorspronklike tydonafhanklike beheervergelykings. Die gedrag van die vloeier, wanneer ten voile ontwikkelde laminêre vloeiing bereik word, is met sukses bereken. ’n Eenvoudige model vir die bepaling van ontwikkeling van vloeiing langs die annulus vir enige gegewe invloeisnelheidsprofiel word voorgestel. Die berekende resultate stem ooreen met die resultate wat uit die fisika van die probleem verwag word.

  1. Cuidador familiar do idoso em cuidados paliativos: o processo de morrer no domicílio Family caregiver of elderly patients in palliative care: the process of dying at home

    Directory of Open Access Journals (Sweden)

    Flavia Renata Fratezi


    Full Text Available Este estudo teve como objetivos: identificar e analisar o significado do processo de morrer para cuidadores familiares de pacientes idosos em cuidados paliativos. Tratou-se de pesquisa qualitativa com utilização de entrevista. Os dados foram analisados por conteúdo. A presença de doenças crônicas que levam o idoso a necessitar de cuidados paliativos impõe sobre o cuidador familiar sentimentos complexos e ambivalentes. A proximidade e inevitabilidade da morte do idoso colaboram para intensificar esses sentimentos, mas possibilitam ao cuidador resignificar como vivencia essa experiência. Diante desta complexidade, torna-se evidente que a equipe paliativista precisa colaborar junto ao cuidador familiar, no sentido de tentar amenizar essa situação.This study sought to identify and analyze the significance of the process of dying for family caregivers of elderly patients in palliative care. It involved qualitative research with the use of interviews. The data were scrutinized by content analysis. The presence of chronic diseases that lead the elderly patient to require palliative care imposes a series of complex and ambivalent feelings on the family caregiver. The proximity and inevitability of death of the elderly patient exacerbate these feelings, but also lead the caregiver to reconsider how to handle this experience. Given this complexity, it becomes clear that the palliative tem need to work with family caregivers, to try to alleviate this situation.

  2. Die kritiek van tradisie en die tradisie van kritiek in die Geesteswetenskappe. 'n Rekonstruksie van die debat tussen Habermas en Gadamer


    Duvenage, Pieter


    In hierdie bydrae word die bekende debat (1967-1971) tussen Jürgen Habermas en Hans-Georg Gadamer gerekonstrueer. Die debat word hier in noue samehang met die kwessie van die geesteswetenskappe gelees. Die bydrae val in vier dele uiteen. In die eerste afdeling word Habermas se opening tot die debat in vyf onderafdelings uiteengesit. Dit gaan hier oor Gadamer se verdediging van tradisie en Habermas se kritiek op die begrip (1.1). In antwoord op Gadamer se begrip van tradisie ontwerp Habermas s...

  3. Enkele opmerkings oor die intrinsieke waarde van die Latynse teks van Kodeks Bezae as herstelbron vir die Griekse teks van die Nuwe Testament

    Directory of Open Access Journals (Sweden)

    G. J.C. Jordaan


    Full Text Available Een van die belangrikste oud-Latynse vertalings word gevind in Kodeks Bezae, ’n vyfde-eeuse manuskrip van die vier Evangelies. Kodeks Bezae bevat ’n Griekse teks (D en ’n Latynse teks (d van die Evangelies langs mekaar, die Latynse teks in ’n lettertipe wat baie aan die Griekse majuskelskrif herinner. Wat hierdie dokument so merkwaardig maak, is die feit dat dit die enigste manuskrip is wat ’n Griekse Evangelie-teks uit die Westerse teksfamilie bevat.

  4. Die gebruik van die mite in Die werfbobbejaan van Alexander Strachan

    Directory of Open Access Journals (Sweden)

    E. M.M. Klopper


    Full Text Available The use of myths in Die werfbobbejaan by Alexander Strachan This article focuses on the rote of Zulu myths in Alexander Strachan’s novel Die werfbobbejaan. It lakes as point of departure sources on mythology like Cuddon (1991, Baldick (1990, Grimal (1969, Levi-Strauss (1979 and Jung (1969. Die werfbobbejaan essentially recounts the story of a man (the adventurer, the academic, the writer, the hunter who also is the central character in Strachan's two preceding novels. Die werfbobbejaan focuses on the completion of an individuation process in the life of the central character, a process already begun in the preceding two novels and which in this novel finally culminates in the confrontation between hunter and baboon. The completion of this process is facilitated by the African milieu of Zululand where people give meaning to their existence by means of myths, and where no distinction is made between the mythic and rational modes of experiencing reality.

  5. Euthanasia, assisted dying and the right to die in Ghana: a socio-legal analysis. (United States)

    Owusu-Dapaa, Ernest


    There is unanimity among states to protect the continuation of life of the individual as a safeguard against their collective extinction. The right to life is accordingly guaranteed but its antithesis, the right to die is the subject of an unending debate. The controversy over the right to die is deepened by rapid advances in medicine, creating the capability for prolongation of life beyond the span which one's natural strength can endure. Ghana's supreme law explicitly guarantees the right to life but remains ambiguous on right to die, particularly euthanasia and assisted dying. Thus, some of the other rights, such as the right to dignity and not to be tortured, can creatively be exploited to justify some instances of euthanasia. Ghana's criminal code largely proscribes euthanasia. Notwithstanding, proscription of euthanasia and assisted dying by the law, in Ghana's empirical work undertaken in some of the communities in Ghana, suggests that euthanasia is quietly practisedin health facilities and private homes, especially in the rural areas. Contrary to the popular reasons assigned in the literature of the Western world, with respect to the practice or quest for legalization of euthanasia as being a necessity for providing relief from pain or hopeless quality of life, empirical data from social and anthropological studies conducted in Ghana reveal that poverty is the motivation for informal euthanasia practice in Ghana rather than genuine desire on part of patients to die or their relatives to see to their accelerated death. Apart from poverty, traditional cultural values of African societies consider non-natural death as a taboo and ignominy to the victim and his family. Thus, any move by the government to legalize euthanasia will need to be informed by widely held consultations and a possible referendum; otherwise the law may be just a mere transplant of Western models of legislation on euthanasia without reflecting the ethos of the African people.

  6. Die rol van die onderwys in die handhawing en uitbouing van ons volkskultuur

    Directory of Open Access Journals (Sweden)

    G.J. Jordaan


    Full Text Available Op die oog af lyk dit ’n baie maklike onderwerp, maar hoe meer 'n mens daaroor nadink hoe ingewikkelder en omvangryker word die implikasies wat verband hou. Dit is veral so omdat dit hier voor alles gaan om eerste fundamentele uitgangspunte, dit wil sê, om lewens- en wêreldbeskouing. Dit geld van albei komponente — van onderwys sowel as van kultuur.

  7. Die vraag na ’n nuwe belydenisskrif

    Directory of Open Access Journals (Sweden)

    J. H. van Wyk


    Full Text Available Die mees bekende reformatoriese belydenisskrifte dateer uit die sestiende en sewentiende eeue (E 16—17 en is dus almal 300 tot 400 jaar oud: Die Galliese Konfessie 1559, die Nederlandse Geloofsbelydenis 1561, die Heidelbergse Kategismus 1563, die 39 Articles 1563, die Tweede Helvietiese Konfessie 1566, die Dordtse Leerreëls 1619, die Westminsterse Konfessie 1646.

  8. as by die huisbesoek. HP WOLMARANS. PROF. DR. SP ...

    African Journals Online (AJOL)


    van 'n evangeüedienaar wat alles fei! gehad het vir die werk en werk kring waartoe God hom geroep het. Hy is dan ook werklik die eerste grondlegger van die gemeente in Zoutpansberg en die man wat dit opgewerk het. Die geskiedenis van Hofmeyer is die geskiedenis van die kerk- vereniging en die redes waarom die ...

  9. Die krisis van ongeloof in Numeri 13-14

    African Journals Online (AJOL)

    Die ver- haal gebruik die aanloklikheid van die land as 'n submotief om 'n groter drama uit te beeld: die konflik tussen Israel en sy God. ISSN 0259 9422 ... In aansluiting by Eksodus 34 laat die liefde en trou van die Here aan Horn die ...... langs die weg van die tema van veertig jaar dat 'de hoofdstukken 13-14 een sleutel-.

  10. Dying or living?: The double bind. (United States)

    Longhofer, J


    Describing the behaviors of terminally ill patients, their families and those charged with their care has received considerable attention during the past decade. This study of comprehensive cancer treatment and research facility indicates that the prevailing theory is limited to explanation at the intra-psychic level. In her work with hundreds of terminal cases, Dr. Elizabeth Kubler-Ross found that patients typically progress through five stages: 1) denial, 2) anger, 3) bargaining, 4) depression, and 5) acceptance. She concludes that the majority of her patients die in a stage of acceptance--a state of equanimity. Recently, scholars have claimed that this five stage scheme has limited applicability and may in fact contribute to the formalization of a dying person's behavior. This preliminary report proposes that the stage theory, if it has any descriptive validity, becomes meaningful only when used to describe behaviors occurring among patients, families, and medical practitioners. A plausible explanation of these behaviors is accomplished by examination of communication patterns containing the structure of paradox or double bind. Patients are forced to perceive realities about their physical conditions not as they appear to them, but as they are defined by those in their environment. This paper explores these communication patterns in relation to the structure of social relationships and the specific contents of messages being transmitted and received.

  11. MR enterography sequence evaluation for patients with Crohn's disease; Sequenz-Evaluation fuer die MR-Enterografie fuer Patienten mit Morbus Crohn

    Energy Technology Data Exchange (ETDEWEB)

    Schleder, S.; Dendle, L.M.; Friedrich, C.; Wiggermann, P.; Stroszczynski, C.; Schreyer, A.G. [Universitaetsklinikum Regensburg (Germany). Inst. fuer Roentgendiagnostik; Pawlik, M. [Caritas-Krankenhaus St. Josef, Regensburg (Germany). Klinik fuer Anaesthesiologie, Intensiv- und Notfallmedizin; Ott, C. [Universitaetsklinikum Regensburg (Germany). Klinik und Poliklinik fuer Innere Medizin I; Agha, A. [Universitaetsklinikum Regensburg (Germany). Klinik und Poliklinik fuer Chirurgie


    Purpose: To evaluate a routine MR enterography (MRE) protocol for patients with Crohn's disease (CD) in order to assess and rank the subjectively most important sequences regarding diagnostic decisions. Materials and Methods: We prospective ly examined 84 patients (42 male) with known CD using a coronal T2/T1-weighted balanced SSFP (TrueFISP), axial T2-weighted single shot TSE (HASTE) as well as an axial T1-weighted gradient-echo sequence (2D-FLASH) before intravenous contrast application and a 2D-FLASH sequence with axial and coronal orientation after in travenous contrast application. 4 experienced radiologists subjectively evaluate d the sequences independently using a scale between 1 and 5 (1 = excellent; 5 = non-diagnostic) regarding their diagnostic significance for a final radiologic d ecision. The ranking of the different sequences was statistically tested by the Friedman analysis. Results: The following ranking was found: HASTE sequences wer e ranked prior to contrast-enhanced axial gradient-echo (2D-FLASH). The third to fifth ranking was TrueFISP, the axial contrast-enhanced 2D-FLASH and the 2D-FLA SH without contrast, respectively. Differences between the first and second rank were significant (p < 0.05), and all other differences were highly significant (p < 0.01). Conclusion: The stable and fast T2-weighted MR sequences without intravenous contrast represented by axial HASTE and coronal TrueFISP were ranked as number 1 and 3. The examination protocol should be completed by a coronal T 1-weighted gradient-echo-sequence after contrast injection, which can be supplemented by an axial acquisition. The T1-weighted gradient-echo sequence without contrast could be omitted. (orig.)

  12. Der Nahostkonflikt und die Medien

    Directory of Open Access Journals (Sweden)

    Carola Richter


    Full Text Available Diese Einführung in eine Themenausgabe zu den vielfältigen Rollen der Medien im Nahostkonflikt skizziert die Probleme, die sich für Medien und Journalisten als Akteure im Konflikt, Adressaten der Konfliktparteien und Anlass für Konflikt durch ihre Berichterstattung ergeben. Das Konfliktgebiet Israel und Palästina ist sowohl für Forschung über Auslandsbericht-erstattung, über transnationale Agenda Building- und Public Diplomacy-Prozesse als auch über mediensystemische Entwicklungen in Besatzer- und Besatzungsgebieten interessant. Der Artikel gibt einen Überblick über das Feld und führt dabei in die in der Themenausgabe präsentierten empirischen Studien zum Nahostkonflikt und den Medien ein.


    African Journals Online (AJOL)

    teen gekant was, is dit op 15 Oktober 1880 by die Kaapkolonie ingelyf.9. Gedurende sy kortstondige bestaan van minder as 'n dekade lank het die kroonkolonie Griekwa- land-Wes met talle finansiele, ekonomiese, so- siale en ander probleme te doen gehad. Een van die ernstige probleme was die bedreiging wat.

  14. Die Gereformeerde Ekumeniese Sinode en Sending 1984

    African Journals Online (AJOL)

    opvatting. Indien 'n mens al die kerke wat aan die Gereformeerde. Ekumeniese Sinode (GES) behoort een vir een sendingmatig sal be- studeer, sal daar waarskynlik 'n sterk differensiasie tussen sommige kerke aan die lig kom. Die GES kan dus nie verantwoordelik gehou word vir individuele kerke se sendingopvatting nie.

  15. voorgeskiedenis tot die stigting van 'n unieverdedigingsmag

    African Journals Online (AJOL)

    gesien nie en toe die wetsontwerp op 23 Februa- rie 1912 deur Smuts in sy hoedanigheid as Mi- nister van Verdediging ingedien is, het Beyers heelwat kritiek daarop gehad. Beyers het be- weer dat dit op vergaderings geblyk het dat die volk wou he Engeland moet steeds die verdedi- ging waarneem aangesien die Unie ...

  16. Moderne diskoerse in die teologie vandag

    Directory of Open Access Journals (Sweden)

    J.H. van Wyk


    Full Text Available In hierdie artikel word aandag gevra vir enkele moderne diskoerse in die teologie vandag. Volgens die outeur staan die vrae oor God, Jesus, die mens en die aarde in die sentrum van belangstelling en oorheers dit in ’n groot mate die teologiese debat. Die opkoms van die moderne aggressiewe ateïsme, die wetenskaplike navorsing oor die historiese Jesus, die groeiende vrae oor die mens en die menslike samelewing, asook die dreigende ekologiese krisis op aarde, sorg vir nuwe debatte van ongekende omvang. Die outeur bespreek hierdie debatte oorsigtelik, met kritiek waar nodig, en sluit af met enkele rigtingwysers van wat hy as ‘goeie teologie’ verstaan. In this article attention is paid to some modern discourses in theology today. According to the author the questions about God, Jesus, man and the earth are in the centre of interest and to a large extent dominate the theological debate. The rise of modern aggressive atheism, the scientific research on the historic Jesus, the growing questions about man and human society as well as the threatening ecological crisis on earth, provide new discourses of unparalleled magnitude. The author provides a broad summary of these discourses, with criticism where necessary, and concludes with some indicators of his view what can be called ‘good theology’.


    African Journals Online (AJOL)

    Die geboorte van meer as 2 lammers per ooi is egter ongewens in die Karakoelbedryf aangesien dit aanleiding gee tot kleiner pelse veral wanneer voedingstoestande nie opti- maal is nie. In stoetteling is selfs tweelinge nie gewens nie, aangesien die ware fenotipiese waarde van die lammers nie in tweelinge te voorskyn ...

  18. Calvyn en die kerklike orde: Enkele opmerkings

    African Journals Online (AJOL)

    Om dié saak verder te belig word ook van die latere uitsprake van Calvyn in hierdie verband in berekening gebring. Met hierdie beperkte studie word dus in die eerste plek die feit in herinnering geroep dat dit vanjaar 450 jaar gelede is dat Calvyn se. Institusie die eerste maal in Basel verskyn het. Terselfdertyd word hier-.

  19. Dying in the Hospital: Perspectives of family members. (United States)

    Dose, Ann Marie; Carey, Elise C; Rhudy, Lori M; Chiu, Yichen; Frimannsdottir, Katrin; Ottenberg, Abigale L; Koenig, Barbara A


    Although most patients express a preference to die at home, many (over 30 percent) still die in hospital. This study's purpose was to explore the experience of hospital death from the perspective of patients' family members. interviews were conducted with family members of patients who had died at hospitals affiliated with a large tertiary referral centre in the United States. Content analysis was used to analyze findings. We interviewed 30 family members by phone. Themes were arranged by time frame: before death, time of death, and after death. Families do not interpret clinical cues leading up to death in the same way healthcare providers do; families need clear and direct explanations from providers. Clinicians should assess patient and family understandings of prognosis and communicate clearly and directly. Family members value being with their loved one at the time of death, and they value spending time with the body after death; this should be facilitated in clinical practice.

  20. Leerteoretiese basis van die andragogie

    Directory of Open Access Journals (Sweden)

    C. J. A. Simpson


    Full Text Available Learning theory basis of andragogy. A cursory glance at andragogy creates the impression that humanistic learning theory plays an all encompassing role in the learner centered approach andragogy espouses. A closer look, however, reveals that Knowles (1973, after having made an intensive study of learning theory, created an extensive framework within which human resource development can take place. The fact that Knowles attracted critique from different areas, led to a need to ascertain the role different learning theories, if any, played in the emergence of andragogy. Having looked at the assumptions displayed by the andragogical approach, as well as a comparison of different learning theories and their connection with andragogy, it became clear that andragogy contains elements of various learning theories in an adapted way. These adaptations resulted in an approach to adult education in which learners are given the opportunity to be part of the learning process in such a way that they themselves contribute to the development which takes place. Opsomming Met 'n eerste oogopslag wil dit voorkom asof humanistiese leerteorie 'n oorheersende rol in die leerdergesentreerde benadering van andragogie speel. By nadere ondersoek blyk dit egter dat Knowles (1973, na 'n deeglike studie van verskillende leerteoretiese beginsels, 'n omvangryke raamwerk geskep het waarbinne, aan die hand van verskeie aangepaste leerteoretiese beginsels, menslike hulpbronontwikkeling kan plaasvind. As gevolg van die feit dat Knowles vanuit verskillende oorde kritiek op die lyf geloop het, is besluit om die rol wat verskillende leerteorieë in andragogie speel, te bestudeer. Dit blyk dat andragogie nie net elemente van verskillende leerteorieë bevat nie, maar dat toepaslike aspekte van die teoriee wat ondersoek is, benut en aangepas is om 'n geintegreerde benadering te bewerkstellig waarin veral volwassene-leerders by leergeleenthede en hulle selfontwikkeling betrek word.

  1. Method of treating tool steel die materials

    International Nuclear Information System (INIS)

    Cook, C.S.; Damon, S.


    In a method of hardening pilger dies to provide a hard case containing residual compressive stresses and tough body, the tool steel die is heated to the austenitizing temperature range, followed by selectively removing heat from the die at a predetermined faster rate in the direction of the desired case than the rate of heat removal from the balance of the die, and thereafter tempering the die. The invention provides a fully hardened and tempered case on the working surface of the die and a tough body in the balance of the die, usually of lower hardness. (author)

  2. Die «ASEAN-Wirtschaftsgemeinschaft»

    DEFF Research Database (Denmark)

    Juego, Bonn


    Seit dem Ende der 1990er-Jahre verfolgt die ASEAN die Vision einer politischen, wirtschaftlichen und sozialen Gemeinschaft. Doch wie realistisch ist die Umsetzung eines solch ambitionierten Vorhabens vor dem Hintergrund der enormen Heterogenität der Region? ASEAN vereint Staaten auf...... Entwicklungsstufen, wie sie unterschiedlicher kaum sein können. Der Autor, Bonn Juego, nimmt die ASEAN Vision 2020 sowie die Debatten, die diesbezüglich in den einzelnen Ländern geführt werden, unter die Lupe. Er geht dem Potenzial des ASEANAnsatzes zu sozialer Teilhabe und wirtschaftlicher Verteilungsgerechtigkeit...

  3. Die pastorale begeleiding van predikante van die Nederduitse ...

    African Journals Online (AJOL)

    21 Jan 2013 ... Stone, M.F., 1999, Coaching, counselling & mentoring: How to choose & use the right technique to boost employee performance, AMACOM, New York. Strydom, W.A., 2011, 'Pastoraat aan getraumatiseerde kinders in die intensiewesorgeenheid: 'n Gestalt benadering', DD tesis, Universiteit van Suid-. Afrika ...

  4. 'n Begronde bedieningsmodel vir die diakonia van die gemeente

    African Journals Online (AJOL)

    15 Feb 2012 ... At first, various angles of approach to the research on ministry in ... Lingenfelter 2005; Armour & Browning 2000) en daarmee saam die ...... Grobler, A.B. & Van der Walt, A.L., 2008, 'An assessment of the management skills.

  5. Die ontwikkeling van menslike potensiaal in die Republiek van Suid ...

    African Journals Online (AJOL)

    Erna Kinsey

    Dit het dus ook te doen met lewenstandaard, aangesien lewenstandaard `n bepalende faktor is met betrekking tot die optimale ontwikkeling van menslike potensiaal. Ander minder materiële aspekte van menslike potensiaal het te doen met menslike vryheid, waaronder vryheid van spraak, beweging en keuse ter sake is.


    African Journals Online (AJOL)

    20 van 1898 van die Kaapkolonie, getiteld The Navy Contribution. Act, i898 is a.m. ... as a contribution towards the annual expenditure by the ...... The above are inclusive of all allowances for lodging and provisions. Petty Officer Ins ...... that system we can retain full constitutional control not only in theory but also complete ...

  7. Die Korallenfauna des Perm von Timor und die permische Vereisung

    NARCIS (Netherlands)

    Gerth, H.


    Bei den zahlreichen Rekonstruktionen der klimatologischen Verhältnisse, die man für das Ende des Palaeozoikums gemacht hat, ist man fast immer von der Kohlenbildung, der Florenverbreitung und den Vereisungserscheinungen ausgegangen. Der marinen Tierwelt hat man bei der Behandlung dieser Fragen meist

  8. [Dying with cancer: Hollywood lessons]. (United States)

    Niemeyer, Fernanda; Kruse, Maria Henriqueta Luce


    The study attempts to understand how dying from cancer is portrayed by five movies produced in Hollywood between 1993 and 2006. Based on the cultural studies and their post-structuralism version and supported by the notions of discourse and subjectivity, as proposed by philosopher Michel Foucault, we suggest one of the possible readings of the movie picture corpus. We assess how the movie picture discourse acts as a cultural pedagogy that produces ways of seeing dying with cancer: immortalizing the healthy body image, silencing death, taking care of the dead body and, finally, accepting death. Our proposal is intended to stimulate reflections that may contribute to care and education in nursing.

  9. ’n Etiek van liefde: Die etiese perspektiewe van die Heidelbergse Kategismus

    Directory of Open Access Journals (Sweden)

    Koos Vorster


    Full Text Available Hierdie artikel behandel die etiese perspektiewe van die Heidelbergse Kategismus – een van die prominente belydenisskrifte in die gereformeerde tradisie. Die etiese relevansie is ingebed in die konfessie se verklaring van die tien gebooie. Die artikel verduidelik dat die etiek van die Heidelbergse Kategismus ten diepste ’n karakteretiek is en dat dit gelowiges oproep tot ’n etiek van liefde. Hierdie liefde sluit in liefde vir die verbondsgemeenskap, die bediening van die Woord, die heiligheid van God en die waardigheid van mense, die gemeenskap van die gelowiges, gesag, die lewe, die huwelik, privaatbesit en arbeid asook waarheid en geregtigheid. As gevolg van die sinekdogeekarakter van die wet is hierdie etiek van liefde vandag baie relevant. This article deals with the ethical relevance of one of the prominent confessions in the reformed tradition, namely the Heidelberg Cathechism. The ethical relevance lies in the confession’s elucidation of the ten commandments and its application to moral conduct. The article explains that the ethics of the Heidelberg Catechism is essentially a virtue ethics calling for an ethics of love. This love should include love for the covenantal communion, ministry of the Word, the holiness of God and the dignity of people, the communion of the saints, authority, life, marriage, private property and labour, and truth and justice. Due to the synecdochical character of the ten commandments this ethics of love is highy relevant in the present times.

  10. Die Freunde im und die Freude am Fernsehen

    Directory of Open Access Journals (Sweden)

    Amina Ovcina Cajacob


    Full Text Available Das Ziel der vorliegenden Arbeit besteht darin, die Wirkungen von Popstars und Popbands auf Jugendliche (13- bis 17-Jährige zu erforschen. Im Mittelpunkt der Interessen steht die Frage, welche Wirkungen aus der Rezeption von Musiksendungen (bzw. Videoclips von Musiksendern entstehen und welche Charakteristika innerhalb der aufgebauten Beziehungen zu den Stars bemerkbar sind. Andererseits wurden die Unterschiede und Parallelen zwischen parasozialen Beziehungen zu den Stars und orthosozialen Beziehungen aufgezeigt. Im Zusammenhang mit der empirischen Untersuchung bezieht sich die Autorin auf den Uses-and-Gratifications-Approach, wobei die bedürfnissbefriedigenden Wirkungen von Musikkanälen und den dazu gehörigen Popstars im Mittelpunkt stehen. Mit Hilfe des Uses-and-Gratifications-Approach wird angenommen, dass das Konsumieren der Musiksendungen und der Musikstars von den Jugendlichen gezielt zur Befriedigung bestimmter Bedürfnisse eingesetzt wird.The objective of this study is to explore the effects of pop stars on adolescents (aged between 13 and 17. The focus of interest is the question what effect music channels (i.e. video clips from music channels produce and what characteristics are noticeable from the formed relationship between adolescents and pop stars. On the other side, parallels and differences have been drawn between the para-social relationships to pop stars and ortho-social relationships. In connection with empirical study, the author also refers to Uses-and Gratification-Approach where the need satisfying effects of music channels and pop stars are in focus. With the help of Uses-and Gratification-Approach it will be assumed, that aim of watching music channels and therefore pop stars will be pointed toward the gratification of specific needs.

  11. Die WTO in Hongkong: Zwischenergebnisse einer "Entwicklungsrunde"


    Küblböck, Karin; Six, Clemens


    Die sechste Ministerkonferenz der Welthandelsorganisation (WTO), die von 13. bis 18. Dezember 2005 in Hongkong stattfand, war mit dem Anspruch angetreten, die Agenda der Doha-Entwicklungsrunde, also die B erücksichtigung der Interessen und ökonomischen Bedürfnisse der Entwicklungsländer und insbesondere der am wenigsten entwickelten Staaten, um wesentliche Schritte im Hinblick auf einen erfolgreichen Abschluss voranzubringen. Die Ergebnisse sind vor dem Hintergrund des Anspruches dieser Verha...

  12. Chirurgie in die Grieks-Romeinse era

    Directory of Open Access Journals (Sweden)

    François P. Retief


    Full Text Available In die Grieks-Romeinse era het mediese behandeling kenmerkend uit drie elemente bestaan, naamlik regimen (dieet en gesonde leefwyse, geneesmiddels en chirurgie – laasgenoemde alleen toegepas indien regimen en geneesmiddels onsuksesvol was. Bewyse van primitiewe chirurgie dateer terug na die Bronstydperk, en in Homerus se eposse is heelwat vermelding van die chirurgiese hantering van oorlogswonde, met tussenkoms van die gode. Met die koms van empiriese geneeskunde in die 5de eeu v.C. het chirurgie in die Hippokratiese Corpus prominent gefigureer met beduidende bydraes in veral die ortopediese veld en hoofbeserings. Uitbouing van anatomiese en fisiologiese kennis, gebaseer op disseksie van menslike kadawers in Alexandrië vanaf die laat 4de eeu v.C., het chirurgie ’n hupstoot gegee. Teen die Romeinse era vanaf die 2de eeu v.C. het snykundetegnieke (en -instrumente beduidend verbeter, maar is steeds oorwegend deur Griekse geneeshere beoefen. Van geneeshere is steeds verwag om al drie bovermelde terapeutiese modaliteite te bemeester, maar chirurgie het meer aansien verwerf en daar is al meer in onderafdelings van chirurgie soos oogheelkunde, vrouesiektes en verloskunde, blaaskwale en mond- en keelsnykunde gespesialiseer. Militêre geneeskunde was in die Romeinse Ryk ’n belangrike aktiwiteit, en het veral traumachirurgie uitgebou. Betreding van die buik- en toraksholtes was nie meer noodwendig fataal nie, en veeartsenykunde het tot stand gekom. Die eerste beduidende chirurgiehandboek ná die Hippokratiese Corpus is in die 1ste eeu n.C. deur Celsus opgestel. Vanaf die 3de eeu het die chirurgieberoep min vordering gemaak, die beroepstaal het mettertyd van Grieks na Latyn verander en kundigheid is later veral deur Islam-geneeshere na die Middeleeue en later oorgedra.

  13. Bevordering van transformerende leer: Die skryf van ’n reflektiewe joernaal in die Natuurwetenskappe

    Directory of Open Access Journals (Sweden)

    Erna R. du Toit


    Full Text Available Die doel van die artikel is om aan te toon hoe die skryf van ’n reflektiewe joernaal in die Natuurwetenskappe die perspektiewe en denke van onderwysstudente kan transformeer en/of leer kan bevorder. Die studie maak voorspraak vir die gebruik van ’n reflektiewe joernaal as ’n instrument vir studente om betekenis te gee aan die leeromgewing vanuit verskillende perspektiewe deur te leer in praktyk. ’n Kwalitatiewe navorsingsmetode is gevolg om die inskrywings in ’n joernaal te analiseer aan die hand van bepaalde indikatore. Die bevindinge toon dat die meeste studente na die praktykervaring positief was en sommiges het tot ander perspektiewe vanweë hul ervaring gekom.

  14. Die invloed van drie kruisbestuiwers op die saadinhoud van Minneola tangelo (Citrus parodist x C reticulata

    Directory of Open Access Journals (Sweden)

    H. J. Esterhuizen


    Full Text Available Die invloed van verskillende kruisbestuiwers (Clementine, Empress en Valencia op die gemiddelde saadinhoud van Minneo­la tangelo is ondersoek. Clementine en Empress as kruisbestuiwers het die grootste invloed op die gemiddelde saadinhoud van die vrugte gehad, terwyl dié van Valencia nie noemenswaardig was nie. Die gemiddelde saadinhoud van die vrugte het afgeneem met toename in afstand vanaf die kruisbestuiwer. Indien ’n beperking op die afstand tussen kultivar en kruisbestuiwer geplaas word, sal ’n groter persentasie vrugte aan uitvoerstandaarde ten opsigte van saadinhoud voldoen.


    African Journals Online (AJOL)

    sedert die vroeg 1900's deur die Weermag be- heer. In 1967 was dit die eerste militere terrein wat tot privaatnatuurreservaat verklaar is. Vhembe bestaan uit 4 hoofplantgemeenskappe nl. rivieraewerbos, vloedvlaktes, ranteveld en die sandveldplato. Wildsoorte op die terrein sl!Jit rooibokke, bosbokke, waterbokke, koedoes,.

  16. Die era van Suid-Afrika se militere hoogbloei met die ...

    African Journals Online (AJOL)

    4 Jun 1976 ... Die Toyota 1200 bakkie is geadverteer met die woorde 'Hier kom die pantserbakkie', teen die agtergrond van 'n olifant tenk.32. Daar is ook 'n betrekking deur Thorold en van Wyk geadverteer waar militere opleiding 'n voorvereiste was.33. Daar was ook films wat weermag en polisie gebasseer is wat in die ...

  17. Riglyne vir ‘n omvattende verrykingsprogram vir die bevordering van die geestesgesondheid

    Directory of Open Access Journals (Sweden)

    Antoinette Gmeiner


    Full Text Available In Suid-Afrika, met die snelle veranderinge in die politiek, ekonomie, lewenstyl en tegnologiese vooruitgang, gepaard met die geweld tans in die land, is die lewenskwaliteit van mense so bemvloed dat produktiwiteit en gedrag benadeel is. *Please note: This is a reduced version of the abstract. Please refer to PDF for full text.

  18. Etíese perspektiewe vir die bantering van konflik in die mediese ...

    African Journals Online (AJOL)

    mits versagtende omstandighede nie aangevoer kan word nie. Die howe oefen dan ook alleen sy regterlike funksie uit oor 'n konkrete geskil wat van daadwerklike belang vir die werklike partye is (Strauss 1982:14). Die hof laat hom lei deur die maatstaf van goeie sedes, die boni mores. Regter Mostert se verduideliking in ...

  19. ontwikkeling van die gemenereg in die lig van artikels 39(2)

    African Journals Online (AJOL)


    'n Mens kan met reg vra of die ius connubiorum van Brouwer en die Law of. Husband and Wife van ... AD 560 (Geheime Raad) 563. 5 Sien vir besonderhede Hahlo en Kahn SA Legal System and its Background 304. ..... Die Franse chemikus, Antoine Lavoisier, is in 1794 tydens die Franse revolusie tereggestel. Terwyl die ...

  20. Die wonders in Johannes 6 verklaar aan die hand van 'n ...

    African Journals Online (AJOL)

    Maar die Evangelie van Johannes gee self 'n aanduiding van wat die intensie van die geskrif is, te wete Johannes 20: 30-31: Jesus het nog baie ander wondertekens, wat nie in hierdie boek beskrywe is nie, voor sy dissipels gedoen. Maar hierdie wonder tekens is beskrywe sodat julle kan glo dat Jesus die Christus is, die.

  1. How Tycho Brahe really died

    DEFF Research Database (Denmark)

    Jacobsen, Aase Roland; Petersen, Lars


    In 2001 we commemorate the 4th centenary of the death of Tycho Brahe, perhaps the first great scientists in a modern sense.This famous Danish astronomer died in Prague on the 24th of October 1601, eleven days after he had attended a banquet at the Bohemian count of Rosenberg. Tycho was too courte...

  2. Die Suche nach den Gottesteilchen

    CERN Multimedia


    2008 wird der größte jemals gebaute Teilchenbeschleuniger in Betrieb genommen Anlässlich des Mathematik-Jahres 2008 hat der Experimentalphysiker der Universität Hamburg und der designierte Generaldirektor des europäischen Zentrums für Teilchenphysik CERN in Genf, Rolf-Dieter Heuer, die Bedeutung des Dialogs zwischen Naturwissenschaftlern und Philosophen hervorgehoben.

  3. When a major star dies

    International Nuclear Information System (INIS)

    Joubert, G.


    Astrologers are slowly learning what happens when a star dies. On the night of 23-24 February 1987, the light of an exploding star - a supernova with the name SN 1987A - reached the earth. In this article this astrological event of the century are discussed, and its importance for astrologers

  4. polisemie in die woordeboek - 'n

    African Journals Online (AJOL)

    mous items, the problem of monosemic prototype categories vs. polysemous prototype categories, ...... bv. te make met kulturele norme vir die drink van warm vloeistowwe. ..... (en nie bv. teen ander soorte water of ander soorte chemiese middele nie) gede- ...... INLIGTING VERSKAF TE WORD (EN VERW AG DIT AS SODA-.

  5. Die verhouding tussen kerk en staat: Enkele modelle met verwysing ...

    African Journals Online (AJOL)

    ook ingaan op die vraag na die reg tot opstand teen die gesag van die staat soos dit in hierdie modelle beantwoord word. Ons wil eindig by die vraag na 'n teologiese model wat geskik is vir ons dag. 1. DIE TEOLOGIESE MODEL VAN DIE ROOMS-KATOLIEKE. KERK. Die Rooms-Katolieke Kerk se opvatting word bepaal ...

  6. die rol van kleurlinge in suid afrika se militere verlede

    African Journals Online (AJOL)

    die geval, want hierdie volks- groep het 'n lang en kleurryke historiese verbin- tenis met die miltere verlede van Suid-Afrika. Die feit dat die Kleurlinge nou op die drumpel staan van 'n nuwe tydvak in die staatkundige ontwikke- ling van die Republiek van Suid-Afrika, beteken ook nie dat hulle vir die eerste maal ten nouste.

  7. Die stand van wiskundeonderwys in Afrikaanse skole

    Directory of Open Access Journals (Sweden)

    Gerrit Stols


    Full Text Available Hoërordedenkvaardighede is noodsaaklike basiese vaardighede vir die een-en-twintigste eeu aangesien rekenaars berekeninge en algoritmes baie vinniger en akkurater kan doen as mense. Dit beteken dat skole leerders moet toerus om logies te dink, patrone te ontdek, bewyse te lewer, asook om nieroetineprobleme op te los. Hierdie fasette wat as hoërordedenke geklassifiseer word, is die kern van wiskundige denke en ontwikkeling. Suid-Afrika neem aan verskeie internasionaal vergelykende studies deel. Met behulp van hierdie vergelykende studies kan bepaal word hoe die Afrikaanse wiskundeleerders in Suid-Afrika se prestasie met dié van leerders in ander lande vergelyk en ook wat die tekortkominge in die wiskundeonderwys is. Volgens die 2003-TIMSS-uitslae is die probleem in Afrikaanse skole juis dié vrae wat hoërordedenke vereis. Dit beteken dat die Afrikaanse skole ’n doelbewuste poging sal moet aanwend om hoërordedenke te ontwikkel. Die 1999-TIMSS-videostudie toon dat die lande wat die beste presteer, soos Japan, tydens onderrig meer tyd wy aan die ontwikkeling van begripsvorming en aan die oplos van moeiliker probleme. Die fokus in die presterende lande is op die ontwikkeling van hoërordedenke deur probleemoplossing. Daar word dus minder tyd afgestaan aan herhaling van roetine- of soortgelyke oefeninge wat ’n rekenaar ook kan doen. Die omgekeerde hiervan is ’n tipiese verskynsel in Afrikaanse skole, waar ’n onderwyser byvoorbeeld een of meer voorbeelde op die bord doen waarna die leerders ’n hele aantal soortgelyke roetine-oefeninge doen.

  8. Die Hervormde Kerk en apartheid

    Directory of Open Access Journals (Sweden)

    Wim A. Dreyer


    Full Text Available The Reformed Church and apartheid. This contribution examines the changing attitude of the Nederduitsch Hervormde Kerk van Afrika (NHKA towards apartheid, specifically since the Second World War. The NHKA’s views started with a theological justification of apartheid and the complete identification of the church with Afrikaner nationalism, moving to a position of critical solidarity and eventually the rejection of apartheid and its own theological justification of apartheid in 2010.

  9. Die naslaanpotensiaal van lemmakandidate vir ʼn ...

    African Journals Online (AJOL)

    Kate H

    Afrikaans-woordeboek in die gedrukte medium plaas welbekende tradisionele beperkinge op die leksikograaf, waarvan die vernaamste dié op ruimte is. Gegee die konteks, teikengebruiker, gebruikersituasie en funksie van die woordeboek moet ...

  10. a studyof faecal of faecal coliform die coliform die coliform die-off

    African Journals Online (AJOL)


    COLIFORM DIE-OFF IN SEWAGE SLUDGE DRYING BED. OFF IN SEWAGE SLUDGE ..... This method was used to measure evaporation from the bed because of .... thermometer with external sensor probe, model No. ST-9283A/B/C and a ...

  11. Die spel van assosiasies in en om 'Die verlossing van die beeld' van Breyten Breytenbach

    Directory of Open Access Journals (Sweden)

    P.A. du Toit


    Full Text Available The play of association in and around 'The liberation of the image' by Breyten Breytenbach This analysis focuses on the conjunction of memory and imagination, which is an important impulse in, and key to, Breytenbach’s work. The play with language and with associations, the foregrounding, in the short story, “Die verlossing van die beeld” (Breytenbach, 1983 with its metafictional title and apparently divergent motifs (rain/water, watch, onion, the death and burial of a grandfather acts, as it were, as an invitation to the reader to become a co-player. The reader ventures on a search for traces, intertextual links within the Breytenbach oeuvre and for already acknowledged influences such as Surrealism (which in turn casts some light on the strange title of the story and the Eastern philosophies such as Zen and the even older Taoism. The analysis also takes into account the context in which “Mouroir” was written, namely Breytenbach’s term in prison (1975-1982. Seeing that the writer had to hand in his manuscripts to the jail authorities regularly, he might have decided, consciously or by intuition, to hide some thoughts and feelings behind a screen or a mask, in, for example in “Die verlossing van die beeld”, a lighter tone and irony.

  12. Die Romeinse nastrewing van onsterflikheid deur middel van memoria

    Directory of Open Access Journals (Sweden)

    D. R. Fouché


    Full Text Available Benewens die omvangryke en nasionale manifestasies van die oorspronklike onsterflikheidsgedagte in die Romeinse gemeenskap, vind ons by die Romein op kleiner skaal in groepe of indiwidueel ’n strewe na onsterflikheid langs die weg van memoria. Soos aangetoon sal word, verskil die pogings van die verskillende groepe radikaal van mekaar, hoewel die strewe en einddoel dieselfde bly, naamlik om deur die daarstelling van memoria op die gebied van woord of daad onsterflikheid te bekom.

  13. Eventual sport performance level: What about the role of type of sport, perception of critical life events, and practice quality? (United States)

    Toering, Tynke


    The target article describes an interesting study, which provides some challenging findings regarding athletes' pathway to excellence. The suggested links between critical life events, need for success, personal characteristics, and eventual performance level make sense from a psychodynamic perspective. This commentary will discuss some critical points related to the application of the findings in talent identification and -development programs. These are (1) the possible effect of the selection of participants on the results (including the impact of dependence on others for team sport athletes and the opportunity for multiple medal attainment), (2) a lack of detail in the description of how the athletes approached the critical life events (the perception of an event may contribute more to development than the event itself), and (3) a lack of detail in the description of the practice process throughout development. Some interesting differences were found in the motivation for and approach to practice, but little detail was given about what the athletes exactly were doing at the time. The concept of self-regulated learning may be useful in explaining how super-elite athletes action their goals through quality practice. © 2017 Elsevier B.V. All rights reserved.

  14. United Kingdom. Development plan for the eventual closure of the UK Drigg nuclear surface low level waste disposal facility

    International Nuclear Information System (INIS)


    The Drigg site, owned and operated by BNFL, is the UK's principal site for the disposal of low level radioactive waste. The site has operated since 1959 and receives wastes from a wide range of sources including nuclear power stations, nuclear fuel cycle facilities, isotope manufacturing sites, universities, general industry and cleanup of historically contaminated sites. Disposals until the late 1980s were solely by tipping essentially loose wastes into excavated trenches. More recently, trench disposals have been phased out in preference to emplacement of containerised, conditioned wastes in concrete vaults. The standardised wasteform consists of high force compacted (or non-compactable) waste immobilised within 20 m 3 steel overpack containers by the addition of cementitious grout. Larger items of wastes are grouted directly, in situ in the vault. The disposal trenches have been completed with an interim cap, as will the vaults when filled. It is currently estimated that sufficient capacity remains at Drigg for disposals to continue until at least 2050. Post-operations it is planned that the site will enter a phase including shut down of operational facilities, emplacement of long term site closure features including a final closure cap and then to an institutional management phase. Planning has therefore been carried out as to the strategy for eventual closure of the site. This closure strategy is also underpinned by an engineering evaluation studies programme to develop and evaluate appropriate closure measures including assessment of the long term performance of such measures. This appendix summarizes some of this work

  15. OpenStack Swift as Multi-Region Eventual Consistency Storage for ownCloud Primary Storage

    CERN Multimedia

    CERN. Geneva


    As more users adopt AARNet’s CloudStor Plus offering within Australia, interim solutions deployed to overcome failures of various distributed replicated storage technologies haven’t kept pace with the growth in data volume. AARNet’s original design goal of user proximal data storage, combined with national and even international data replication for redundancy reasons continues to be a key driver for design choices. AARNet’s national network is over 90ms from end to end, and accommodating this has been a key issue with numerous software solutions, hindering attempts to provide both original design goals in a reliable real-time manner. With the addition of features to the ownCloud software allowing primary data storage on OpenStack Swift, AARNet has chosen to deploy Swift in a nation spanning multi-region ring to take advantage of Swift’s eventual consistency capabilities and the local region quorum functionality for fast writes. The scaling capability of Swift resolves the twin problems of geogr...

  16. Professionalisme met verwysing na die posisie van bedryfsielkunde en die bedryfsielkundige in Suid-Afrika

    Directory of Open Access Journals (Sweden)

    A. van der Merwe


    Bedryfsielkunde, as relatief jong maar snelgroeiende wetenskap, word aan die hand van ses kriteria vir 'n professie evalueer. Resultate in hierdie verband dui in die algemeen daarop dat die vakgebied alreeds vir 'n aantal jare in 'n oorgangsfase tot ‘n volwaardige professie is en dat daar in hierdie proses reeds ver op die professionele kontinuum gevorder is. Verdere onder-soeke ten opsigte van professionele opleiding, die statutêre organisering van Bedryfsielkunde asook 'n professionele kode en vereniging vir die Bedryfsielkunde word bepleit ten einde die professionele posisie van die vakgebied volledig te konsolideer.

  17. Die ausbildung von wertbedeutungen im schuljugendalter*

    Directory of Open Access Journals (Sweden)

    Siegfried Heusinger


    Full Text Available Die folgenden Darlegungen stützen sich auf Untersuchungsergebnisse des Verlassers zur Sprachentwicklung in der Ontogenese. Angeregt wurde die UnterSuchung durch die besonders in den letzten Jahren in mehreren Ländern verstärkt erhobenen Forderungen, nicht nur die Sprache des Klein­ kindes, sondern vornehmlich den Entwicklungsstand der Schülersprache auf den einzelnen Klassenstufen zu erforschen und den Prozeß der Sprachentwicklung des Schülers genauer zu bestimmen. Die Forderungen sind (so z. B. in der DDR durch das Bestreben motiviert, weitere wissenschaftliche Voraussetzungen für die Verbesserung der muttersprachlichen Bildung und Erzliehung zu schaffen. Es geht also vor allem um Bedürfnisse des Muttersprachunterrichts, die aus der gesellschaftlichen Bedeutung der Sprache überhaupt und den steigenden Anforderungen an die gesellschaftliche Kommunikation insbesondere erwachsen.


    African Journals Online (AJOL)

    soortnaam plus soortnaam" kan albei komponente in Engels. 'n hoofletter kry, in Afrikaans slegs die eerste lid. Vergelyk Cash. Sale,. Kontantultverkoping. Uit 'n reklame-oogpunt Is die Engelse model bulgsamer, funksioneler en doelmatiger as ...

  19. [Die Gründung...] / Anders Henriksson

    Index Scriptorium Estoniae

    Henriksson, Anders


    Rets.: Karsten Brüggemann. Die Gründung der Republik Estland und das Ende des "Einen und unteilbaren Russland" : die Petrograder Front des Russischen Bürgerkrieges, 1918-1920. Wiesbaden : Harrassowitz, 2002

  20. Die uitbeelding van die vrou in Huisgenoot (1963 en 2013: ’n Multimodale diskoersanalise

    Directory of Open Access Journals (Sweden)

    Susann H. Marais


    Full Text Available Die standpunt dat die mens en die media in ’n verhouding van wedersydse beïnvloeding staan, sowel as die studie wat die kulturele konseptualisering van vroulikheid in twee Huisgenoot-uitgawes (1953 en 2003 ondersoek, geld as uitgangspunt vir dié studie. Hierdie studie het ten doel om te bepaal of daar ’n verskil is in die uitbeelding van die vrou in die Huisgenoot uitgawes van onderskeidelik 1963 en 2013. Volgens navorsing werk die visuele beeld en geskrewe teks saam om ’n boodskap oor te dra. Multimodale diskoersanalise (MDA word juis gebruik om beide visuele beeld en geskrewe teks te bestudeer. Sodoende word die metode van intersemiotiese komplementariteit binne MDA in hierdie studie gebruik. Die studie kom tot die gevolgtrekking dat die uitbeelding van die ideale vrou se verantwoordelikhede uitgebrei is, maar dat die vrou se rol tóg tot sekere ruimtes beperk word, soos die sigbaarheid van die moeder-stereotipe weerspieël.

  1. Die waarde van voorafopleiding deur die ouer vir pedo-oudiometrie by drie- en vierjarige kleuters

    Directory of Open Access Journals (Sweden)

    Merisa Lodewyckx


    Full Text Available Die verkryging van akkurate, betroubare inligting aangaande die gehoorvermoë van jong kinders is van besondere belang vir die oudioloog, maar word dikwels bemoeilik aangesien die kleuter nie goeie samewerking bied in die vreemde pedo-oudiometriese situasie nie. Die oplossing hiervoor is grootliks geleë in die opleiding van die kind voor formele  gehoortoetsing en meer spesifiek  opleiding tuis deur die ouer. Die doel van hierdie studie was om 'n voorbereidende program op te stel wat die ouer tuis met die kind kan uitvoer, voordat formele  toetsing plaasvind. Die waarde en effek van hierdie program in die pedo-oudiometriese situasie is geevalueer by 'n groep drie- en vierjarige kleuters. Resultate dui daarop dat laer en meer akkurate drempels, 'n korter toetstydperk, verminderde angs en beter samewerking verkry is by die kleuters wat vooraf  opleiding ontvang het. Die opleidingsprogram kan dus in die kliniese praktyk benut word as voorafopleiding  vir pedo-oudiometrie.

  2. Die woordeboek vir meganiese ingenieurs: Vorderingsverslag

    Directory of Open Access Journals (Sweden)

    Editorial Office


    Full Text Available Die komitee van die Nasionale Vakterminologiediens (NVD wat ’n woordeboek vir meganiese ingenieurswese saamstel en in Januarie 1986 met sy werksaamhede begin het, maak goeie vordering. Die dag-tot-dag-werk word deur 'n redaksiekomitee behartig wat twee keer maandeliks vergader en uit verteenwoordigers van universiteite, SAVD, YSKOR, SABS en ander instansies bestaan.

  3. Die Reformdiskussion in der senegalesischen Sprachplanungs- politik

    African Journals Online (AJOL)

    Die Reformdiskussion in der senegalesischen Sprachplanungspolitik 13 hatten afrikanische Bildungspolitiker und Kulturtheoretiker (Senghor, Nkrumah, Kenyatta, etc.) sehr früh die Rolle der Sprache und Bildung in einem zukünftigen souveränen afrikanischen Staat anerkannt. Die damals geführten staatsrechtlichen ...

  4. Taalgesindhede en die onderrig van Afrikaans

    Directory of Open Access Journals (Sweden)

    Barbara Bosch


    Full Text Available In die onderrig aan en aanleer van Afrikaans deur nie-moedertaalsprekers behoort daar in 'n multi-kulturele omgewing met taalgesindhede rekening gehou te word: die taalaanleerder se gesindheid teenoor en stereotipiese sienswyses van die sprekers van die teikentaal en die teikentaal self beinvloed die sukses van die verskil/ende stadia van die aanleerproses. Hierdie beinvloeding vind plaas omdat gesindhede motivering beinvloed en as sosio-affektiewe filter in die taalaanleerproses kan optree. Die implikasies van heersende gesindhede teenoor Afrikaans vir die onderrig en aanleer van die taal in 'n multitalige situasie word indringend bespreek. In the teaching of Afrikaans to and the acquisition of the language by non-mother tongue speakers in a multi-lingual environment, cognizance should be taken of prevailing attitudes: the attitudes of the learner towards the target language and his/her stereotypical perceptions of the target language and its speakers which influence the success of the language learning process in various stages. This influence takes place because attitudes affect motivation and can also act as a socio-ajjective filter in the language acquisition process. The implications of existing attitudes towards Afrikaans for the teaching and acquisition of the language in a multi-lingual situation are discussed in depth.

  5. Die ontwerp van ʼn Afrikaanse taakgebaseerde rekenaaronderrig ...

    African Journals Online (AJOL)

    Kate H

    gelewer word, is om die moontlike ontwerp van ʼn taakgebaseerde rekenaarprogram vir die kursus. Beginner Afrikaans Vlak 1 te ... to transfer the required amount of credits back to their home universities. The Language Centre ..... 3.1.1 Die tweeledige kanaal-aanname (“dual channel assumption”). Hierdie aanname ...

  6. Leibniz und die Psychophysik des Gehirns

    NARCIS (Netherlands)

    S. Tuinen (Sjoerd)


    textabstract1. Das Gehirn als Medium allen Denkens Die Probleme der Philosophie sind laut Deleuze niemals von sich aus philosophisch. Bereits eine Antwort auf die Frage Was ist Philosophie? setzt ein nicht-philosophisches 'Bild des Denkens' voraus, eine Art absoluten Hintergrund, in den die

  7. uniform van die staatspresidentswag - herkoms en tradisie

    African Journals Online (AJOL)

    A blue uniform was inter alia proposed in 1980 but finally rejected by the Prime Minister in 1984. Instructions were issued to put forth new ideas. All the arguments in ..... In 1896 Is die rang van kommandant van die Staatsartlllerie verhoog tot die van lultenant-kolonel. Henning Pretorlus, father and first commandant of the.

  8. Straatsburg en artikel 2 van die dordtse kerkorde

    Directory of Open Access Journals (Sweden)

    L. F. Schulze


    Full Text Available In art. 2 K.O. word daar vier soorte kerklike dienste on dcrskei, nl. „dié van die bedienaars van die Woord, dié van die professore aan die teologiese skool, die van die ouderlinge, en dié van die diakens”.

  9. Die skrywer. Esta Steyn. Kaapstad: Tafelberg, 2012. 214 pp. ISBN ...

    African Journals Online (AJOL)

    ningsromans in Duits, is die Christelike ele- mente en die humor. Die straatslim Anabella wat twee plaaswerkers aansê om nie die Here se naam te misbruik nie, toon kenmerke van die heldin in 'n Afrikaanse liefdesverhaal. Hierdie roman sal byval vind by lesers wat. Esta Steyn se vorige romans geniet het. Die humor in die ...

  10. To operate or not to operate on women with deep infiltrating endometriosis (DIE) before in vitro fertilization (IVF)


    Carneiro, M?rcia Mendon?a; Costa, Luciana Maria Pyramo; de ?vila, Ivete


    Deep infiltrating endometriosis (DIE) can cause infertility and pelvic pain. There is little evidence of a clear connection between DIE and infertility, and the absolute benefits of surgery for DIE have not been established. This paper aimed to review the current literature on the effect of surgery for DIE on fertility, pregnancy, and IVF outcomes. Clinicians should bear in mind that a comprehensive clinical history is useful to identify patients at risk for endometriosis, although many women...

  11. Studie: Die Generation Y und deren organisatorische Implikationen


    Klein, Helmut


    Die vorliegende Studie betrifft die Gen. Y und ihre spezifischen Anforderungen an die Unternehmensorganisation. Im Ergebnis einer durchgeführten Befragung ist festzuhalten, dass die Gen. Y die Kernkompetenzen eines Managers verstärkt einfordert und eine hohe Betreuungsintensität verlangt. Dies hat Auswirkungen auf die Führungsspanne, Planung und Kontrolle von Aufgaben, die Gestaltung der vertikalen und horizontalen Prozesse sowie die Zusammensetzung von Teamarbeitsformen. Projektarbeit sowie ...

  12. Die lewensvatbaarheid van 'n slaghuisfranchise / deur Johan Smit


    Smit, Johan


    Die Suid-Afrikaanse rooivleisindustrie is lomp en wyd. Een van die redes vir hierdie toedrag van sake is die verskeie rolspelers in die industrie. 'n Moontlike oplossing vir hierdie probleem is die vertikale integrasie-sisteem gerugsteun deur 'n lewensvatbare franchise in die kleinhandelsektor. Die studie fokus op die lewensvatbaarheid van 'n slaghuisfranchise. Daar moet egter ook bepaal word of 'n slaghuis wei gefranchise kan word, voordat die lewensvatbaarheid van 'n slaghuisfranchise be...

  13. Paleontologie en die Suid-Afrikaanse samelewing vandag


    Durand, JF


    Die huidige oënskynlike ondersteuning van paleontologie deur die regering en die insluiting en beklemtoning van evolusie in die skoolleerplan word bespreek in die lig van sekere politieke ontwikkelings wat oor die laaste twee dekades in Suid-Afrika plaasgevind het. Dit sluit die regering se ondersteuning van paleontologiese ontdekkings in die media, die ontwikkeling van fossielterreine en paleotoerisme in. Ondanks hierdie positiewe inisiatiewe gedy paleontologie nie in Suid-Afrika nie en is d...


    African Journals Online (AJOL)


    as 'n volk in daardie sin aangemerk kon word, en in die O.T. Israel dan ook 'n paar maal, teen die reël wat ons as beginnende studente geleer het,. 1) Die leser vind hier die lesing, deur die skrywer op 29 Februarie 1956 vir die Predikante- vergadering te Pretoria gehou. Die formulering van die titel was van die skriba van.

  15. Artikel 2 van die Nederlandse Geloofsbelydenis as geloofsvooronderstelling in die gesprek tussen wetenskap en geloof

    Directory of Open Access Journals (Sweden)

    Jan A. Erasmus


    Full Text Available Artikel 2 van die Nederlandse Geloofsbelydenis bely dat God deur twee middele geken word, te wete deur middel van die skepping, onderhouding en regering van die wêreld (waaronder die wetenskap en deur die heilige en goddelike Woord (die Bybel. Hierdie belydenis is van groot belang vir die gesprek tussen Wetenskap en Teologie. In hierdie artikel word gepoog om die verskille, maar ook die ooreenkomste tussen hierdie twee middele van openbaring uit te lig, elkeen tot sy reg te laat kom, maar hulle ook in balans met mekaar te stel. Die wyse waarop te werk gegaan word, is die volgende: eers word gestel wat vooronderstellings is, asook die plek wat vooronderstellings in die beoefening van wetenskap sowel as geloof inneem. Daarna word nagevors watter perspektiewe artikel 2 van die Nederlandse Geloofsbelydenis as geloofsvooronderstelling vir die wetenskaps- en teologiebeoefening respektiewelik bied. Hieruit word ’n aantal gevolgtrekkings gemaak wat kan help om die problematiek in die wetenskap-geloofsgesprek op te los. Die kernbevinding van hierdie artikel is die volgende: Vanweë die verskil in die aard en die doel tussen Bybelfeite en wetenskaplike navorsingsresultate kan en sal klaarblyklike harmonieprobleme tussen die Skrif en die wetenskap ontstaan. Hierdie is egter slegs klaarblyklike probleme, omdat ’n verrekening van die verskil in die aard en die bedoeling van die wetenskapresultate en die Bybelfeite hierdie probleem sal oplos. Article 2 of the Belgic Confession as faith presupposition in the science-faith debate. Article 2 of the Belgic Confession confesses that God can be known by two means: firstly by studying the creation, preservation and government of the universe (i.e. science and secondly by studying the Word of God (the Bible. This confession is very important for the discussion between science and faith. In this article the similarities, but also the differences between these two means of revelation are researched. The aim is to

  16. Die wet is evangelie: Die Heidelbergse Kategismus steeds aktueel na 450 jaar

    Directory of Open Access Journals (Sweden)

    Piet Strauss


    Full Text Available In die denke van Martin Luther bestaan daar spanning tussen die wet van God en die evangelie. Vir Luther is liefde die eie werk en die wet die vreemde werk van God. Daarteenoor integreer of versoen Johannes Calvyn God se wet met die evangelie. Hy vertolk die openingswoorde van die wet byvoorbeeld as liefdevol en bevrydend en daarom evangelies. Calvyn beskou die wet as die manier waarop ’n Christen sy liefde vir God uitleef en sy dankaarheid teenoor God vir sy verlossing betoon. Calvyn se siening oor die verhouding tussen die wet en die evangelie het ’n betekenisvolle invloed op die Heidelbergse Kategismus se formulering ten opsigte van hierdie saak. Volgens die Kategismus is die wet evangelie, of die vorm wat die evangelie in die lewe van die mens aanneem. In the thought of Martin Luther tension exists between the law of God and the gospel. Luther regards love as the own work of God and the law as something strange to the Lord. John Calvin, however, integrates Gods law and the gospel to the extent that the opening words of the ten commandments are regarded as words of love and redemption and therefore evangelical. To Calvin the law becomes the way in which a converted Christian lives and shows his gratitude to God for his salvation. Calvin’s view on the relationship between law and gospel had a significant influence on the way in which the Heidelberg Cathecism formulates these two concepts. For the Cathecism the law is gospel or the form in which the gospel takes shape in human life.

  17. Thermal Fatigue of Die-Casting Dies: An Overview

    Directory of Open Access Journals (Sweden)

    Abdulhadi Hassan A.


    Full Text Available Coupled studies by experimental and numerical simulations are necessary for an increased understanding of the material behaviour as related to the interaction between the thermal and mechanical conditions. This paper focus on the mechanisms of thermal fatigue in the failure of dies and cores used in the die casting of aluminum alloys. The thermal fatigue resistance is expressed by two crack parameters which are the average maximum crack and the average cracked area. Samples of various types of H13 steel were compared with a standard H13 steel by testing under identical thermal fatigue cycles. To determine the thermal constraint developed in the sample during the test, a finite difference technique was used to obtain the temperature distribution, based on temperature measurements at the boundaries. The resulting stresses and strains were computed, and the strain calculated at the edge or weakest point of the sample was used to correlate the number of cycles to crack initiation. As the strain at the edge increased, the number of cycles to failure decreased. The influence of various factors on thermal fatigue behavior was studied including austenitizing temperature, surface condition, stress relieving, casting, vacuum melting, and resulfurization. The thermal fatigue resistance improved as the austenitizing temperature increased from 1750 to 2050ºF.

  18. Clinical Criteria for Physician Aid in Dying. (United States)

    Orentlicher, David; Pope, Thaddeus Mason; Rich, Ben A


    More than 20 years ago, even before voters in Oregon had enacted the first aid in dying (AID) statute in the United States, Timothy Quill and colleagues proposed clinical criteria AID. Their proposal was carefully considered and temperate, but there were little data on the practice of AID at the time. (With AID, a physician writes a prescription for life-ending medication for a terminally ill, mentally capacitated adult.) With the passage of time, a substantial body of data on AID has developed from the states of Oregon and Washington. For more than 17 years, physicians in Oregon have been authorized to provide a prescription for AID. Accordingly, we have updated the clinical criteria of Quill, et al., based on the many years of experience with AID. With more jurisdictions authorizing AID, it is critical that physicians can turn to reliable clinical criteria. As with any medical practice, AID must be provided in a safe and effective manner. Physicians need to know (1) how to respond to a patient's inquiry about AID, (2) how to assess patient decision making capacity, and (3) how to address a range of other issues that may arise. To ensure that physicians have the guidance they need, Compassion & Choices convened the Physician Aid-in-Dying Clinical Criteria Committee, in July 2012, to create clinical criteria for physicians who are willing to provide AID to patients who request it. The committee includes experts in medicine, law, bioethics, hospice, nursing, social work, and pharmacy. Using an iterative consensus process, the Committee drafted the criteria over a one-year period.

  19. Die impak van die verbond op 'n paradigma vir pastoraat: research ...

    African Journals Online (AJOL)

    Die verbond het 'n meer omvattende impak op pastorale sorg as ander paradigmas. Genoemde stelling word in hierdie artikel beredeneer. Daar word aangetoon dat die inhoud wat aan die gelowige gekommunikeer word, asook die tegnieke wat gebruik word, deur 'n verbondmatige paradigma vir pastorale sorg be?nvloed ...

  20. Die rol van kapitaal in die ekonomiese groei en ontwikkeling van onderontwikkelde gebiede*

    Directory of Open Access Journals (Sweden)

    F. J. du Plessis


    Full Text Available In die teorie oor ekonomiese groei speel kapitaal ’n besonder prominente rol. Kapitaal met die daarby behorende tegnologiese ontwikkeling, word beskou as die belangrikste enkele faktor verantwoordelik vir die bereiking en instandhouding van ’n „ten voile ontwikkelde” volkshuishouding.

  1. Die taak van akademiese geletterdheid/hede binne die konteks van ...

    African Journals Online (AJOL)

    Opsomming. Die vestiging van Akademiese Geletterdheid by tersiêre instansies in Suid-Afrika het gegroei uit die besef dat 'n goedontwikkelde akademiese taalvermoë essensieel is vir akademiese prestasie. Gepubliseerde literatuur getuig van die belangrike verskuiwings wat oor die afgelope aantal dekades plaasgevind ...

  2. Ek wil hier graag van die geleentheid gebruik maak am die ...

    African Journals Online (AJOL)

    die wildlewe am van die jagters nie eers mel- ding te maak nie en in Lucas se werk kan hulle ure van genot deurbring. Wat ons veral in Lucas se publikasie interes- seer is sy deelname aan die agste grensoor~' log (1850-1853), sy aantekeninge in verband met die slag by Berea (20 Oesember 1852) en sy indrukke van ...

  3. Die dinamika van die beperkte drie-deeltjie-probleem in sterrekunde

    Directory of Open Access Journals (Sweden)

    Keegan D. Anderson


    Full Text Available Die beperkte drie-deeltjie-probleem is een van die oudste probleme in klassieke fisika en is alvir ongeveer die afgelope honderd jaar bestudeer. Die probleem is nie oplosbaar op ‘n geslote analitiese wyse nie, alhoewel ’n oneindige reeks oplossing bestaan.

  4. Die reg van die homoseksuele ouer om beheer en toesig oor 'n kind ...

    African Journals Online (AJOL)


    regtens seëvier sodat die grondwetlike verbod op onbillike diskriminasie teen mense op grond van hul seksuele georiënteerdheid so .... gerig teen die homoseksueel self en die homoseksuele daad wat hy/sy beoefen, maar dat daar ook gediskrimineer ..... Die Uniform Marriage and Divorce Act,. 60 aangeneem in verskeie ...

  5. Die huwelik in die eerste-eeuse Mediterreense wêreld (III): Jesus en ...

    African Journals Online (AJOL)


    30 Jan 2007 ... description of what marriage, betrothal, adultery, divorce and ..... egbreuk teen wie? Wanneer daar in ag geneem word dat 'n man in die eerste- eeuse Mediterreense wêreld nie egbreuk teenoor sy vrou kon pleeg nie (kyk ... volg egbreuk teen die vrou in die huwelik beteken – al het die vrou owerspel.

  6. Die Ontstaan en Ontwikkeling van die Pan-Afrikanisme en due implikasies daarvan

    Directory of Open Access Journals (Sweden)

    A. J.H. van der Walt


    Full Text Available Dit was nie voor 1880 dat tropiese Afrika, dil is die grootste gedeelte van Wes-, Oos- en Midde-Afrika, deur ontdekkingsreisigers,handelaars en sendelinge tot so ’11 mate ontsluit is, dat dit in die vaarwater van die wêreldpolitiek geraak het nie. Lank voor hierdie tyd is natuurlik steunpunte aan die Wes-, Suid- en Ooskusdeur die Portugese en later die Nederlanders en Engelse eset ter wille van óf dieslawehandel en/óf as steunpunte op dielarig handelsweg na die ryke Ooste.

  7. Sonnet XXX: Love, dignity, and dying. (United States)

    Ely, E Wesley


    All of us in medicine who care for patients who are chronically critically ill, dying of incurable illnesses, will be faced with discussions about the value of their lives and about the appropriateness of ongoing supportive care. Such discussions are good and true, and they must always be done within the context of the sanctity of every human life and the promise of God that we are His children, each and every one of us. In this article, I explore the end-of-life path of a patient with amyotrophic lateral sclerosis (ALS) and the courageous faith that she demonstrated in the face of her illness. I explore with you, the reader, the hard-core conversations that took place at her bedside and their meaning in light of Catholic moral teaching. This story is not meant to indicate that we should always do all interventions at all times for all patients. That would be a teaching counter to Evangelium vitae . This story is meant to help you think through the path of your patients and of you as a physician or other type of healthcare professional in serving your patients. Primum non nocere. Ad majorem Dei gloriam .

  8. Ouditiewe aandag by die voorskoolse kind

    Directory of Open Access Journals (Sweden)

    Elmarie Niemand


    Full Text Available Daar is met hierdie navorsingsprojek gepoog om 'n duidelike beeld te vorm van ouditiewe aandagsprosessering by die voorskoolse kind. Aangesien ouditiewe aandagsprosessering van groot belang is vir die kind wat skool toe gaan is daar op die groep wat in die daaropvolgende jaar skool toe gaan besluit. 'n Groep van 64 kinders is geselekteer. Daar is gebruik gemaak van 'n gegradeerde ouditiefgerigte  ondersoekprogram wat so saamgestel is dat dit wetenskaplik verantwoordbaar is. In sy geheel gesien dui die navorsingsresultate daarop dat die basiese ontwikkelingsproses van ouditiewe aandagsprosessering op hierdie ouderdom (5;2 tot 5;8 voltooi is. 'n Verdere evaluering van die resultate in terme van die uiteengesette doelstellings van die navorsingsprojek dui daarop dat kinders in hierdie ouderdomsgroep nog soms moeite ondervind om aan 'n ouditiewe sei binne omgewingslawaai aandag te skenk. Bekende seine verhoog die vermoë om aandag te skenk. Daar kon egter nie vir alle aannames wat in die literatuur gemaak word, bewys gevind word nie.

  9. The Decisonal Autonomy Defending the Right to Die With Dignity

    Directory of Open Access Journals (Sweden)

    Riva Sobrado de Freitas


    Full Text Available This article aims to verify the possibility that the terminal patient, provided with decisional autonomy, can claim the right to die with dignity. To achieve the intent, it was done a bibliographic exploratory-explanatory research, qualitative, using the deductive method. Concluding that, even if the subject is polemic, the decisional autonomy deserves to be considered, including in the execution of the right to die with dignity, since it is intended to safeguard the human being in the most intimate aspects of one’s life and, because, choose the death with dignity doesn’t mean to give up from the right to life.

  10. Die invloed van ‘n intensiewe opleidingsprogram op die Kardio Stres-indeks

    Directory of Open Access Journals (Sweden)

    Tammy Claassen


    Full Text Available Mense ondervind baie stressors in hul alledaagse lewe, wat ‘n groot uitwerking het op daagliksefunksionering. Kardio Stres-indeks (KSI is ‘n nie-indringende mate van die stres wat die hartervaar. KSI (uitgedruk as ‘n persentasie berekeninge word gebaseer op die duur van die QRSkompleks, hart tempo, ritme en standaardafwyking van die RR-interval (RRSD spesifieke parameters.

  11. Die effek van intelligensie op die verhouding tussen lokus van kontrole en taakkompleksiteit

    Directory of Open Access Journals (Sweden)

    F. G. de Kock


    Full Text Available The effect of intelligence on the relationship between locus of control and task complexity. The aim of the study was to establish the effects of intelligence on the relationship between locus of control and task complexity. These constructs were selected by virtue of their importance in the literature, as well as the lack of empirical research regarding the assumed relationship which exists between them. The Human Sciences Research Council's (HSRC General Scholastic Aptitude Test (ASAT was used for measuring intelligence, Duttweiler's Internal Control Index (ICI was used for determining locus of control and the Raven's Advanced Progressive Matrices (APM was used as a criterion for coping with task complexity. These instruments were administered to 292 subjects to determine whether the relationship between locus of control and task complexity was effected when the effect of intelligence was controlled. The results indicated a significant relationship between locus of control and task complexity, however the relationship was no longer significant after the effect of intelligence was controlled. Opsomming Die doel van die studie was om die effek van intelligensie op die verhouding tussen lokus van kontrole en taak-kompleksiteit te ondersoek. Hierdie konstrukte is gekies na aanleiding van hulle belangrikheid in die literatuur asook die leemte in empiric se navorsing rakende die veronderstelde verband wat tussen hulle bestaan. Die Algemene Skolastiese Aanlegtoets (ASAT van die Raad vir Geesteswetenskaplike Navorsing (RGN is gebruik vir die meting van intelligensie, die Internal Control Index (ICI van Duttweiler is gebruik vir die meting van lokus van kontrole en die Advanced Progressive Matrices (APM van Raven is gebruik as maatstaf vir die bantering van taakkompleksiteit. Die genoemde meetinstrumente is op 292 proefpersone toegepas om te bepaal of die verband tussen lokus van kontrole en taakkompleksiteit geaffekteer word wanneer daar vir die effek

  12. Die kriminelle Frau“ – ein „Anwendungsfall“ für die Anomietheorie?


    Gabriele Schmölzer


    Die von der Verfasserin vorgenommene Bearbeitung der Anomietheorie des Soziologen Robert K. Merton zielt darauf ab, „relevante Unterschiede zwischen Frauen und Männern zu finden, die den unterschiedlichen Anteil der Geschlechter bei der registrierten Kriminalität erklären können“ (S. 223). Dies gelingt insofern, als sie strukturelle Variablen herausarbeiten kann, die per se die Wahrscheinlichkeit von strafbarem Verhalten erhöhen. Das Geschlecht spielt dabei (nur) insofern eine Rolle, als der ...

  13. Die nut van kriging in gravitasie-opnames

    Directory of Open Access Journals (Sweden)

    G. J. van Tonder


    Full Text Available Ondersoek is ingestel na die gebruik van kriging as hulpmiddel by die gravitasiemetode vir die opsporing van verweerde sones in die dolomitiese gebiede van Suid-Afrika. Na ’n kort bespreking van die basiese beginsels van kriging, word die metode toegepas op die Bouguer-anomaliewaardes, soos waargeneem op ’n deel van die Zuurbekomkompartement. Daar word getoon dat die aantal waarnemingspunte met tot soveel as 90 persent verminder kan word, sonder ’n noemenswaardige verlies van akkuraatheid in die bepaling van die geskatte volumes verweerde dolomiet.

  14. Die poësie van Elisabeth Eybers

    African Journals Online (AJOL)


    26 Feb 2005 ... Eybers. “Musiek” en “Kind voor die klavier” het 'n religieuse perspektief waar die musiek verband hou met die betree van 'n ander dimensie. Die speel van Mozart se musiek op die klavier is vir die tienerkind 'n transendente ervaring: “Sy tas tot oor die rand van die gebied / waar drome klank word, klaar en ...

  15. Die eerste siklus. Etienne Leroux. Kaapstad: Human & Rous- seau ...

    African Journals Online (AJOL)

    Ulysses) om die prys wat hy in 'n lotery gewen het op te eis. In die proses kom hy in aanraking met 'n mikrokosmiese snit van die Suid-. Afrikaanse samelewing en word hy ook gaandeweg verlos van sy illusies. Alhoewel 'n mens vandag die roman sou kon waardeer vir die wyse waarop dit Kaapstad in die vyftigerjare en ...

  16. die geometriese en riviergrense van suidwes-afrika, met spesiale ...

    African Journals Online (AJOL)

    tuig die" Star" oak gestuur am die Britse vlag by al die aandoenplekke langs die weskus tot so ver as Angola te ... Anderson wat oak tussen 1859 en 1867 verkenningstogte in die land onderneem het, het veral die ylbe- .... upon maps where no White man's foot has ever trod; we have been giving away mountains and rivers ...


    African Journals Online (AJOL)


    moet bid. Sedert die laaste oorlog is dit duidelik dat die mensheid begin het om teen sy grense aan te stoot. Dis nie meer so dat die gebeure van die wêreldgeskiedenis elke keer net 'n deel van die aarde of sekere kultuurkringe in beroering bring nie. Agter die wat in beroering gebring is, was daar nie meer ander bekende ...

  18. Hoe geregverdig is die kritiek teen 'n toeganklike vertaalteks ...

    African Journals Online (AJOL)

    Met die huidige demografiese verspreiding en die taalopset in ons land behoort die dienste van vertalers en tolke meer sigbaar te word en behoort hulle 'n groter rol in die samelewing te speel. Deur die ondersteuning van gekwalifiseerde vertalers, tolke en vertaalprojekte sal ons meehelp om die talige werklikheid te ...


    African Journals Online (AJOL)

    onder Chiang. Kaishek teen die Kommuniste onder. Mao Tse-tung. Die stryd kan verdeel word in vier fases: (1) Die stryd in Suidoos-China in dele van die provinsies Hunan, Kiangsi en. Fukien, 1928- 1934. (2) Die Lang Mars van die Kommunis- tiese stryders onder leiding van Mao van Suidoos-China na Noordwes-China.

  20. Die TAT-Z as voorspeller vir prestasiemotivering

    Directory of Open Access Journals (Sweden)

    F. V. N. Cilliers


    Die gebruik van die TAT-Z, 'n projeksietoets vir Swartmans, word ondersoek om prestasiemotivering veral tydens die indiensnemingsituasie te voorspel. Positiewe resultate is op 3 van die 10 kaarte (nrs. 4, 6 en 9 van die TAT-Z verkry. Aanbevelings word gemaak aangaande die aanpassing van hierdie projeksietoets ten einde meer inligting oor prestasiemotivering, bloot te lê.


    African Journals Online (AJOL)

    grond daarvan dat Marx en Lenin niks geweet het van 'n pre-kapitalistiese gemeenskap nie en dat hulle vertroue in die klassestryd nie verband hou met die situasie in Afrika nie asook dat hulle nie die groei van kapitalisme en die mee- gaande stryd tussen die industriele proletariaat en die kapitalistiese klas meegemaak.

  2. Geskiedsfilosofie in 'n krisis: Die noodwendigheid en aktualiteit van ...

    African Journals Online (AJOL)

    Die filosofie is deel van die mens se lewenspraxis wat horn altyd voltrek binne die raamw^erk van wat een- maal genoem is die 'polis', en wat ons vandag breedweg kan bestempel as die politieke proses waardeur mense in staatlike en interstaatlike verband poog om iets van die goeie lewe (the good life) te verwerklik.

  3. Vacuum die attach for integrated circuits (United States)

    Schmitt, E.H.; Tuckerman, D.B.


    A thin film eutectic bond for attaching an integrated circuit die to a circuit substrate is formed by coating at least one bonding surface on the die and substrate with an alloying metal, assembling the die and substrate under compression loading, and heating the assembly to an alloying temperature in a vacuum. A very thin bond, 10 microns or less, which is substantially void free, is produced. These bonds have high reliability, good heat and electrical conduction, and high temperature tolerance. The bonds are formed in a vacuum chamber, using a positioning and loading fixture to compression load the die, and an IR lamp or other heat source. For bonding a silicon die to a silicon substrate, a gold silicon alloy bond is used. Multiple dies can be bonded simultaneously. No scrubbing is required. 1 figure.

  4. Die singulation method and package formed thereby (United States)

    Anderson, Robert C [Tucson, AZ; Shul, Randy J [Albuquerque, NM; Clews, Peggy J [Tijeras, NM; Baker, Michael S [Albuquerque, NM; De Boer, Maarten P [Albuquerque, NM


    A method is disclosed for singulating die from a substrate having a sacrificial layer and one or more device layers, with a retainer being formed in the device layer(s) and anchored to the substrate. Deep Reactive Ion Etching (DRIE) etching of a trench through the substrate from the bottom side defines a shape for each die. A handle wafer is then attached to the bottom side of the substrate, and the sacrificial layer is etched to singulate the die and to form a frame from the retainer and the substrate. The frame and handle wafer, which retain the singulated die in place, can be attached together with a clamp or a clip and to form a package for the singulated die. One or more stops can be formed from the device layer(s) to limit a sliding motion of the singulated die.

  5. Modeling of high temperature- and diffusion-controlled die soldering in aluminum high pressure die casting

    DEFF Research Database (Denmark)

    Domkin, Konstantin; Hattel, Jesper Henri; Thorborg, Jesper


    of the die lifetime based on a quantitative analysis of die soldering in the framework of the numerical simulations of the die-casting process. Full 3D simulations of the process, including the filling. solidification, and the die cooling, are carried out using the casting simulation software MAGMAsoft....... The resulting transient temperature fields on the die surface and in the casting are then post-processed to estimate the die soldering. The present work deals only with the metallurgical/chemical kind of soldering which occurs at high temperatures and involves formation and growth of intermetallic layers...

  6. Polen, Deutschland, die EU und Russland


    Wilkiewicz, Zbigniew


    Besonders seit dem EU-Beitritt Polens ist es um die deutsch-polnischen Beziehungen nicht besonders gut bestellt. In den vergangenen Jahren hat man sich in erster Linie an bilateralen Konflikten abgearbeitet und keine gemeinsame Europapolitik betrieben. Im Beitrag wird diese Entwicklung rekonstruiert und danach gefragt, ob es angesichts einer solchen Entwicklung Aussichten auf die Wiederherstellung der deutsch-polnischen Interessengemeinschaft gibt oder die Interessen beider Staaten so stark d...

  7. Hemofilie onder die nasate van koningin Victoria

    Directory of Open Access Journals (Sweden)

    Francois P. Retief


    Full Text Available Hierdie studie bespreek die uitwerking van die sogenaamde Victoriaanse hemofilie op Europese koningshuise gedurende die negentiende en twintigste eeu. Hemofilie as molekulêre defek word verduidelik en die kliniese beeld van die siekte word aangedui. ’n Bespreking van toepaslike terapeutiese ingrepe volg. Dan word ’n historiese oorsig verskaf van die verspreiding van Victoriaanse hemofilie vanaf koningin Victoria (Britse monarg, 1837–1901 via sommige van haar dogters na ander lede van die Britse koningshuis en ook na die Duitse, Russiese en Spaanse koningshuise. Elf bevestigde gevalle van hemofilie onder lede van koningin Victoria se nageslag word vermeld, asook drie ander moontlike gevalle van die siekte. Die effek van hemofilie op die verloop van die geskiedenis word ook ondersoek.Haemophilia amongst the descendants of Queen Victoria. This study discusses the impact of ‘Victorian haemophilia’ on the royal houses of Europe during the 19th and 20th centuries. Haemophilia as a molecular defect is explained and the clinical picture of the condition is indicated. Applicable therapeutic interventions also receive attention. Next, an historical review is provided of how ‘Victorian haemophilia’ spread from Queen Victoria (British monarch, 1837–1901 via some of her daughters to other members of the British royal family and also to the royal houses of Germany, Russia and Spain. Eleven confirmed cases of haemophilia amongst the descendants of Queen Victoria are mentioned, as well as three other possible cases. The effect of haemophilia on the course of history is also investigated.

  8. Die Kardiomyopathie in der Friedreich-Ataxie


    Reichert [geb. Florescu], Christiane Katharina


    Die Friedreich-Ataxie ist eine autosomal-rezessiv vererbte neurodegenerative Erkrankung, die sich meistens vor dem 20. Lebensjahr manifestiert. Der Erkrankung liegt eine GAA-Trinukleotid-Expansion im FXN-Gen (Chromosom 9q13) zu Grunde. Diese Mutation führt zu einer verminderten Bildung von Frataxin, wodurch es zur Eisenanreicherung in den Mitochondrien kommt. Diese Eisenakkumulation führt zu oxidativem Stress und mitochondrialer Dysfunktion, die sich vor allem in Gewebe mit einem hohen An...

  9. Anfangen, sich die Welt anders vorzustellen

    Directory of Open Access Journals (Sweden)

    Sabine Fuchs


    Full Text Available Der Sammelband Butler Matters bezeugt Judith Butlers außerordentliche Bedeutung für feministische und queere Studien und Forschung. In elf Beiträgen wird Butlers (frühes Werk von Gender Trouble und Bodies That Matter über Excitable Speech bis zu The Psychic Life of Power betrachtet und sein weit reichender Einfluss quer durch die wissenschaftlichen Disziplinen nachgewiesen. Dargestellt werden auch die kontroverse Rezeption von Butlers Werk sowie die politischen Wirkungen von Butlers Denken. Besonders anregend ist ein zweiteiliges Interview mit Judith Butler, in dem sie auf ein breites Spektrum von Fragen eingeht, die auch wichtige Themen ihrer aktuelleren Werke betreffen.

  10. Die Biopsie von Knochen- und Weichteiltumoren


    Fuchs, B


    Technisch stellt die Biopsie von Knochen- und Weichteiltumoren einen simplen Akt dar, intellektuell aber ist die Planung einer Biopsie höchst anspruchsvoll. Zu häufig werden heutzutage immer noch Biopsien unsachgemäss durchgeführt, so dass die Behandlung - im besten Fall - erschwert wird. Eine unsachgemäss durchgeführte Biopsie führt häufig zu negativen funktionellen Konsequenzen für den Patienten, im schlimmsten Fall kann es die Prognose direkt beeinträchtigen. Aus diesem Grund soll...

  11. Die Altäre von Selinunt


    Voigts, Clemens


    In der Dissertation wurden die Altäre von Selinunt, einer griechischen Kolonie auf Sizilien, mit den Methoden der Bauforschung untersucht. Die neun behandelten Brandopferaltäre sind monumentale Quaderbauten, die bis zu 20 m Länge erreichen. Sie stammen aus der Blütezeit Selinunts, dem 6. und 5. Jh. v. Chr. Die Bauten waren bereits im 19. und 20. Jh. freigelegt worden und wurden nun in Bauaufnahmen dokumentiert, zeichnerisch rekonstruiert und zeitlich eingeordnet. Dabei ließ sich an ihnen eine...

  12. Die samestelling en evaluering van 'n groepfasiliteringskursus

    Directory of Open Access Journals (Sweden)

    S. Rothmann


    Full Text Available The development and evaluation of a group facilitation course. The personality profile of a group facilitator is conceptualised as consisting of group knowledge and skills, interpersonal effectiveness, and personality traits. A group facilitation course directed at the stimulation of this profile was developed. The course improved the skills of praticipants to respond to process issues in a group, as well as their knowledge of group facilitation. Their empathy, respect, genuineness and concreteness improved significantly. Although changes in spontaneity, time competence and existentiality were found after completing the course, these changes cannot be ascribed to the course. Organisational factors may impede the development of the personality traits of the group facilitator. Opsomming Die persoonlikheidsprofiel van die groepfasiliteerder word gekonseptualiseer as groepkennis en -vaardighede, interpersoonike effektiwiteit, en persoonlikheidskenmerke. 'n Groepfasiliteringskursus gerig op die stimulering van hierdie profiel is ontwikkel. Die kursus het daartoe bygedra om deelnemers se vaardigheid om op prosesaangeleenthede in 'n groep te reageer, asook om hul kennis van groepfasilitering te verbeter. Deelnemers se empatie, respek, egtheid en konkreetheid het beduidend toegeneem. Alhoewel veranderinge ten opsigte van spontaneïteit, tydsbewustheid en eksistensialiteit gevind is, kan hierdie veranderinge nie aan die kursus toegeskryf word nie. Organisasiefaktore kan struikelblokke wees in die weg van die ontwikkeling van die persoonliheidskenmerke van die groepfasiliteerder.

  13. Declarations on euthanasia and assisted dying. (United States)

    Inbadas, Hamilton; Zaman, Shahaduz; Whitelaw, Sandy; Clark, David


    Declarations on end-of-life issues are advocacy interventions that seek to influence policy, raise awareness and call others to action. Despite increasing prominence, they have attracted little attention from researchers. This study tracks the emergence, content, and purpose of declarations concerned with assisted dying and euthanasia, in the global context. The authors identified 62 assisted dying/euthanasia declarations covering 1974-2016 and analyzed them for originating organization, geographic scope, format, and stated viewpoint on assisted dying/euthanasia. The declarations emerged from diverse organizational settings and became more frequent over time. Most opposed assisted dying/euthanasia.

  14. Declarations on euthanasia and assisted dying (United States)

    Inbadas, Hamilton; Zaman, Shahaduz; Whitelaw, Sandy; Clark, David


    ABSTRACT Declarations on end-of-life issues are advocacy interventions that seek to influence policy, raise awareness and call others to action. Despite increasing prominence, they have attracted little attention from researchers. This study tracks the emergence, content, and purpose of declarations concerned with assisted dying and euthanasia, in the global context. The authors identified 62 assisted dying/euthanasia declarations covering 1974–2016 and analyzed them for originating organization, geographic scope, format, and stated viewpoint on assisted dying/euthanasia. The declarations emerged from diverse organizational settings and became more frequent over time. Most opposed assisted dying/euthanasia. PMID:28398131

  15. Acceptance of dying: a discourse analysis of palliative care literature. (United States)

    Zimmermann, Camilla


    The subject of death denial in the West has been examined extensively in the sociological literature. However, there has not been a similar examination of its "opposite", the acceptance of death. In this study, I use the qualitative method of discourse analysis to examine the use of the term "acceptance" of dying in the palliative care literature from 1970 to 2001. A Medline search was performed by combining the text words "accept or acceptance" with the subject headings "terminal care or palliative care or hospice care", and restricting the search to English language articles in clinical journals discussing acceptance of death in adults. The 40 articles were coded and analysed using a critical discourse analysis method. This paper focuses on the theme of acceptance as integral to palliative care, which had subthemes of acceptance as a goal of care, personal acceptance of healthcare workers, and acceptance as a facilitator of care. For patients and families, death acceptance is a goal that they can be helped to attain; for palliative care staff, acceptance of dying is a personal quality that is a precondition for effective practice. Acceptance not only facilitates the dying process for the patient and family, but also renders care easier. The analysis investigates the intertextuality of these themes with each other and with previous texts. From a Foucauldian perspective, I suggest that the discourse on acceptance of dying represents a productive power, which disciplines patients through apparent psychological and spiritual gratification, and encourages participation in a certain way to die. Copyright © 2012 Elsevier Ltd. All rights reserved.

  16. Kontekstuele bepalers by die beplanning van skoolwoordeboeke

    Directory of Open Access Journals (Sweden)

    Herman L. Beyer


    Full Text Available

    OPSOMMING: Die doel van hierdie artikel is om tot die metaleksikografiese gesprek oor skoolwoordeboeke as 'n tipe pedagogiese woordeboek by te dra. Die fokus is op kontekstuele bepalers wat by die beplanning van skoolwoordeboeke verreken behoort te word: Binne die konteks van 'n veeltalige Namibië word enkele onderwyskundige sisteme verken wat 'n impak op die ontwerp van gedrukte skoolwoordeboeke vir die sekondêre skoolfase kan hê, naamlik skoolkurrikula, die nasionale taalbeleid vir skole en die beleid van leerdergerigte onderwys. Hierdie artikel voer ook aan dat die voor die hand liggende teikengebruiker van 'n skoolwoordeboek, naamlik die leerder, nie die enigste teikengebruiker is nie: Die onderwyser word as medeteikengebruiker gestel wanneer dit by die gebruik van woordeboeke in die onderrigleersituasie kom. Verskillende tipes gevalle van woordeboekgebruik in die mikrokonteks van die onderrigleersituasie word onderskei, naamlik woordeboekonderrig, woordeboekgeïntegreerde taalonderrig en woordeboekgeondersteunde taalonderrig. Hierdie tipes gebruik behoort komponente van 'n woordeboekpedagogie te wees, wat uiteindelik behoort te lei tot outonome woordeboekgebruik en die gepaardgaande vestiging van 'n individuele woordeboekkultuur by die leerder. Die leksikograaf moet al hierdie aspekte inreken wanneer 'n skoolwoordeboek beplan word ten einde die nodige leksikografiese vernuwing in te voer. Enkele voorstelle vir sodanige vernuwings en vir verdere navorsing word ten slotte aangebied.


    ABSTRACT: Contextual Determiners in the Planning of School

  17. 'n Verkennende studie met die oog op die identifísering en ...

    African Journals Online (AJOL)

    De Klerk 1977:74-75). ... de leermodel bepaalde gevolgtrekkings gemaak. ..... Maslow word die basiese vraag tot die leerproses - hoekom leer mense, ... Gagne se piramide van leervorme bied inderdaad 'n werkbare en sinvolle integrasie.

  18. Dr. E.S. Mulder, Die Teologie van die Jesaja-apokalipse (Jes. 24-27 ...

    African Journals Online (AJOL)

    Dr. E.S. Mulder, Die Teologie van die Jesaja-apokalipse (Jes. 24-27). Proefschrift ter verkrijging van de graad van Doctor in de Godgeleerdheid aan de Rijksuniversiteit te Groningen. Groningen, J. B. Wolters, 1954, 125 bis.

  19. Faktoren, die das Eiablageverhalten und die Ovulation Wüsten bewohnender Tenebrioniden (Coleoptera: Insecta) beeinflussen


    Rössl, Rüdiger


    Über das Eiablage Verhalten und die Faktoren, welche die Eiablage begünstigen, ist bei den meisten der fast 20000 Tenebrioniden nichts bekannt. Lediglich bei einigen wirtschaftlich wichtigen Arten gibt es dazu Untersuchungen (JAKOBS & RENNER 1988). Als eine der wasserärmsten Wüsten der Welt ist die Namib reich an endemischen Coleopteren – insbesondere 320 Tenebrionidaearten (HOLM & DE MEILLON 1996). Langzeituntersuchungen an Tenebrioniden (HENSCHEL 1994, HENSCHEL et al. 1998) legen die Vermut...

  20. Goethe almost died of urosepsis. (United States)

    Gross, A J; Hummel, G


    In the year of 1805, Goethe almost died of urosepsis. His urological problems were not diseases arising from full health but a new variation in a life accompanied by illnesses. Some sources date the first colics he experienced to the year 1795 and others say 1805. The most dramatic period in the course of his illness was in February, when he suffered from fever of such an extent that one could speak of urosepsis. Recovery took place slowly and was accompanied by minor relapses. Nothing about this is written down in his work. On the advice of his doctors, Goethe undertook a cure in Lauchstädt in July and August. The report of his consultant, Professor Johann Christian Reil, on his problems in the field of urology remained undiscovered until 1937. Professor Reil recommended treatment with thermae carolinae, aqua calcis, soap soda crystallisata, herbae subastringentes, and uva ursi, among other measures. With increasing age, Goethe's colics disappeared. The passing of a stone has never been described. Whereas Goethe hinted about medical problem other than those reported herein, the urological problems discussed in this article were left unmentioned. Nonetheless, literature that deals with Goethe's diseases is interesting from the aspect of both the history of medicine and the history of culture.