Differentiation of eosinophilic leukemia EoL-1 cells into eosinophils induced by histone deacetylase inhibitors.

Science.gov (United States)

Ishihara, Kenji; Takahashi, Aki; Kaneko, Motoko; Sugeno, Hiroki; Hirasawa, Noriyasu; Hong, JangJa; Zee, OkPyo; Ohuchi, Kazuo

2007-03-06

EoL-1 cells differentiate into eosinophils in the presence of n-butyrate, but the mechanism has remained to be elucidated. Because n-butyrate can inhibit histone deacetylases, we hypothesized that the inhibition of histone deacetylases induces the differentiation of EoL-1 cells into eosinophils. In this study, using n-butyrate and two other histone deacetylase inhibitors, apicidin and trichostatin A, we have analyzed the relationship between the inhibition of histone deacetylases and the differentiation into eosinophils in EoL-1 cells. It was demonstrated that apicidin and n-butyrate induced a continuous acetylation of histones H4 and H3, inhibited the proliferation of EoL-1 cells without attenuating the level of FIP1L1-PDGFRA mRNA, and induced the expression of markers for mature eosinophils such as integrin beta7, CCR1, and CCR3 on EoL-1 cells, while trichostatin A evoked a transient acetylation of histones and induced no differentiation into eosinophils. These findings suggest that the continuous inhibition of histone deacetylases in EoL-1 cells induces the differentiation into mature eosinophils.

EOL-1, the homolog of the mammalian Dom3Z, regulates olfactory learning in C. elegans

OpenAIRE

Zhang, J; Calarco, JA; Shen, Y; Zhang, Y

2014-01-01

Learning is an essential function of the nervous system. However, our understanding of molecular underpinnings of learning remains incomplete. Here, we characterize a conserved protein EOL-1 that regulates olfactory learning in Caenorhabditis elegans. A recessive allele of eol-1 (enhanced olfactory learning) learns better to adjust its olfactory preference for bacteria foods and eol-1 acts in the URX sensory neurons to regulate learning. The mammalian homolog of EOL-1, Dom3Z, which regulates ...

End-of-life (EoL) mobile phone management in Hong Kong households.

Science.gov (United States)

Deng, Wen-Jing; Giesy, John P; So, C S; Zheng, Hai-Long

2017-09-15

A questionnaire survey and interviews were conducted in households and end-of-life (EoL) mobile phone business centres in Hong Kong. Widespread Internet use, combined with the rapid evolution of modern social networks, has resulted in the more rapid obsolescence of mobile phones, and thus a tremendous increase in the number of obsolete phones. In 2013, the volume of EoL mobile phones generated in Hong Kong totalled at least 330 tonnes, and the amount is rising. Approximately 80% of electronic waste is exported to Africa and developing countries such as mainland China or Pakistan for recycling. However, the material flow of the large number of obsolete phones generated by the territory's households remains unclear. Hence, the flow of EoL mobile phones in those households was analysed, with the average lifespan of a mobile phone in Hong Kong found to be just under two years (nearly 23 months). Most EoL mobile phones are transferred to mainland China for disposal. Current recycling methods are neither environmentally friendly nor sustainable, with serious implications for the environment and human health. The results of this analysis provide useful information for planning the collection system and facilities needed in Hong Kong and mainland China to better manage EoL mobile phones in the future. Copyright © 2017 Elsevier Ltd. All rights reserved.

What evidence is available on end-of-life (EOL) care and Latino elders? A literature review.

Science.gov (United States)

Cruz-Oliver, Dulce M; Talamantes, Melissa; Sanchez-Reilly, Sandra

2014-02-01

Low-income and minority persons, such as Latinos, encounter substantial barriers in accessing effective end-of-life (EOL) care. This study intends to review current evidence on how to deliver EOL care to Latino elders. Literature search in PubMed and Ovid Web sites of articles indexed in Medline (1948-2011), Cochrane (2005-2011), Embase, and PsychInfo (1967-2011) databases. Articles were included if they contained (1) study participants' race/ethnicity, (2) adults or population older than 60 years, and (3) information related to EOL care. A total of 64 abstracts were reviewed, and 38 articles met the inclusion criteria. After reviewing the quality of evidence, 4 themes were identified and summarized: EOL preferences, hospice, Latino culture, and caregiving. Latino elders have traditional acculturation practices, face EOL decisions with family support, and, if educated, are receptive toward hospice and caregiver support.

Please Ask Gently: Using Culturally Targeted Communication Strategies to Initiate End-of-Life Care Discussions With Older Chinese Americans.

Science.gov (United States)

Chi, Han-Lin; Cataldo, Janine; Ho, Evelyn Y; Rehm, Roberta S

2018-01-01

Health-care providers (HCPs) find facilitating end-of-life (EOL) care discussions challenging, especially with patients whose ethnicities differ from their own. Currently, there is little guidance on how to initiate and facilitate such discussions with older Chinese Americans (≥55 years) and their families. To explore communication strategies for HCPs to initiate EOL care discussions with older Chinese Americans in the San Francisco Bay Area. This qualitative (focused) ethnographic study included field observations and individual semistructured interviews with 14 community-dwelling older Chinese Americans who lived independently at home, 9 adult children, and 7 HCPs. Responses were analyzed using open coding, memos, and comparison across participants. The study participants emphasized the importance of assessing readiness for early EOL care discussions. All recommended using indirect communication approaches to determine older Chinese Americans' readiness. Indirect communication can be culturally targeted and applied at both system-wide (ie, health-care system) and individual (ie, HCP) levels. To institutionalize the practice, health-care facilities should implement EOL care discussion inquiries as part of routine during check-in or intake questionnaires. In individual practice, using depersonalized communication strategies to initiate the discussion was recommended to determine older Chinese Americans' readiness. Assessing readiness should be an essential and necessary action for early EOL care discussions. Culturally targeted assessment of older Chinese Americans includes using indirect communication approaches to initiate an EOL care discussion to determine their readiness. In addition to health-care system integration, providers should implement and evaluate proposed EOL discussion initiation prompts with their older Chinese American patients.

Mechanism for the differentiation of EoL-1 cells into eosinophils by histone deacetylase inhibitors.

Science.gov (United States)

Kaneko, Motoko; Ishihara, Kenji; Takahashi, Aki; Hong, Jangja; Hirasawa, Noriyasu; Zee, Okpyo; Ohuchi, Kazuo

2007-01-01

EoL-1 cells have a FIP1L1-PDGFRA fusion gene which causes the transformation of eosinophilic precursor cells into leukemia cells. Recently, we suggested that the induction of differentiation of EoL-1 cells into eosinophils by the HDAC inhibitors apicidin and n-butyrate is due to the continuous inhibition of HDACs. However, neither apicidin nor n-butyrate inhibited the expression of FIP1L1-PDGFRA mRNA, although both these inhibitors suppressed cell proliferation. Therefore, in this study, we analyzed whether the levels of FIP1L1-PDGFRalpha protein and phosphorylated-Stat5 involved in the signaling for the proliferation of EoL-1 cells are attenuated by HDAC inhibitors. EoL-1 cells were incubated in the presence of apicidin, TSA or n-butyrate. FIP1L1-PDGFRalpha and phosphorylated-Stat5 were detected by Western blotting. Treatment of EoL-1 cells with apicidin at 100 nM or n-butyrate at 500 microM decreased the levels of FIP1L1-PDGFRalpha protein and phosphorylated-Stat5, while that with trichostatin A at 30 nM did not. The decrease in the level of FIP1L1-PDGFRalpha protein caused by apicidin and n-butyrate might be one of the mechanisms by which EoL-1 cells are induced to differentiate into eosinophils by these HDAC inhibitors.

Development, Qualification and Production of Space Solar Cells with 30% EOL Efficiency

Science.gov (United States)

Guter, Wolfgang; Ebel, Lars; Fuhrmann, Daniel; Kostler, Wolfgang; Meusel, Matthias

2014-08-01

AZUR SPACE's latest qualified solar cell product 3G30-advanced provides a high end-of-life (EOL) efficiency of 27.8% for 5E14 (1 MeV e-/cm2) at low production costs. In order to further reduce the mass, the 3G30-advanced was thinned down to as thin as 20 μm and tested in space. Next generation solar cells must exceed the EOL efficiency of the 3G30-advanced and therefore will utilize the excess current of the Ge subcell. This can be achieved by a metamorphic cell concept. While average beginning-of-life efficiencies above 31% have already been demonstrated with upright metamorphic triple-junction cells, AZUR's next generation product will comprise a metamorphic 4- junction device targeting 30% EOL.

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

Science.gov (United States)

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

2006-09-01

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

End-of-Life Care and Discussions in Japanese Geriatric Health Service Facilities: A Nationwide Survey of Managing Directors' Viewpoints.

Science.gov (United States)

Kanoh, Asako; Kizawa, Yoshiyuki; Tsuneto, Satoru; Yokoya, Shoji

2018-01-01

Geriatric health service facilities (GHSFs) play important roles as intermediate care facilities for elderly individuals temporarily when they need rehabilitation before returning home. However, the number of residents spending their end-of-life (EOL) period in such facilities is increasing. To improve the quality of EOL care, end-of-life discussions (EOLDs) are recommended by some guidelines and studies. This study aimed to clarify the current practice of EOL care and EOLDs in GHSFs in Japan. We conducted a nationwide cross-sectional survey by mailing questionnaires about EOL care and EOLDs to 3437 GHSF managing directors. The questionnaire was developed through a literature review and discussion among the researchers and experts. Descriptive statistics summarized the data. We also analyzed the factors related to GHSFs conducting EOLDs using Fisher exact tests. The response rate was 20.7% (713 of 3437). Among the respondents, 75.2% (536 of 713) of GHSFs provided EOL care and 73.1% (521 of 713) conducted EOLDs. The most common reasons for difficulties in providing EOL care included the lack of EOL education for nurses and care workers, and their fear about caring for dying residents. End-of-life discussions were mostly initiated after the deterioration of a resident's condition and were conducted with families by physicians. Statistically significant factors of GHSFs conducting EOLDs included providing EOL education for nurses and care workers, availability of private room for critically ill residents, emergency on-call doctors, and EOL care. Adequate practical staff education programs for EOL care including EOLDs may be crucial for quality of end-of-life care in aged care facilities.

The roles of MCP-1 and protein kinase C delta activation in human eosinophilic leukemia EoL-1 cells.

Science.gov (United States)

Lee, Ji-Sook; Yang, Eun Ju; Kim, In Sik

2009-12-01

Idiopathic hypereosinophilc syndrome is a disorder associated with clonally eosinophilic proliferation. The importance of FIP1-like-1-platelet-derived growth factor receptor-alpha (FIP1L1-PDGFRA) in the pathogenesis and classification of HES has been recently reported. In this study, we investigated the contribution of monocyte chemoattractant protein-1 (MCP-1)/CCL2 to chemotactic activity and protein kinase C delta (PKC delta in the human eosinophilic leukemia cell line EoL-1. These cells express CCR2 protein among the CC chemokine receptors (CCR1-5). MCP-1 induces strong migration of EoL-1 cells and the chemotaxis signal in response to MCP-1 involves a G(i)/G(o) protein, phospholipase C (PLC), PKC delta, p38 MAPK and NF-kappaB. MCP-1 activates p38 MAPK via G(i)/G(o) protein, PLC and PKC delta cascade. MCP-1 also induces NF-kappaB translocation and the activation is inhibited by PKC delta activation. The increase in the basal expression and activity of PKC delta in EoL-1 cells, compared to normal eosinophils, inhibits apoptosis in EoL-1 cells. Anti-apoptotic mechanism of PKC delta is related to inhibition of caspase 3 and caspase 9, but not to FIP1L1-PDGFRA. PKC delta functions as an anti-apoptotic molecule, and is involved in EoL-1 cell movement stimulated by MCP-1. This study contributes to an understanding of MCP-1 in eosinophil biology and pathogenic mechanism of eosinophilic disorders.

Leukotriene D4 induces chemotaxis in human eosinophilc cell line, EoL-1 cells via CysLT1 receptor activation.

Science.gov (United States)

Shirasaki, Hideaki; Kanaizumi, Etsuko; Himi, Tetsuo

2017-11-01

Numerous reports have shown that cysteinyl leukotrienes (CysLTs) contribute to tissue accumulation of eosinophils in allergic airway inflammation. To date, only a few studies have reported that CysLTs promote chemotactic activity of human eosinophils in vitro. The purpose of this study was to investigate whether CysLTs promote chemotaxis in the human eosinophilic cell line, EoL-1. EoL-1 cells were induced to differentiate into mature eosinophil-like cells via incubation with butyric acid and cytokines (IL-3, IL-5 and GM-CSF). The chemotactic activity of the differentiated EoL-1 cells was assessed using the commercial cell migration assay kit. LTD 4 elicited dose-related chemotactic activity in the differntiated EoL-1 cells in the range of 1-100 nM. A typical bell-shaped dose-response curve was observed with optimal activity at 10 nM. The chemotactic activity elicited by LTD 4 (10 nM) was significantly inhibited by montelukast (control, 345 ± 19.2 × 10 3 RFU; LTD 4 10 nM alone, 511 ± 39.2 × 10 3 RFU; LTD 4 10 nM plus montelukast 100 nM, 387 ± 28.2 × 10 3 RFU). LTD 4 induces migration in eosinophilic cells via activation of CysLT1 receptor. The present in vitro model may be useful for elucidation of the mechanism underlying CysLT-induced tissue eosinophilia.

Comparative Analysis of Dibutyric cAMP and Butyric Acid on the Differentiation of Human Eosinophilic Leukemia EoL-1 Cells.

Science.gov (United States)

Jung, YunJae

2015-12-01

Purification of enough numbers of circulating eosinophils is difficult because eosinophils account for less than 5% peripheral blood leukocytes. Human eosinophilic leukemia EoL-1 cells have been considered an in vitro source of eosinophils as they can differentiate into mature eosinophil-like cells when incubated with dibutyryl cAMP (dbcAMP) or butyric acid. In this study, the viability and phenotypic maturation of EoL-1 cells stimulated by either dbcAMP or butyric acid were comparatively analyzed. After treatment with 100 µM dbcAMP or 0.5 µM butyric acid, EoL-1 cells showed morphological signs of differentiation, although the number of nonviable EoL-1 cells was significantly increased following butyric acid treatment. Stimulation of EoL-1 cells with 0.5 µM butyric acid more effectively induced the expression of mature eosinophil markers than stimulation with dbcAMP. These results suggest that treatment of EoL-1 cells with 0.5 µM butyric acid for limited duration could be an effective strategy for inducing their differentiation. Considering that expression of CCR3 was not sufficient in EoL-1 cells stimulated with 0.5 µM butyric acid, treatment of the chemically stimulated EoL-1 cells with cytokines, which primarily support eosinophil maturation, would help to obtain differentiated EoL-1 cells with greater functional maturity.

House dust mite induces expression of intercellular adhesion molecule-1 in EoL-1 human eosinophilic leukemic cells.

Science.gov (United States)

Kwon, Byoung Chul; Sohn, Myung Hyun; Kim, Kyung Won; Kim, Eun Soo; Kim, Kyu-Earn; Shin, Myeong Heon

2007-10-01

The house dust mite (HDM) is considered to be the most common indoor allergen associated with bronchial asthma. In this study, we investigated whether crude extract of the HDM Dermatophagoides farinae could activate human eosinophilic leukemic cells (EoL-1) to induce upregulation of cell-surface adhesion molecules. When EoL-1 cells were incubated with D. farinae extract, expression of intercellular adhesion molecule-1 (ICAM-1) significantly increased on the cell surfaces compared to cells incubated with medium alone. In contrast, surface expression of CD11b and CD49d in EoL-1 cells was not affected by D. farinae extract. In addition, pretreatment of cells with NF-kappaB inhibitor (MG-132) or JNK inhibitor (SP600125) significantly inhibited ICAM-1 expression promoted by HDM extract. However, neither p38 MAP kinase inhibitor nor MEK inhibitor prevented HDM-induced ICAM-1 expression in EoL-1 cells. These results suggest that crude extract of D. farinae induces ICAM-1 expression in EoL-1 cells through signaling pathways involving both NF-kappaB and JNK.

Evaluation of Maintenance and EOL Operation Performance of Sensor-Embedded Laptops

Directory of Open Access Journals (Sweden)

Mehmet Talha Dulman

2018-01-01

Full Text Available Sensors are commonly employed to monitor products during their life cycles and to remotely and continuously track their usage patterns. Installing sensors into products can help generate useful data related to the conditions of products and their components, and this information can subsequently be used to inform EOL decision-making. As such, embedded sensors can enhance the performance of EOL product processing operations. The information collected by the sensors can also be used to estimate and predict product failures, thereby helping to improve maintenance operations. This paper describes a study in which system maintenance and EOL processes were combined and closed-loop supply chain systems were constructed to analyze the financial contribution that sensors can make to these procedures by using discrete event simulation to model and compare regular systems and sensor-embedded systems. The factors that had an impact on the performance measures, such as disassembly cost, maintenance cost, inspection cost, sales revenues, and profitability, were determined and a design of experiments study was carried out. The experiment results were compared, and pairwise t-tests were executed. The results reveal that sensor-embedded systems are significantly superior to regular systems in terms of the identified performance measures.

Intensive procedure preferences at the end of life (EOL) in older Latino adults with end stage renal disease (ESRD) on dialysis.

Science.gov (United States)

Gonzalez, Karla; Ulloa, Jesus G; Moreno, Gerardo; Echeverría, Oscar; Norris, Keith; Talamantes, Efrain

2017-10-23

Latinos in the U.S. are almost twice as likely to progress to End Stage Renal disease (ESRD) compared to non-Latino whites. Patients with ESRD on dialysis experience high morbidity, pre-mature mortality and receive intensive procedures at the end of life (EOL). This study explores intensive procedure preferences at the EOL in older Latino adults. Seventy-three community-dwelling Spanish- and English-Speaking Latinos over the age of 60 with and without ESRD participated in this study. Those without ESRD (n = 47) participated in one of five focus group sessions, and those with ESRD on dialysis (n = 26) participated in one-on-one semi-structured interviews. Focus group and individual participants answered questions regarding intensive procedures at the EOL. Recurring themes were identified using standard qualitative content-analysis methods. Participants also completed a brief survey that included demographics, language preference, health insurance coverage, co-morbidities, Emergency Department visits and functional limitations. The majority of participants were of Mexican origin with mean age of 70, and there were more female participants in the non-ESRD group, compared to the ESRD dialysis dependent group. The dialysis group reported a higher number of co-morbidities and functional limitations. Nearly 69% of those in the dialysis group reported one or more emergency department visits in the past year, compared to 38% in the non-ESRD group. Primary themes centered on 1) The acceptability of a "natural" versus "invasive" procedure 2) Cultural traditions and family involvement 3) Level of trust in physicians and autonomy in decision-making. Our results highlight the need for improved patient- and family-centered approaches to better understand intensive procedure preferences at the EOL in this underserved population of older adults.

Optimized collection of EoL electronic products for Circular economy: A techno-economic assessment

DEFF Research Database (Denmark)

Angouria-Tsorochidou, Elisavet; Cimpan, Ciprian; Parajuly, Keshav

2018-01-01

The relevance of a circular model is widely accepted for the lifecycle management of electrical and electronic products (e-products), given the low recovery rates of valuable resources in current end-of-life (EoL) practices focused on recycling. However, missing insight into the technical...... and business potential for alternative EoL options (reuse, repair and remanufacturing) holds stakeholders from implementing circular strategies. In this context, our study first mapped by means of material flow analysis (MFA) the life cycle stages of e-products in Denmark and then performed a preliminary...

Opening end-of-life discussions: how to introduce Voicing My CHOiCES™, an advance care planning guide for adolescents and young adults.

Science.gov (United States)

Zadeh, Sima; Pao, Maryland; Wiener, Lori

2015-06-01

Each year, more than 11,000 adolescents and young adults (AYAs), aged 15-34, die from cancer and other life-threatening conditions. In order to facilitate the transition from curative to end-of-life (EoL) care, it is recommended that EoL discussions be routine, begin close to the time of diagnosis, and continue throughout the illness trajectory. However, due largely to discomfort with the topic of EoL and how to approach the conversation, healthcare providers have largely avoided these discussions. We conducted a two-phase study through the National Cancer Institute with AYAs living with cancer or pediatric HIV to assess AYA interest in EoL planning and to determine in which aspects of EoL planning AYAs wanted to participate. These results provided insight regarding what EoL concepts were important to AYAs, as well as preferences in terms of content, design, format, and style. The findings from this research led to the development of an age-appropriate advance care planning guide, Voicing My CHOiCES™. Voicing My CHOiCES™: An Advanced Care Planning Guide for AYA became available in November 2012. This manuscript provides guidelines on how to introduce and utilize an advance care planning guide for AYAs and discusses potential barriers. Successful use of Voicing My CHOiCES™ will depend on the comfort and skills of the healthcare provider. The present paper is intended to introduce the guide to providers who may utilize it as a resource in their practice, including physicians, nurses, social workers, chaplains, psychiatrists, and psychologists. We suggest guidelines on how to: incorporate EoL planning into the practice setting, identify timepoints at which a patient's goals of care are discussed, and address how to empower the patient and incorporate the family in EoL planning. Recommendations for introducing Voicing My CHOiCES™ and on how to work through each section alongside the patient are provided.

Helios1A EoL: A Success. For the first Time a Long Final Thrust Scenario, Respecting the French Law on Space Operations

Science.gov (United States)

Guerry, Agnes; Moussi, Aurelie; Sartine, Christian; Beaumet, Gregory

2013-09-01

HELIOS1A End Of Live (EOL) operations occurred in the early 2012. Through this EOL operation, CNES wanted to make an example of French Space Act compliance. Because the satellite wasn't natively designed for such an EOL phase, the operation was touchy and risky. It was organized as a real full project in order to assess every scenario details with dedicated Mission Analysis, to secure the operations through detailed risk analysis at system level and to consider the major failures that could occur during the EOL. A short scenario allowing to reach several objectives with benefits was eventually selected. The main objective of this project was to preserve space environment. The operations were led on a "best effort" basis. The French Space Operations Act (FSOA) requirements were met: HELIOS-1A EOL operations had been led successfully.

The effect of tributyltin on human eosinophilic [correction of eosinophylic] leukemia EoL-1 cells.

Science.gov (United States)

Sroka, Jolanta; Włosiak, Przemysław; Wilk, Anna; Antonik, Justyna; Czyz, Jarosław; Madeja, Zbigniew

2008-01-01

Organotin compounds are chemicals that are widely used in industry and agriculture as plastic stabilizers, catalysts and biocides. Many of them, including tributyltin (TBT), have been detected in human food and, as a consequence, detectable levels have been found in human blood. As organotin compounds were shown to possess immunotoxic activity, we focused our attention on the effect of TBT on the basic determinants of the function of eosinophils, i.e. cell adhesiveness and motility. We used human eosinophylic leukemia EoL-1 cells, a common in vitro cellular model of human eosinophils. Here, we demonstrate that TBT causes a dose-dependent decrease in the viability of EoL-1 cells. When administered at sub-lethal concentrations, TBT significantly decreases the adhesion of EoL-1 cells to human fibroblasts (HSFs) and inhibits their migration on fibroblast surfaces. Since the basic function of eosinophils is to invade inflamed tissues, our results indicate that TBT, and possibly other organotin compounds, may affect major cellular properties involved in the determination of in vivo eosinophil function.

Membrane receptor-mediated apoptosis and caspase activation in the differentiated EoL-1 eosinophilic cell line.

Science.gov (United States)

Al-Rabia, Mohammed W; Blaylock, Morgan G; Sexton, Darren W; Walsh, Garry M

2004-06-01

Caspases are key molecules in the control of apoptosis, but relatively little is known about their contribution to eosinophil apoptosis. We examined caspase-3, -8, and -9 activities in receptor ligation-dependent apoptosis induction in the differentiated human eosinophilic cell line EoL-1. Differentiated EoL-1 exhibited bi-lobed nuclei, eosinophil-associated membrane receptors, and basic granule proteins. Annexin-V fluorescein isothiocyanate binding to EoL-1 revealed significant (PEoL-1 but had no effect on constitutive (baseline) apoptosis at 16 and 20 h. Caspase activity was analyzed using the novel CaspaTag trade mark technique and flow cytometry. EoL-1 treated with pan-CD45, CD45RA, CD45RB, and CD95 mAb exhibited caspase-3 and -9 activation at 12 h post-treatment, which increased at 16 and 20 h. Activated caspase-8 was detected 12 and 16 h after ligation with CD45, CD45RA, CD45RB, and CD95 mAb followed by a trend toward basal levels at 20 h. CD69 ligation resulted in caspase-3 activation, a modest but significant activation of caspase-8, and a loss in mitochondrial transmembrane potential but had no significant effect on activation of caspase-9. Thus, the intrinsic and extrinsic caspase pathways are involved in controlling receptor ligation-mediated apoptosis induction in human eosinophils, findings that may aid the development of a more targeted, anti-inflammatory therapy for asthma.

All-trans-retinoic acid enhances apoptosis induction by tyrosine kinase inhibitors in the eosinophilic leukemia-derived EoL-1 cell line.

Science.gov (United States)

Robert, Carine; Apàti, Agota; Chomienne, Christine; Papp, Béla

2008-02-01

Imatinib and retinoids induce apoptosis in FIP1L1/PDGFRalpha-positive EoL-1 leukemia cells. Although imatinib induces complete remission in most FIP1L1/PDGFRalpha-positive patients, response to imatinib is sometimes suboptimal. In order to enhance the potency of the molecularly targeted therapy of eosinophilic leukemia, we investigated the effect of retinoids combined with tyrosine kinase inhibitors on EoL-1 cells. We demonstrate that retinoids combined with tyrosine kinase inhibitors lead to enhanced apoptosis induction in EoL-1 cells. Our results suggest that tyrosine kinase inhibitors combined with retinoids may constitute a valuable therapeutic approach for sensitive neoplasias that may display enhanced anti-leukemic potency when compared to single drug treatments.

ENVIRONMENTS and EOL: identification of Environment Ontology terms in text and the annotation of the Encyclopedia of Life.

Science.gov (United States)

Pafilis, Evangelos; Frankild, Sune P; Schnetzer, Julia; Fanini, Lucia; Faulwetter, Sarah; Pavloudi, Christina; Vasileiadou, Katerina; Leary, Patrick; Hammock, Jennifer; Schulz, Katja; Parr, Cynthia Sims; Arvanitidis, Christos; Jensen, Lars Juhl

2015-06-01

The association of organisms to their environments is a key issue in exploring biodiversity patterns. This knowledge has traditionally been scattered, but textual descriptions of taxa and their habitats are now being consolidated in centralized resources. However, structured annotations are needed to facilitate large-scale analyses. Therefore, we developed ENVIRONMENTS, a fast dictionary-based tagger capable of identifying Environment Ontology (ENVO) terms in text. We evaluate the accuracy of the tagger on a new manually curated corpus of 600 Encyclopedia of Life (EOL) species pages. We use the tagger to associate taxa with environments by tagging EOL text content monthly, and integrate the results into the EOL to disseminate them to a broad audience of users. The software and the corpus are available under the open-source BSD and the CC-BY-NC-SA 3.0 licenses, respectively, at http://environments.hcmr.gr. © The Author 2015. Published by Oxford University Press.

French wind power generation programme EOLE 2005 - first results

Energy Technology Data Exchange (ETDEWEB)

Laali, A.R. [Electricite de France (EDF), Chatou (France); Benard, M. [Electricite de France (EDF), Paris (France)

1997-12-31

EOLE 2005 has been launched in July 1996 by the French Ministry of Industry, Electricite de France and ADEME (Agency for Environment and Energy Management). The Ministries of Research and Environment are participating also in this programme. The purpose is to create an initial market in France for wind power generation in order to evaluate the cost-effectiveness and the competitiveness of the wind energy compared to other energy sources by 2005. The installed capacity will reach at least 250 MW and possibly 500 MW.

Trisubstituted purine inhibitors of PDGFRα and their antileukemic activity in the human eosinophilic cell line EOL-1.

Science.gov (United States)

Malínková, Veronika; Řezníčková, Eva; Jorda, Radek; Gucký, Tomáš; Kryštof, Vladimír

2017-12-15

Inhibition of protein kinases is a validated concept for pharmacological intervention in cancers. Many kinase inhibitors have been approved for clinical use, but their practical application is often limited. Here, we describe a collection of 23 novel 2,6,9-trisubstituted purine derivatives with nanomolar inhibitory activities against PDGFRα, a receptor tyrosine kinase often found constitutively activated in various tumours. The compounds demonstrated strong and selective cytotoxicity in the human eosinophilic leukemia cell line EOL-1, whereas several other cell lines were substantially less sensitive. The cytotoxicity in EOL-1, which is known to express the FIP1L1-PDGFRA fusion gene encoding an oncogenic kinase, correlated significantly with PDGFRα inhibition. EOL-1 cells treated with the compounds also exhibited dose-dependent inhibition of PDGFRα autophosphorylation and suppression of its downstream signaling pathways with concomitant G 1 phase arrest, confirming the proposed mechanism of action. Our results show that substituted purines can be used as platforms for preparing tyrosine kinase inhibitors with specific activity towards eosinophilic leukemia. Copyright © 2017 Elsevier Ltd. All rights reserved.

Electricity production from wind energy: world situation and the French program EOLE 2005; Production d'electricite par energie eolienne: situation dans le monde et programme francais EOLE 2005

Energy Technology Data Exchange (ETDEWEB)

Electricite de France [ed.] [Electricite de France (EDF), 75 - Paris (France)

2000-06-07

The wind electricity world market shows at present an important development stage characterized by an annual increase rate of 20% to 30%. The total installed power in the world reached the value 7,200 MW in November 1997 and, according to forecasts, it could increase fivefold up to 2005. For France's high wind potential sites, namely the DOM-TOM and in Corsica, where the electricity production is more expensive than in inland France, this energy production mode approaches the threshold of competitiveness with other production means. The program EOLE 2005 (targeting 250 to 500 MW from wind turbines to be installed in France until 2005), launched in 1996 by EDF in collaboration with ADEME, on request of public authorities, is thought to implement this demand. The sections of the report are titled as following: - An energy used by man from long time ago; - Momentous developments of the wind power technology since eighties; - From wind turbines of some hundreds kW to 3 MW, based on robust technologies and newly devised methods; - Wind energy becomes equally interesting from economic viewpoint but for which applications?; - This option presents some drawbacks; - Which is the wind potential economically acceptable if the mentioned constraints are taken into account?; - The wind generators will be installed on sea near seashores; - An outstanding change in this field in France since 1996: the programme EOLE 2005; - 35 selected projects of 125,3 MW total power; - Future. The electricity production from wind energy seems promising particularly for the countries that have not resorted to either nuclear energy or hydropower options and which possess important wind resources.

No Easy Talk: A Mixed Methods Study of Doctor Reported Barriers to Conducting Effective End-of-Life Conversations with Diverse Patients.

Directory of Open Access Journals (Sweden)

Vyjeyanthi S Periyakoil

Full Text Available Though most patients wish to discuss end-of-life (EOL issues, doctors are reluctant to conduct end-of-life conversations. Little is known about the barriers doctors face in conducting effective EOL conversations with diverse patients. This mixed methods study was undertaken to empirically identify barriers faced by doctors (if any in conducting effective EOL conversations with diverse patients and to determine if the doctors' age, gender, ethnicity and medical sub-specialty influenced the barriers reported.Mixed-methods study of multi-specialty doctors caring for diverse, seriously ill patients in two large academic medical centers at the end of the training; data were collected from 2010 to 2012.Doctor-reported barriers to EOL conversations with diverse patients.1040 of 1234 potential subjects (84.3% participated. 29 participants were designated as the development cohort for coding and grounded theory analyses to identify primary barriers. The codes were validated by analyses of responses from 50 randomly drawn subjects from the validation cohort (n= 996 doctors. Qualitative responses from the validation cohort were coded and analyzed using quantitative methods. Only 0.01% doctors reported no barriers to conducting EOL conversations with patients. 99.99% doctors reported barriers with 85.7% finding it very challenging to conduct EOL conversations with all patients and especially so with patients whose ethnicity was different than their own. Asian-American doctors reported the most struggles (91.3%, followed by African Americans (85.3%, Caucasians (83.5% and Hispanic Americans (79.3% in conducting EOL conversations with their patients. The biggest doctor-reported barriers to effective EOL conversations are (i language and medical interpretation issues, (ii patient/family religio-spiritual beliefs about death and dying, (iii doctors' ignorance of patients' cultural beliefs, values and practices, (iv patient/family's cultural differences in truth

Danish general practitioners’ self-reported competences in end-of-life care

Science.gov (United States)

Winthereik, Anna; Neergaard, Mette; Vedsted, Peter; Jensen, Anders

2016-01-01

Objective General practitioners (GPs) are pivotal in end-of-life (EOL) care. This study aimed to assess GP-reported provision of EOL care and to assess associations with GP characteristics. Design Population-based questionnaire study. Setting Central Denmark Region with approximately 1.3 million inhabitants. Subjects All 843 active GPs in the Central Denmark Region were sent a questionnaire by mail. Main outcome measures Responses to 18 items concerning four aspects: provision of EOL care to patients with different diagnosis, confidence with being a key worker, organisation of EOL care and EOL skills (medical and psychosocial). Results In total, 573 (68%) GPs responded. Of these, 85% often/always offered EOL care to cancer patients, which was twice as often as to patients with non-malignancies (34–40%). Moreover, 76% felt confident about being a key worker, 60% had a proactive approach, and 58% talked to their patients about dying. Only 9% kept a register of patients with EOL needs, and 19% had specific EOL procedures. GP confidence with own EOL skills varied; from 55% feeling confident using terminal medications to 90% feeling confident treating nausea/vomiting. Increasing GP age was associated with increased confidence about being a key worker and provision of EOL care to patients with non-malignancies. In rural areas, GPs were more confident about administering medicine subcutaneously than in urban areas. Conclusion We found considerable diversity in self-reported EOL care competences. Interventions should focus on increasing GPs’ provision of EOL care to patients with non-malignancies, promoting better EOL care concerning organisation and symptom management. KEY POINTSGPs are pivotal in end-of-life (EOL) care, but their involvement has been questioned. Hence, GPs’ perceived competencies were explored.GPs were twice as likely to provide EOL care for patients with cancer than for patients with non-malignancies.EOL care was lacking clear organisation in

Apoptosis- and differentiation-inducing activities of jacaric acid, a conjugated linolenic acid isomer, on human eosinophilic leukemia EoL-1 cells.

Science.gov (United States)

Liu, Wai-Nam; Leung, Kwok-Nam

2014-11-01

Conjugated linolenic acids (CLNAs) are a group of naturally occurring positional and geometrical isomers of the C18 polyunsaturated essential fatty acid, linolenic acid (LNA), with three conjugated double bonds (C18:3). Although previous research has demonstrated the growth-inhibitory effects of CLNA on a wide variety of cancer cell lines in vitro, their action mechanisms and therapeutic potential on human myeloid leukemia cells remain poorly understood. In the present study, we found that jacaric acid (8Z,10E,12Z-octadecatrienoic acid), a CLNA isomer which is present in jacaranda seed oil, inhibited the in vitro growth of human eosinophilic leukemia EoL-1 cells in a time- and concentration-dependent manner. Mechanistic studies showed that jacaric acid triggered cell cycle arrest of EoL-1 cells at the G0/G1 phase and induced apoptosis of the EoL-1 cells, as measured by the Cell Death Detection ELISAPLUS kit, Annexin V assay and JC-1 dye staining. Notably, the jacaric acid-treated EoL-1 cells also underwent differentiation as revealed by morphological and phenotypic analysis. Collectively, our results demonstrated the capability of jacaric acid to inhibit the growth of EoL-1 cells in vitro through triggering cell cycle arrest and by inducing apoptosis and differentiation of the leukemia cells. Therefore, jacaric acid might be developed as a potential candidate for the treatment of certain forms of myeloid leukemia with minimal toxicity and few side effects.

Dasatinib inhibits the growth and survival of neoplastic human eosinophils (EOL-1) through targeting of FIP1L1-PDGFRalpha.

Science.gov (United States)

Baumgartner, Christian; Gleixner, Karoline V; Peter, Barbara; Ferenc, Veronika; Gruze, Alexander; Remsing Rix, Lily L; Bennett, Keiryn L; Samorapoompichit, Puchit; Lee, Francis Y; Pickl, Winfried F; Esterbauer, Harald; Sillaber, Christian; Superti-Furga, Giulio; Valent, Peter

2008-10-01

Chronic eosinophilic leukemia (CEL) is a myeloproliferative disorder characterized by molecular and/or cytogenetic evidence of clonality of eosinophils, marked eosinophilia, and organ damage. In many patients, the transforming mutation FIP1L1-PDGFRalpha and the related CHIC2 deletion are found. The respective oncoprotein, FIP1L1-PDGFRalpha, is considered to play a major role in malignant cell growth in CEL. The tyrosine kinase (TK) inhibitor imatinib (STI571) has been described to counteract the TK activity of FIP1L1-PDGFRalpha in most patients. However, not all patients with CEL show a response to imatinib. Therefore, several attempts have been made to identify other TK inhibitors that counteract growth of neoplastic eosinophils. We provide evidence that dasatinib, a multi-targeted kinase inhibitor, blocks the growth and survival of EOL-1, an eosinophil leukemia cell line carrying FIP1L1-PDGFRalpha. The effects of dasatinib on proliferation of EOL-1 cells were dose-dependent, with an IC50 of 0.5 to 1 nM, which was found to be in the same range when compared to IC50 values produced with imatinib. Dasatinib was also found to induce apoptosis in EOL-1 cells in a dose-dependent manner (IC50: 1-10 nM). The apoptosis-inducing effects of dasatinib on EOL-1 cells were demonstrable by light microscopy, flow cytometry, and in a TUNEL assay. In Western blot experiments, dasatinib completely blocked the phosphorylation of FIP1L1-PDGFRalpha in EOL-1 cells. Dasatinib inhibits the growth of leukemic eosinophils through targeting of the disease-related oncoprotein FIP1L1-PDGFRalpha. Based on this observation, dasatinib may be considered as a new interesting treatment option for patients with CEL.

Wellness in Sickness and Health (The W.I.S.H. Project): Advance Care Planning Preferences and Experiences Among Elderly Latino Patients.

Science.gov (United States)

Maldonado, Lauren Y; Goodson, Ruth B; Mulroy, Matthew C; Johnson, Emily M; Reilly, Jo M; Homeier, Diana C

2017-10-25

To assess advance care planning (ACP) preferences, experiences, and comfort in discussing end-of-life (EOL) care among elderly Latinos. Patients aged 60 and older from the Los Angeles County and University of Southern California (LAC+USC) Medical Center Geriatrics Clinic (n = 41) participated in this intervention. Trained staff conducted ACP counseling with participants in their preferred language, which included: (a) pre-counseling survey about demographics and EOL care attitudes, (b) discussion of ACP and optional completion of an advance directive (AD), and (c) post-session survey. Patients were primarily Spanish speaking with an average of 2.7 chronic medical conditions. Most had not previously documented (95%) or discussed (76%) EOL wishes. Most were unaware they had control over their EOL treatment (61%), but valued learning about EOL options (83%). Post-counseling, 85% reported comfort discussing EOL goals compared to 66% pre-session, and 88% elected to complete an AD. Nearly half of patients reported a desire to discuss EOL wishes sooner. Elderly Latino patients are interested in ACP, given individualized, culturally competent counseling in their preferred language. Patients should be offered the opportunity to discuss and document EOL wishes at all primary care appointments, regardless of health status. Counseling should be completed in the patient's preferred language, using culturally competent materials, and with family members present if this is the patient's preference. Cultural-competency training for providers could enhance the impact of EOL discussions and improve ACP completion rates for Latino patients.

EOL performance comparison of GaAs/Ge and Si BSF/R solar arrays

Science.gov (United States)

Woike, Thomas J.

1993-01-01

EOL power estimates for solar array designs are significantly influenced by the predicted degradation due to charged particle radiation. New radiation-induced power degradation data for GaAs/Ge solar arrays applicable to missions ranging from low earth orbit (LEO) to geosynchronous earth orbit (GEO) and compares these results to silicon BSF/R arrays. These results are based on recently published radiation damage coefficients for GaAs/Ge cells. The power density ratio (GaAs/Ge to Si BSF/R) was found to be as high as 1.83 for the proton-dominated worst-case altitude of 7408 km medium Earth orbit (MEO). Based on the EOL GaAs/Ge solar array power density results for MEO, missions which were previously considered infeasible may be reviewed based on these more favorable results. The additional life afforded by using GaAs/Ge cells is an important factor in system-level trade studies when selecting a solar cell technology for a mission and needs to be considered. The data presented supports this decision since the selected orbits have characteristics similar to most orbits of interest.

Simulation of Phenix EOL Asymmetric Test

Energy Technology Data Exchange (ETDEWEB)

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

2012-05-15

The asymmetric test of End-Of-Life (EOL) tests on the Phenix plant was used for the evaluation of the MARS-LMR in the Generation IV frame as a part of the code validation. The purpose of the test is to evaluate the ability of the system code to describe asymmetric situations and to identify important phenomena during asymmetrical transient such as a three dimensional effect, buoyancy influence, and thermal stratification in the hot and cold pools. 3-dimensional sodium coolant mixing in the pools has different characteristics from the one dimensional full instantaneous mixing. The velocities and temperatures at the core outlet level differ at each sub-assembly and the temperature in the center of the hot pool may be high because the driver fuels are located at the center region. The temperatures in the hot pool are not the same in the radial and axial locations due to the buoyancy effect. The temperatures in the cold pool also differ along with the elevations and azimuthal directions due to the outlet location of IHX and the thermal stratification

Anti-proliferative and differentiation-inducing activities of the green tea catechin epigallocatechin-3-gallate (EGCG) on the human eosinophilic leukemia EoL-1 cell line.

Science.gov (United States)

Lung, H L; Ip, W K; Wong, C K; Mak, N K; Chen, Z Y; Leung, K N

2002-12-06

A novel approach for the treatment of leukemia is the differentiation therapy in which immature leukemia cells are induced to attain a mature phenotype when exposed to differentiation inducers, either alone or in combinations with other chemotherapeutic or chemopreventive drugs. Over the past decade, numerous studies indicated that green tea catechins (GTC) could suppress the growth and induce apoptosis on a number of human cancer cell lines. However, the differentiation-inducing activity of GTC on human tumors remains poorly understood. In the present study, the effect of the major GTC epigallocatechin-3-gallate (EGCG) on the proliferation and differentiation of a human eosinophilc leukemic cell line, EoL-1, was examined. Our results showed that EGCG suppressed the proliferation of the EoL-1 cells in a dose-dependent manner, with an estimated IC(50) value of 31.5 microM. On the other hand, EGCG at a concentration of 40 microM could trigger the EoL-1 cells to undergo morphological differentiation into mature eosinophil-like cells. Using RT-PCR and flow cytometry, it was found that EGCG upregulated the gene and protein expression of two eosinophil-specific granule proteins, the major basic protein (MBP) and eosinophil peroxidase (EPO), in EoL-1 cells. Taken together, our findings suggest that EGCG can exhibit anti-leukemic activity on a human eosinophilic cell line EoL-1 by suppressing the proliferation and by inducing the differentiation of the leukemia cells.

What Is the End of Life Period? Trajectories and Characterization Based on Primary Caregiver Reports.

Science.gov (United States)

Cohen-Mansfield, Jiska; Cohen, Rinat; Skornick-Bouchbinder, Michal; Brill, Shai

2018-04-17

As the population lives longer, end of life (EOL) is emerging as a distinct life phase, about which there is still limited understanding. Characterizing this important period is vital for clarifying issues regarding trajectory and decline at EOL and for health service planning on an institutional, communal, and societal level. In this article, we aim to characterize the EOL period, examining the duration and number of EOL stages, as well as functional, attitudinal, and emotional trajectories. In this cross-sectional study, 70 primary caregivers of deceased persons were interviewed. Standardized rates of functional, attitudinal, and emotional change across the EOL period were calculated. Frequencies were compared using the McNemar statistical test. EOL period was found to have a median length of 3.25 years, and an average of approximately three progressive stages. The duration of EOL stages tended to decrease as death approached. Unexpected events (eg new medical diagnosis/accident) served as the precipitating event for the EOL period for approximately half of the deceased persons, and changes in existing conditions (eg health status/cognitive state) were also reported to precipitate EOL for a similar proportion. Reports of functionality across stages found the steepest decline in the "physical" domain and the most moderate decline in the "social" domain. With each stage, positive indicators, such as "will to live," showed a progressive decline, whereas negative indicators, including "suffering" and "dependence level," progressively increased. Results help characterize EOL trajectories and should inform care planning and decision making at various levels. In addition, they suggest a methodology for better understanding EOL.

Effect of benzo[a]pyrene on the production of vascular endothelial growth factor by human eosinophilic leukemia EoL-1 cells.

Science.gov (United States)

Gu, Jie; Chan, Lai-Sheung; Wong, Chris Kong-Chu; Wong, Ngok-Shun; Wong, Chun-Kwok; Leung, Kok-Nam; Mak, Naiki K

2011-01-01

Benzo[a]pyrene (BaP) has been shown to affect both the development and response of T and B cells in the immune system. However, the effect of BaP on other immune cells, such as eosionophils, is unknown. In this study, we investigated the effect of BaP on the production of vascular endothelial growth factor (VEGF) using an in vitro eosinophilic EoL-1 cell and human umbilical vein endothelial cell (HUVEC) co-culture system. EoL-1-conditioned medium was found to promote the growth of HUVEC in a time-dependent manner. The growth stimulating activity was due to the production of VEGF by the EoL-1 cells. The production of VEGF was correlated with the enhanced expression of the phosphorylated form of extracellular signal-regulated kinases (p-ERKs) and the upregulated expression of VEGF mRNA. Furthermore, BaP-induced expression of VEGF mRNA was reduced by the ERK inhibitor PD98059. Results from this study suggested that BaP might affect the growth of endothelial cells through the modulation of VEGF production by eosinophils.

Let's Talk About It: Supporting Family Communication during End-of-Life Care of Pediatric Patients.

Science.gov (United States)

Marsac, Meghan L; Kindler, Christine; Weiss, Danielle; Ragsdale, Lindsay

2018-05-18

Communication is key in optimizing medical care when a child is approaching end of life (EOL). Research is yet to establish best practices for how medical teams can guide intrafamily communication (including surviving siblings) when EOL care is underway or anticipated for a pediatric patient. While recommendations regarding how medical teams can facilitate communication between the medical team and the family exist, various barriers may prevent the implementation of these recommendations. This review aims to provide a summary of research-to-date on family and medical provider perceptions of communication during pediatric EOL care. Systematic review. Findings from a review of 65 studies suggest that when a child enters EOL care, many parents try to protect their child and/or themselves by avoiding discussions about death. Despite current recommendations, medical teams often refrain from discussing EOL care with pediatric patients until death is imminent for a variety of reasons (e.g., family factors and discomfort with EOL conversations). Parents consistently report a need for honest complete information, delivered with sensitivity. Pediatric patients often report a preference to be informed of their prognosis, and siblings express a desire to be involved in EOL discussions. Families may benefit from enhanced communication around EOL planning, both within the family and between the family and medical team. Future research should investigate a potential role for medical teams in supporting intrafamily communication about EOL challenges and should examine how communication between medical teams and families can be facilitated as EOL approaches.

Annual Report 2000

International Nuclear Information System (INIS)

2000-01-01

This annual report gives the activities during the year 2000 and information about the General Direction of the Energy and Raw Materials (DGEMP) in France. The highlights of the year are discussed in the main following topics: public utilities, the Erika oil slick, the petroleum products prices increase, the energy efficiency national program, Eole 2005, the nuclear industry management. The french energy accounting, the publications and the organization of the DGEMP are also provided. (A.L.B.)

Rumex L. species induce apoptosis in 1301, EOL-1 and H-9 cell lines.

Science.gov (United States)

Wegiera, Magdalena; Smolarz, Helena D; Bogucka-Kocka, Anna

2012-01-01

The Rumex L. (dock) species for many centuries have been used in medical treatment, through their adstringent, spasmolitic or cholagogic action. In the present study, the in vitro screening of cytotoxic activities of ethanol extract from roots, leaves and fruits of six Rumex species: R. acetosa L., R. acetosella L., R. confertus Willd., R. crispus L., R. hydrolapathum Huds. and R. obtusifolius L. were performed. We found remarkable cytotoxic activities on leukemic 1301 and EOL-1 cell lines and T cell line at concentration dependent manners. Cytotoxic activity was determined in two ways: trypan blue test and annexin-V FITC and propidium iodide assay. Received IC50 values of investigated extracts on 1301, EOL-1 and H-9 cell lines ranged from 0.22, 0.17 and 0.04 to 2.56, 1.91 and 1.83 mg/mL, respectively. Analysis of morphological changes demonstrated that the extract exerted cell-death via apoptosis. The overall activities of Rumex species support the traditional use of the extract from the fruits of R. confertus, R. crispus, R. hydrolapathum and R. obtusifolius in the treatment of cancer.

Trends in advance care planning in cancer patients: Results from a national, longitudinal survey

Science.gov (United States)

Narang, Amol K.; Wright, Alexi A.; Nicholas, Lauren H.

2015-01-01

Importance Advance care planning (ACP) may prevent end-of-life (EOL) care that is non-beneficial and discordant with patient wishes. Despite long-standing recognition of the merits of ACP in oncology, it is unclear whether cancer patients’ participation in ACP has increased over time. Objective To characterize trends in durable power of attorney (DPOA) assignment, living will creation, and participation in discussions of EOL care preferences, and to explore associations between ACP subtypes and EOL treatment intensity, as reflected in EOL care decisions and terminal hospitalizations. Design Prospectively collected survey data from the Health and Retirement Study (HRS), including data from in-depth “exit” interviews conducted with next-of-kin surrogates following the death of an HRS participant. Trends in ACP subtypes were tested, and multivariable logistic regression models examined associations between ACP subtypes and measures of treatment intensity. Setting HRS, a nationally representative, biennial, longitudinal panel study of U.S. residents over age 50. Participants 1,985 next-of-kin surrogates of HRS participants with cancer who died between 2000 and 2012. Main Outcome and Measures Trends in the surrogate-reported frequency of DPOA assignment, living will creation, and participation in discussions of EOL care preferences, as well as associations between ACP subtypes and surrogate-reported EOL care decisions/terminal hospitalizations. Results From 2000-2012, there was an increase in DPOA assignment (52% to 74%, p=0.03), without change in use of living wills (49% to 40%, p=0.63) or EOL discussions (68% to 60%, p=0.62). Surrogates increasingly reported that patients received “all care possible” at EOL (7% to 58%, p=0.004), and rates of terminal hospitalizations were unchanged (29% to 27%, p=0.70). Both living wills and EOL discussions were associated with limiting/withholding treatment [living will: adjusted odds ratio (AOR)=2.51, 95% confidence

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

Science.gov (United States)

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

2016-01-01

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

Trends in Advance Care Planning in Patients With Cancer: Results From a National Longitudinal Survey.

Science.gov (United States)

Narang, Amol K; Wright, Alexi A; Nicholas, Lauren H

2015-08-01

Advance care planning (ACP) may prevent end-of-life (EOL) care that is nonbeneficial and discordant with patient wishes. Despite long-standing recognition of the merits of ACP in oncology, it is unclear whether participation in ACP by patients with cancer has increased over time. To characterize trends in durable power of attorney (DPOA) assignment, living will creation, and participation in discussions of EOL care preferences and to explore associations between ACP subtypes and EOL treatment intensity as reflected in EOL care decisions and terminal hospitalizations. We analyzed prospectively collected survey data from 1985 next-of-kin surrogates of Health and Retirement Study (HRS) participants with cancer who died between 2000 and 2012, including data from in-depth "exit" interviews conducted with the surrogates after the participant's death. The HRS is a nationally representative, biennial, longitudinal panel study of US residents older than 50 years. Trends in ACP subtypes were tested, and multivariable logistic regression models examined for associations between ACP subtypes and measures of treatment intensity. Trends in the surrogate-reported frequency of DPOA assignment, living will creation, and participation in discussions of EOL care preferences; associations between ACP subtypes and both surrogate-reported EOL care decisions and terminal hospitalizations. From 2000 to 2012, there was an increase in DPOA assignment (52% to 74%, P = .03), without significant change in use of living wills (49% to 40%, P = .63) or EOL discussions (68% to 60%, P = .62). Surrogate reports that patients received "all care possible" at EOL increased during the period (7% to 58%, P = .004), and rates of terminal hospitalizations were unchanged (29% to 27%, P = .70). Limiting or withholding treatment was associated with living wills (adjusted odds ratio [AOR], 2.51; 95% CI, 1.53-4.11; P EOL discussions (AOR, 1.93; 95% CI, 1.53-3.14; P = .002) but not with

Reactor pressure vessel status report

International Nuclear Information System (INIS)

Strosnider, J.; Wichman, K.; Elliot, B.

1994-12-01

This report gives a brief description of the reactor pressure vessel (RPV), followed by a discussion of the radiation embrittlement of RPV beltline materials and the two indicators for measuring embrittlement, the end-of-license (EOL) reference temperature and the EOL upper-shelf energy. It also summarizes the GL 92-01 effort and presents, for all 37 boiling water reactor plants and 74 pressurized water reactor plants in the United States, the current status of compliance with regulatory requirements related to ensuring RPV integrity. The staff has evaluated the material data needed to predict neutron embrittlement of the reactor vessel beltline materials. These data will be stored in a computer database entitled the reactor vessel integrity database (RVID). This database will be updated annually to reflect the changes made by the licensees in future submittals and will be used by the NRC staff to assess the issues related to vessel structural integrity

Danish general practitioners? self-reported competences in end-of-life care

OpenAIRE

Winthereik, Anna; Neergaard, Mette; Vedsted, Peter; Jensen, Anders

2016-01-01

Objective General practitioners (GPs) are pivotal in end-of-life (EOL) care. This study aimed to assess GP-reported provision of EOL care and to assess associations with GP characteristics. Design Population-based questionnaire study. Setting Central Denmark Region with approximately 1.3 million inhabitants. Subjects All 843 active GPs in the Central Denmark Region were sent a questionnaire by mail. Main outcome measures Responses to 18 items concerning four aspects: provision of EOL care to ...

Centenarians' End-of-Life Thoughts and Plans: Is Their Social Network on the Same Page?

Science.gov (United States)

Boerner, Kathrin; Kim, Kyungmin; Kim, Yijung; Rott, Christoph; Jopp, Daniela S

2018-05-22

To explore how centenarians think about and plan for the end of life (EOL) and to what extent their primary contacts (proxy informants) are aware of these thoughts. Population-based study with semistructured in-person interviews. Defined geographical region approximately 60 km around Heidelberg, Germany. Subsample drawn from the larger study of centenarians (N = 78) with data on centenarians' EOL thoughts from the centenarian and the proxy informant. Centenarians reported on their thoughts about the EOL, perception of the EOL as threatening, longing for death, engagement in any EOL planning, and type of EOL plan (will, living will, healthcare surrogate) in place. Proxy respondents answered the same set of questions based on what they thought the centenarians' perspective was. In nearly half of cases, proxies misjudged whether the centenarian thought about EOL. Although only few centenarians perceived the EOL as threatening, and approximately one-quarter reported longing for death, proxies overestimated centenarians' reports on the former and underestimated the latter. Proxies reported more centenarian EOL planning than centenarians themselves. Even though enrolled proxies were mostly persons very close to the centenarian, many of them did not seem to be well informed about the centenarians' thoughts and plans regarding the EOL, suggesting a lack of communication between centenarians and social network members in this respect. Healthcare professionals should be aware that, even for very old adults approaching the end of their lives, discussions about EOL and EOL planning may need to be actively encouraged and supported. © 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.

Mechanism for the decrease in the FIP1L1-PDGFRalpha protein level in EoL-1 cells by histone deacetylase inhibitors.

Science.gov (United States)

Ishihara, Kenji; Kaneko, Motoko; Kitamura, Hajime; Takahashi, Aki; Hong, Jang Ja; Seyama, Toshio; Iida, Koji; Wada, Hiroshi; Hirasawa, Noriyasu; Ohuchi, Kazuo

2008-01-01

Acetylation and deacetylation of proteins occur in cells in response to various stimuli, and are reversibly catalyzed by histone acetyltransferase and histone deacetylase (HDAC), respectively. EoL-1 cells have an FIP1L1-PDGFRA fusion gene that causes transformation of eosinophilic precursor cells into leukemia cells. The HDAC inhibitors apicidin and n-butyrate suppress the proliferation of EoL-1 cells and induce differentiation into eosinophils by a decrease in the protein level of FIP1L1-PDGFRalpha without affecting the mRNA level for FIP1L1-PDGFRA. In this study, we analyzed the mechanism by which the protein level of FIP1L1-PDGFRalpha is decreased by apicidin and n-butyrate. EoL-1 cells were incubated in the presence of the HDAC inhibitors apicidin, trichostatin A or n-butyrate. The protein levels of FIP1L1-PDGFRalpha and phosphorylated eIF-2alpha were determined by Western blotting. Actinomycin D and cycloheximide were used to block RNA synthesis and protein synthesis, respectively, in the chasing experiment of the amount of FIP1L1-PDGFRalpha protein. When apicidin- and n-butyrate-treated EoL-1 cells were incubated in the presence of actinomycin D, the decrease in the protein level of FIP1L1-PDGFRalpha was significantly enhanced when compared with controls. In contrast, the protein levels were not changed by cycloheximide among these groups. Apicidin and n-butyrate induced the continuous phosphorylation of eIF-2alpha for up to 8 days. The decrease in the level of FIP1L1-PDGFRalpha protein by continuous inhibition of HDAC may be due to the decrease in the translation rate of FIP1L1-PDGFRA. Copyright 2008 S. Karger AG, Basel.

Annual Report 2000; Rapport annuel 2000

Energy Technology Data Exchange (ETDEWEB)

NONE

2000-07-01

This annual report gives the activities during the year 2000 and information about the General Direction of the Energy and Raw Materials (DGEMP) in France. The highlights of the year are discussed in the main following topics: public utilities, the Erika oil slick, the petroleum products prices increase, the energy efficiency national program, Eole 2005, the nuclear industry management. The french energy accounting, the publications and the organization of the DGEMP are also provided. (A.L.B.)

The effect of rapid response teams on end-of-life care: A retrospective chart review

Science.gov (United States)

Tam, Benjamin; Salib, Mary; Fox-Robichaud, Alison

2014-01-01

BACKGROUND: A subset of critically ill patients have end-of-life (EOL) goals that are unclear. Rapid response teams (RRTs) may aid in the identification of these patients and the delivery of their EOL care. OBJECTIVES: To characterize the impact of RRT discussion on EOL care, and to examine how a preprinted order (PPO) set for EOL care influenced EOL discussions and outcomes. METHODS: A single-centre retrospective chart review of all RRT calls (January 2009 to December 2010) was performed. The effect of RRT EOL discussions and the effect of a hospital-wide PPO set on EOL care was examined. Charts were from the Ontario Ministry of Health and Long-Term Care Critical Care Information Systemic database, and were interrogated by two reviewers. RESULTS: In patients whose EOL status changed following RRT EOL discussion, there were fewer intensive care unit (ICU) transfers (8.4% versus 17%; PEOL status following the introduction of an EOL PPO, from 20% (before) to 31% (after) (PEOL status following RRT-led EOL discussion was associated with reduced ICU transfers and enhanced access to palliative care services. Further study is required to identify and deconstruct barriers impairing timely and appropriate EOL discussions. PMID:25299222

Leukotactin-1/CCL15 induces cell migration and differentiation of human eosinophilic leukemia EoL-1 cells through PKCdelta activation.

Science.gov (United States)

Lee, Ji-Sook; Kim, In Sik

2010-06-01

Leukotactin-1 (Lkn-1)/CCL15 is a CC chemokine that binds to the CCR1 and CCR3. Lkn-1 functions as an essential factor in the migration of monocytes, lymphocytes, and neutrophils. Although eosinophils express both receptors, the role of Lkn-1 in immature eosinophils remains to be elucidated. In this present study, we investigated the contribution of the CCR1-binding chemokines to chemotactic activity and in the differentiation in the human eosinophilic leukemia cell line EoL-1. Lkn-1 induced the stronger migration of EoL-1 cells than other CCR1-binding chemokines such as RANTES/CCL5, MIP-1alpha/CCL3 and HCC-4/CCL16. Lkn-1-induced chemotaxis was inhibited by pertussis toxin, an inhibitor of G(i)/G(o) protein; U73122, an inhibitor of phospholipase C and rottlerin, an inhibitor of protein kinase C delta (PKCdelta). Lkn-1 increased PKCdelta activity, which was partially blocked by the pertussis toxin and U73122. Lkn-1 enhanced the butyric acid-induced differentiation via PKCdelta after binding to the increased CCR1 because Lkn-1 caused EoL-1 cells to change morphologically into mature eosinophil-like cells. Likewise, Lkn-1 increased the expression of both eosinophil peroxidase (EPO) and the major basic protein (MBP). PKCdelta activation due to Lkn-1 is involved in migration, as well as the butyric acid-induced differentiation. This finding contributes to an understanding of CC chemokines in eosinophil biology and to the development of novel therapies for the treatment of eosinophilic disorders. This study suggests the pivotal roles of Lkn-1 in the regulation of the movement and development of eosinophils.

End-of-Life Care for Blood Cancers: A Series of Focus Groups With Hematologic Oncologists

Science.gov (United States)

Odejide, Oreofe O.; Salas Coronado, Diana Y.; Watts, Corey D.; Wright, Alexi A.; Abel, Gregory A.

2014-01-01

Purpose: Hematologic cancers are associated with aggressive cancer-directed care near death and underuse of hospice and palliative care services. We sought to explore hematologic oncologists' perspectives and decision-making processes regarding end-of-life (EOL) care. Methods: Between September 2013 and January 2014, 20 hematologic oncologists from the Dana-Farber/Harvard Cancer Center participated in four focus groups regarding EOL care for leukemia, lymphoma, multiple myeloma, and hematopoietic stem-cell transplantation. Focus groups employed a semistructured format with case vignettes and open-ended questions and were followed by thematic analysis. Results: Many participants felt that identifying the EOL phase for patients with hematologic cancers was challenging as a result of the continuing potential for cure with advanced disease and the often rapid pace of decline near death. This difficulty was reported to result in later initiation of EOL care. Barriers to high-quality EOL care were also reported to be multifactorial, including unrealistic expectations from both physicians and patients, long-term patient-physician relationships resulting in difficulty conducting EOL discussions, and inadequacy of existing home-based EOL services. Participants also expressed concern that some EOL quality measures developed for solid tumors may be unacceptable for patients with blood cancers given their unique needs at the EOL (eg, palliative transfusions). Conclusion: Our analysis suggests that hematologic oncologists need better clinical markers for when to initiate EOL care. In addition, current quality measures may be inappropriate for identifying overly aggressive care for patients with blood cancers. Further research is needed to develop effective interventions to improve EOL care for this patient population. PMID:25294393

Dances With Denial: Have Medical Oncology Outpatients Conveyed Their End-of-Life Wishes and Do They Want To?

Science.gov (United States)

Waller, Amy; Douglas, Charles; Sanson-Fisher, Rob; Zdenkowski, Nicholas; Pearce, Angela; Evans, Tiffany; Walsh, Justin

2018-05-01

Objectives: This study surveyed a sample of medical oncology outpatients to determine (1) the proportion who have already discussed and documented their end-of-life (EOL) wishes; (2) when and with whom they would prefer to convey their EOL wishes; (3) the EOL issues they would want to discuss; and (4) the association between perceived cancer status and advance care planning (ACP) participation. Methods: Adult medical oncology outpatients were approached in the waiting room of an Australian tertiary treatment center. Consenting participants completed a pen-and-paper survey assessing participation in ACP, preferences for conveying EOL wishes, timing of EOL discussions, and EOL issues they want to be asked about. Results: A total of 203 patients returned the survey (47% of eligible). EOL discussions occurred more frequently with support persons (47%) than with doctors (7%). Only 14% had recorded their wishes, and 45% had appointed an enduring guardian. Those who perceived their cancer as incurable were more likely to have participated in ACP. If facing EOL, patients indicated that they would want family involved in discussions (85%), to be able to write down EOL wishes (82%), and to appoint enduring guardians (91%). Many (45%) preferred the first discussion to happen when their disease became incurable. Slightly less than one-third thought discussions regarding EOL should be patient-initiated. Most agreed doctors should ask about preferred decision-making involvement (92%), how important it is that pain is managed well (95%), and how important it is to remain conscious (82%). Fewer (55%) wanted to be asked about the importance of care extending life. Conclusions: Many patients would like to have discussions regarding EOL care with their doctor and involve their support persons in this process. Only a small percentage of respondents had discussed EOL care with their doctors, recorded their wishes, or appointed an enduring guardian. The first step requires clinicians to

Development and Pilot Evaluation of a Novel Dignity-Conserving End-of-Life (EoL) Care Model for Nursing Homes in Chinese Societies.

Science.gov (United States)

Ho, Andy H Y; Dai, Annie A N; Lam, Shu-Hang; Wong, Sandy W P; Tsui, Amy L M; Tang, Jervis C S; Lou, Vivian W Q

2016-06-01

The provision of end-of-life (EoL) care in long-term-care settings remains largely underdeveloped in most Chinese societies, and nursing home residents often fail to obtain good care as they approach death. This paper systematically describes the development and implementation mechanisms of a novel Dignity-Conserving EoL Care model that has been successfully adopted by three nursing homes in Hong Kong and presents preliminary evidence of its effectiveness on enhancing dignity and quality of life (QoL) of terminally ill residents. Nine terminally ill nursing home residents completed the McGill Quality of Life Questionnaire and the Nursing Facilities Quality of Life Questionnaire at baseline and 6 months post-EoL program enrollment. Wilcoxon signed rank test was used to detect significance changes in each QoL domains across time. Although significant deterioration was recorded for physical QoL, significant improvement was observed for social QoL. Moreover, a clear trend toward significant improvements was identified for the QoL domains of individuality and relationships. A holistic and compassionate caring environment, together with the core principles of family-centered care, interagency and interdisciplinary teamwork, as well as cultural-specific psycho-socio-spiritual support, are all essential elements for optimizing QoL and promoting death with dignity for nursing home residents facing morality. This study provides a useful framework to facilitate the future development of EoL care in long-term-care settings in the Chinese context. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

"End-of-Life Care? I'm not Going to Worry About That Yet." Health Literacy Gaps and End-of-Life Planning Among Elderly Dialysis Patients.

Science.gov (United States)

Ladin, Keren; Buttafarro, Katie; Hahn, Emily; Koch-Weser, Susan; Weiner, Daniel E

2018-03-19

Between 2000 and 2012, the incident dialysis population in the United States increased by nearly 60%, most sharply among adults 75 years and older. End-of-life (EOL) conversations among dialysis patients are associated with better patient-centered outcomes and lower use of aggressive interventions in the last month of life. This study examined how health literacy may affect engagement, comprehension, and satisfaction with EOL conversations among elderly dialysis patients. Qualitative/descriptive study with semi-structured interviews about health literacy, EOL conversations, and goals of care with 31 elderly dialysis patients at 2 centers in Boston. Themes were interpreted in the context of Nutbeam's health literacy framework. Despite high mortality risk in this population, only 13% of patients had discussed EOL preferences with physicians, half had discussed EOL with their social network, and 25% of participants explicitly stated that they had never considered EOL preferences. Less than 30% of participants could correctly define terminology commonly used in EOL conversations. Analyses yielded 5 themes: (1) Misunderstanding EOL terminology; (2) Nephrologists reluctant to discuss EOL; (3) Patients conforming to socially constructed roles; (4) Discordant expectations and dialysis experiences; and (5) Reconciling EOL values and future care. Patients had limited understanding of EOL terminology, lacked of opportunities for meaningful EOL discussion with providers and family, resulting in uncertainty about future care. Limited health literacy presents a substantial barrier to communication and could lead to older adults committing to an intensive pattern of care without adequate information. Clinicians should consider health literacy when discussing dialysis initiation.

Large-scale kinetic energy spectra from Eulerian analysis of EOLE wind data

Science.gov (United States)

Desbois, M.

1975-01-01

A data set of 56,000 winds determined from the horizontal displacements of EOLE balloons at the 200 mb level in the Southern Hemisphere during the period October 1971-February 1972 is utilized for the computation of planetary- and synoptic-scale kinetic energy space spectra. However, the random distribution of measurements in space and time presents some problems for the spectral analysis. Two different approaches are used, i.e., a harmonic analysis of daily wind values at equi-distant points obtained by space-time interpolation of the data, and a correlation method using the direct measurements. Both methods give similar results for small wavenumbers, but the second is more accurate for higher wavenumbers (k above or equal to 10). The spectra show a maximum at wavenumbers 5 and 6 due to baroclinic instability and then decrease for high wavenumbers up to wavenumber 35 (which is the limit of the analysis), according to the inverse power law k to the negative p, with p close to 3.

Adolescent end of life preferences and congruence with their parents' preferences: results of a survey of adolescents with cancer.

Science.gov (United States)

Jacobs, Shana; Perez, Jennie; Cheng, Yao Iris; Sill, Anne; Wang, Jichuan; Lyon, Maureen E

2015-04-01

Little is known about how well family members accurately represent adolescents when making EOL decisions on their behalf. This study reports on surveys given to adolescents with cancer and their parents as part of a larger study facilitating advanced care discussions, as well as the results of a survey for health care providers. Trained facilitators administered surveys orally to adolescents and families in the intervention arm of the FAmily CEntered Advance Care Planning (ACP) for Teens with Cancer (FACE-TC) study. In addition, a post-hoc survey was sent to oncology providers. Seventeen adolescent/family dyads completed this survey. Seventy five percent of adolescents believed it was appropriate to discuss EOL decisions early and only 12% were not comfortable discussing death. Most preferred to be at home if dying. There were substantial areas of congruence between adolescents and their surrogates, but lower agreement on the importance of dying a natural death, dying at home and "wanting to know if I were dying." Among providers, 83% felt their patients' participation in the study was helpful to the patients and 78% felt it was helpful to them as providers. Adolescents with cancer were comfortable discussing EOL, and the majority preferred to talk about EOL issues before they are facing EOL. There were substantive areas of agreement between adolescents and their surrogates, but important facets of adolescents' EOL wishes were not known by their families, reinforcing the importance of eliciting individual preferences and engaging dyads so parents can understand their children's wishes. © 2014 Wiley Periodicals, Inc.

Final report for the Light Water Breeder Reactor proof-of-breeding analytical support project

International Nuclear Information System (INIS)

Graczyk, D.G.; Hoh, J.C.; Martino, F.J.; Nelson, R.E.; Osudar, J.; Levitz, N.M.

1987-05-01

The technology of breeding 233 U from 232 Th in a light water reactor is being developed and evaluated by the Westinghouse Bettis Atomic Power Laboratory (BAPL) through operation and examination of the Shippingport Light Water Breeder Reactor (LWBR). Bettis is determining the end-of-life (EOL) inventory of fissile uranium in the LWBR core by nondestructive assay of a statistical sample comprising approximately 500 EOL fuel rods. This determination is being made with an irradiated-fuel assay gauge based on neutron interrogation and detection of delayed neutrons from each rod. The EOL fissile inventory will be compared with the beginning-of-life fissile loading of the LWBR to determine the extent of breeding. In support of the BAPL proof-of-breeding (POB) effort, Argonne National Laboratory (ANL) carried out destructive physical, chemical, and radiometric analyses on 17 EOL LWBR fuel rods that were previously assayed with the nondestructive gauge. The ANL work included measurements on the intact rods; shearing of the rods into pre-designated contiguous segments; separate dissolution of each of the more than 150 segments; and analysis of the dissolver solutions to determine each segment's uranium content, uranium isotopic composition, and loading of selected fission products. This report describes the facilities in which this work was carried out, details operations involved in processing each rod, and presents a comprehensive discussion of uncertainties associated with each result of the ANL measurements. Most operations were carried out remotely in shielded cells. Automated equipment and procedures, controlled by a computer system, provided error-free data acquisition and processing, as well as full replication of operations with each rod. Despite difficulties that arose during processing of a few rod segments, the ANL destructive-assay results satisfied the demanding needs of the parent LWBR-POB program

Final report for the Light Water Breeder Reactor proof-of-breeding analytical support project

Energy Technology Data Exchange (ETDEWEB)

Graczyk, D.G.; Hoh, J.C.; Martino, F.J.; Nelson, R.E.; Osudar, J.; Levitz, N.M.

1987-05-01

The technology of breeding /sup 233/U from /sup 232/Th in a light water reactor is being developed and evaluated by the Westinghouse Bettis Atomic Power Laboratory (BAPL) through operation and examination of the Shippingport Light Water Breeder Reactor (LWBR). Bettis is determining the end-of-life (EOL) inventory of fissile uranium in the LWBR core by nondestructive assay of a statistical sample comprising approximately 500 EOL fuel rods. This determination is being made with an irradiated-fuel assay gauge based on neutron interrogation and detection of delayed neutrons from each rod. The EOL fissile inventory will be compared with the beginning-of-life fissile loading of the LWBR to determine the extent of breeding. In support of the BAPL proof-of-breeding (POB) effort, Argonne National Laboratory (ANL) carried out destructive physical, chemical, and radiometric analyses on 17 EOL LWBR fuel rods that were previously assayed with the nondestructive gauge. The ANL work included measurements on the intact rods; shearing of the rods into pre-designated contiguous segments; separate dissolution of each of the more than 150 segments; and analysis of the dissolver solutions to determine each segment's uranium content, uranium isotopic composition, and loading of selected fission products. This report describes the facilities in which this work was carried out, details operations involved in processing each rod, and presents a comprehensive discussion of uncertainties associated with each result of the ANL measurements. Most operations were carried out remotely in shielded cells. Automated equipment and procedures, controlled by a computer system, provided error-free data acquisition and processing, as well as full replication of operations with each rod. Despite difficulties that arose during processing of a few rod segments, the ANL destructive-assay results satisfied the demanding needs of the parent LWBR-POB program.

Caregiving Youth Knowledge and Perceptions of Parental End-of-Life Wishes in Huntington's Disease.

Science.gov (United States)

Kavanaugh, Melinda S; Noh, Hyunjin; Zhang, Lixia

2016-01-01

Knowledge of patient end-of-life (EOL) wishes and discussions are vital for family caregivers, including children and youth who may be in caregiving roles ("young carers" or "caregiving youth"). However, little is known about caregiving youth awareness and perceptions of EOL issues. This study sought to explore caregiving youth knowledge of EOL wishes and their willingness for EOL discussions. Face-to-face interviews with 40 caregiving youth ages 10-20, who have a parent with Huntington's disease (HD), provided information about their knowledge of the presence of their ill parent's living will (LW) and durable power of attorney for health care (DPAHC), and willingness to talk with the parent about EOL choices and possibility of death. Less than one-half of the participants were aware of the parent's LW or DPAHC. Content analysis revealed themes in reasons to want or not want EOL discussion with the parent: respect for the parent's wishes, caregiving youths' opinion not valued, and avoidance of EOL issues. Themes also included reasons to not want discussion with the parent about possibility of death: protecting the parent, parent in denial, parent not ready, and realization of the terminal outcome. Findings suggest HD patients and their caregiving youth need support for open EOL discussions, and could benefit from educational programs and support groups around EOL issues.

Communication for end-of-life care planning among Korean patients with terminal cancer: A context-oriented model.

Science.gov (United States)

Koh, Su Jin; Kim, Shinmi; Kim, Jinshil

2016-02-01

In Korea, patients with terminal cancer are often caught out of the loop in end-of-life (EoL) care discussions. Healthcare professionals also have difficulty engaging in such communication in a variety of healthcare contexts. Therefore, the objective of our study was to develop a communication model for EoL care decision making compatible with the clinical environment in Korea. Using focus-group interview methodology, participants included eight doctors and five nurses who provide EoL care for terminal cancer patients in acute hospital settings or hospice care facilities in various provinces of Korea. Five themes emerged regarding EoL care discussion, which included: (1) timing, (2) responsible professionals, (3) disclosure of bad news, (4) content areas of EoL care discussion, and (5) implementing strategies for EoL care discussions. These themes were based on development of a communication algorithm for EoL discussion among patients with terminal cancer. A structural communication step for delivery of a terminal prognosis was specified at the phase of disclosure of bad news: beginning with determination of a patient's decision-making capability, followed by a patient's perception of his/her condition, a patient's wish to know, family dynamics, and a patient's and/or family's readiness for EoL discussions. The proposed context-oriented communication algorithm could provide a helpful guideline for EoL communication and, accordingly, facilitate meaningful improvements in EoL care in Korean clinical practice. The feasibility of this algorithm has not yet been determined, and its validation in a larger sample of patients with terminal cancers, using a quantitative research methodology, is a priority of research.

Perspectives of an Interdisciplinaryg Research Team to Engage Practice: Lessons from a Knowledge Exchange Trainee Experience

Science.gov (United States)

Urquhart, Robin L.; Johnston, Grace M.; McVorran, Shauna M.; Burge, Fred I.

2010-01-01

End-of-life (EOL) care is an area of health services that will ultimately affect us all. To share the knowledge emerging from EOL research and to address inequities in the quality of EOL care in Nova Scotia, a knowledge exchange (KE) trainee was hired to translate research and surveillance into a Surveillance Report. The purpose of this paper is to reflect upon this initiative and share the research team's perspectives on their KE experiences. We describe four key competencies of the KE trainee selected, and discuss lessons learned from this KE trainee experience, to expand our understanding of KE. PMID:21532769

Communication About Advance Directives and End-of-Life Care Options Among Internal Medicine Residents

Science.gov (United States)

Rhodes, Ramona L.; Tindall, Kate; Xuan, Lei; Paulk, M. Elizabeth; Halm, Ethan A.

2015-01-01

Background Despite increasing awareness about the importance of discussing end-of-life (EOL) care options with terminally ill patients and families, many physicians remain uncomfortable with these discussions. Objective The objective of the study was to examine perceptions of and comfort with EOL care discussions among a group of internal medicine residents and the extent to which comfort with these discussions has improved over time. Methods In 2013, internal medicine residents at a large academic medical center were asked to participate in an on-line survey that assessed their attitudes and experiences with discussing EOL care with terminally-ill patients. These results were compared to data from a similar survey residents in the same program completed in 2006. Results Eighty-three (50%) residents completed the 2013 survey. About half (52%) felt strongly that they were able to have open, honest discussions with patients and families, while 71% felt conflicted about whether CPR was in the patient’s best interest. About half (53%) felt strongly that it was okay for them to tell a patient/family member whether or not CPR was a good idea for them. Compared to 2006 respondents, the 2013 cohort felt they had more lectures about EOL communication, and had watched an attending have an EOL discussion more often. Conclusions Modest improvements were made over time in trainees’ exposure to EOL discussions; however, many residents remain uncomfortable and conflicted with having EOL care discussions with their patients. More effective training approaches in EOL communication are needed to train the next generation of internists. PMID:24418692

Communication About Advance Directives and End-of-Life Care Options Among Internal Medicine Residents.

Science.gov (United States)

Rhodes, Ramona L; Tindall, Kate; Xuan, Lei; Paulk, M Elizabeth; Halm, Ethan A

2015-05-01

Despite increasing awareness about the importance of discussing end-of-life (EOL) care options with terminally ill patients and families, many physicians remain uncomfortable with these discussions. The objective of the study was to examine perceptions of and comfort with EOL care discussions among a group of internal medicine residents and the extent to which comfort with these discussions has improved over time. In 2013, internal medicine residents at a large academic medical center were asked to participate in an on-line survey that assessed their attitudes and experiences with discussing EOL care with terminally-ill patients. These results were compared to data from a similar survey residents in the same program completed in 2006. Eighty-three (50%) residents completed the 2013 survey. About half (52%) felt strongly that they were able to have open, honest discussions with patients and families, while 71% felt conflicted about whether CPR was in the patient's best interest. About half (53%) felt strongly that it was okay for them to tell a patient/family member whether or not CPR was a good idea for them. Compared to 2006 respondents, the 2013 cohort felt they had more lectures about EOL communication, and had watched an attending have an EOL discussion more often. Modest improvements were made over time in trainees' exposure to EOL discussions; however, many residents remain uncomfortable and conflicted with having EOL care discussions with their patients. More effective training approaches in EOL communication are needed to train the next generation of internists. © The Author(s) 2014.

A Qualitative Examination of Physician Gender and Parental Status in Pediatric End-of-Life Communication.

Science.gov (United States)

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

2017-07-01

In this study we utilized the framework of patient-centered communication to explore the influence of physician gender and physician parental status on (1) physician-parent communication and (2) care of pediatric patients at the end of life (EOL). The findings presented here emerged from a larger qualitative study that explored physician narratives surrounding pediatric EOL communication. The current study includes 17 pediatric critical care and pediatric emergency medicine physician participants who completed narrative interviews between March and October 2012 to discuss how their backgrounds influenced their approaches to pediatric EOL communication. Between April and June of 2013, participants completed a second round of narrative interviews to discuss topics generated out of the first round of interviews. We used grounded theory to inform the design and analysis of the study. Findings indicated that physician gender is related to pediatric EOL communication and care in two primary ways: (1) the level of physician emotional distress and (2) the way physicians perceive the influence of gender on communication. Additionally, parental status emerged as an important theme as it related to EOL decision-making and communication, emotional distress, and empathy. Although physicians reported experiencing more emotional distress related to interacting with patients at the EOL after they became parents, they also felt that they were better able to show empathy to parents of their patients.

Development and evaluation of the EOL-ICDQ as a measure of experiences, attitudes and knowledge in end-of-life in patients living with an implantable cardioverter defibrillator.

Science.gov (United States)

Thylén, Ingela; Wenemark, Marika; Fluur, Christina; Strömberg, Anna; Bolse, Kärstin; Årestedt, Kristofer

2014-04-01

Due to extended indications and resynchronization therapy, many implantable cardioverter defibrillator (ICD) recipients will experience progressive co-morbid conditions and will be more likely to die of causes other than cardiac death. It is therefore important to elucidate the ICD patients' preferences when nearing end-of-life. Instead of avoiding the subject of end-of-life, a validated questionnaire may be helpful to explore patients' experiences and attitudes about end-of-life concerns and to assess knowledge of the function of the ICD in end-of-life. Validated instruments assessing patients' perspective concerning end-of-life issues are scarce. The purpose of this study was to develop and evaluate respondent satisfaction and measurement properties of the 'Experiences, Attitudes and Knowledge of End-of-Life Issues in Implantable Cardioverter Defibrillator Patients' Questionnaire' (EOL-ICDQ). The instrument was tested for validity, respondent satisfaction, and for homogeneity and stability in the Swedish language. An English version of the EOL-ICDQ was validated, but has not yet been pilot tested. The final instrument contained three domains, which were clustered into 39 items measuring: experiences (10 items), attitudes (18 items), and knowledge (11 items) of end-of-life concerns in ICD patients. In addition, the questionnaire also contained items on socio-demographic background (six items) and ICD-specific background (eight items). The validity and reliability properties were considered sufficient. The EOL-ICDQ has the potential to be used in clinical practice and future research. Further studies are needed using this instrument in an Anglo-Saxon context with a sample of English-speaking ICD recipients.

Aircraft Measurements for Understanding Air-Sea Coupling and Improving Coupled Model Predictions Over the Indian Ocean

Science.gov (United States)

2012-09-30

briefing for aircraft operations in Diego Garcia, reports posted on EOL field catalog in realtime (http://catalog.eol.ucar.edu/cgi- bin/dynamo/report...index); • Dropsonde data processing on all P3 flights and realtime QC/reporting to GTS; and • Science summary of aircraft missions posted on EOL ...data analysis, worked with EOL on data quality control (QC), participated in the DYNAMO Sounding Workshop at EOL /NCAR from 6-7 February 2012

End-of-life parental communication priorities among bereaved fathers due to cancer.

Science.gov (United States)

Park, Eliza M; Deal, Allison M; Yopp, Justin M; Edwards, Teresa; Stephenson, Elise M; Hailey, Claire E; Nakamura, Zev M; Rosenstein, Donald L

2017-05-01

To elicit widowed fathers' perspectives on which domains of parenting-related communication they consider most important for dying parents to discuss at the end of life (EOL). Two hundred seventy nine fathers widowed by cancer completed a survey about their own depression and bereavement symptoms, their wife's illness, and EOL parental communication priorities. Chi square and Fisher's exact tests and logistic regression were used to evaluate relationships between maternal EOL characteristics and fathers' responses to parenting-related EOL communication priorities. Fathers identified raising children in a manner that reflected maternal wishes, whether/how to talk with children about their mother's death, and how the mother wanted to be remembered as the most important EOL communication domains. Fathers who reported that their dying wives were worried about the children were more likely to prioritize raising children in ways that reflect her wishes (p=0.01). Other EOL characteristics were not associated with communication domains. Communicating with children and maintaining emotional connection with the deceased parent are important priorities for bereaved fathers who lost a spouse to cancer. Health care providers working with seriously ill parents may improve family outcomes by supporting communication at the EOL between co-parents. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

The Role of End-of-Life Issues in the Design and Reporting of Cancer Clinical Trials: A Structured Literature Review.

Science.gov (United States)

Gaertner, Jan; Weingärtner, Vera; Lange, Stefan; Hausner, Elke; Gerhardus, Ansgar; Simon, Steffen T; Voltz, Raymond; Becker, Gerhild; Schmacke, Norbert

2015-01-01

implications of treatment-related harms for the patients were discussed in 22/100 appraisals. Terminology referring to the patients' EoL situation (e.g. "terminal") was scarce, whereas terms suggesting control of the disease (e.g. "cancer control") were common. The EoL situation of patients with advanced cancer should be more carefully considered in clinical trials. Although the investigation and robust reporting of PROs is a prerequisite for informed decision-making in healthcare, they are rarely defined as endpoints and HRQoL is rarely mentioned as a therapeutic goal. Suggestions for improving standards for study design and reporting are presented.

The Role of End-of-Life Issues in the Design and Reporting of Cancer Clinical Trials: A Structured Literature Review

Science.gov (United States)

Lange, Stefan; Hausner, Elke; Gerhardus, Ansgar; Simon, Steffen T.; Voltz, Raymond; Becker, Gerhild; Schmacke, Norbert

2015-01-01

assessed in 36/100 RCTs. The implications of treatment-related harms for the patients were discussed in 22/100 appraisals. Terminology referring to the patients’ EoL situation (e.g. “terminal”) was scarce, whereas terms suggesting control of the disease (e.g. “cancer control“) were common. Conclusions The EoL situation of patients with advanced cancer should be more carefully considered in clinical trials. Although the investigation and robust reporting of PROs is a prerequisite for informed decision-making in healthcare, they are rarely defined as endpoints and HRQoL is rarely mentioned as a therapeutic goal. Suggestions for improving standards for study design and reporting are presented. PMID:26327232

Intensive Care Nurses' Attitude on Palliative and End of Life Care.

Science.gov (United States)

Tripathy, Swagata; Routray, Pragyan K; Mishra, Jagdish C

2017-10-01

Intensive Care Unit (ICU) nurses have a vital role in the implementation of end of life (EOL) care. There is limited data on the attitude of ICU nurses toward EOL and palliation. This study aimed to investigate knowledge, attitude, and beliefs of intensive care nurses in eastern India toward EOL. A self-administered questionnaire was distributed to delegates in two regional critical care nurses' training programs. Of 178 questionnaires distributed, 138 completed, with a response rate of 75.5*. About half (48.5*) had more than 1 year ICU experience. A majority (81.9*) agreed that nurses should be involved in and initiate (62.3*) EOL discussions. Terms "EOL care or palliative care in ICU" were new for 19.6*; 21* and 55.8* disagreed with allowing peaceful death in terminal patients and unrestricted family visits, respectively. Work experience was associated with wanting unrestricted family visitation, discontinuing monitoring and investigations at EOL, equating withholding and withdrawal of treatment, and being a part of EOL team discussions ( P = 0.005, 0.01, 0.01, and 0.001), respectively. Religiousness was associated with a greater desire to initiate EOL discussions ( P = 0.001). Greater emphasis on palliative care in critical care curriculum may improve awareness among critical care nurses.

Challenges in the Management and Stewardship of Airborne Observational Data at the National Center for Atmospheric Research (NCAR) Earth Observing Laboratory (EOL)

Science.gov (United States)

Aquino, J.; Daniels, M. D.

2015-12-01

The National Science Foundation (NSF) provides the National Center for Atmospheric Research (NCAR) Earth Observing Laboratory (EOL) funding for the operation, maintenance and upgrade of two research aircraft: the NSF/NCAR High-performance Instrumented Airborne Platform for Environmental Research (HIAPER) Gulfstream V and the NSF/NCAR Hercules C-130. A suite of in-situ and remote sensing airborne instruments housed at the EOL Research Aviation Facility (RAF) provide a basic set of measurements that are typically deployed on most airborne field campaigns. In addition, instruments to address more specific research requirements are provided by collaborating participants from universities, industry, NASA, NOAA or other agencies (referred to as Principal Investigator, or PI, instruments). At the 2014 AGU Fall Meeting, a poster (IN13B-3639) was presented outlining the components of Airborne Data Management included field phase data collection, formats, data archival and documentation, version control, storage practices, stewardship and obsolete data formats, and public data access. This talk will cover lessons learned, challenges associated with the above components, and current developments to address these challenges, including: tracking data workflows for aircraft instrumentation to facilitate identification, and correction, of gaps in these workflows; implementation of dataset versioning guidelines; and assignment of Digital Object Identifiers (DOIs) to data and instrumentation to facilitate tracking data and facility use in publications.

Inhibitory effect of turmeric curcuminoids on FLT3 expression and cell cycle arrest in the FLT3-overexpressing EoL-1 leukemic cell line.

Science.gov (United States)

Tima, Singkome; Ichikawa, Hideki; Ampasavate, Chadarat; Okonogi, Siriporn; Anuchapreeda, Songyot

2014-04-25

Leukemia is a hematologic malignancy with a frequent incidence and high mortality rate. Previous studies have shown that the FLT3 gene is overexpressed in leukemic blast cells, especially in acute myeloid leukemia. In this study, a commercially available curcuminoid mixture (1), pure curcumin (2), pure demethoxycurcumin (3), and pure bisdemethoxycurcumin (4) were investigated for their inhibitory effects on cell growth, FLT3 expression, and cell cycle progression in an FLT3-overexpressing EoL-1 leukemic cell line using an MTT assay, Western blotting, and flow cytometry, respectively. The mixture (1) and compounds 2-4 demonstrated cytotoxic effects with IC50 values ranging from 6.5 to 22.5 μM. A significant decrease in FLT3 protein levels was found after curcuminoid treatment with IC20 doses, especially with mixture 1 and compound 2. In addition, mixture 1 and curcumin (2) showed activity on cell cycle arrest at the G0/G1 phase and decreased the FLT3 and STAT5A protein levels in a dose-dependent manner. Compound 2 demonstrated the greatest potential for inhibiting cell growth, cell cycle progression, and FLT3 expression in EoL-1 cells. This investigation has provided new findings regarding the effect of turmeric curcuminoids on FLT3 expression in leukemic cells.

The Next Generation of Airborne Polarimetric Doppler Weather Radar: NCAR/EOL Airborne Phased Array Radar (APAR) Development

Science.gov (United States)

Moore, James; Lee, Wen-Chau; Loew, Eric; Vivekanandan, Jothiram; Grubišić, Vanda; Tsai, Peisang; Dixon, Mike; Emmett, Jonathan; Lord, Mark; Lussier, Louis; Hwang, Kyuil; Ranson, James

2017-04-01

The National Center for Atmospheric Research (NCAR) Earth observing Laboratory (EOL) is entering the third year of preliminary system design studies, engineering prototype testing and project management plan preparation for the development of a novel Airborne Phased Array Radar (APAR). This system being designed by NCAR/EOL will be installed and operated on the NSF/NCAR C-130 aircraft. The APAR system will consist of four removable C-band Active Electronically Scanned Arrays (AESA) strategically placed on the fuselage of the aircraft. Each AESA measures approximately 1.5 x 1.9 m and is composed of 3000 active radiating elements arranged in an array of line replaceable units (LRU) to simplify maintenance. APAR will provide unprecedented observations, and in conjunction with the advanced radar data assimilation schema, will be able to address the key science questions to improve understanding and predictability of significant and high-impact weather APAR, operating at C-band, allows the measurement of 3-D kinematics of the more intense portions of storms (e.g. thunderstorm dynamics and tornadic development, tropical cyclone rainband structure and evolution) with less attenuation compared with current airborne Doppler radar systems. Polarimetric measurements are not available from current airborne tail Doppler radars. However, APAR, with dual-Doppler and dual polarization diversity at a lesser attenuating C-band wavelength, will further advance the understanding of the microphysical processes within a variety of precipitation systems. The radar is sensitive enough to provide high resolution measurements of winter storm dynamics and microphysics. The planned APAR development that would bring the system to operational readiness for research community use aboard the C-130 is expected to take 8 years once major funding support is realized. The authors will review the overall APAR design and provide new details of the system based on our Technical Requirements Document

D 3.6 Africa: Discussion report

DEFF Research Database (Denmark)

Mandrup, Thomas

2017-01-01

in general, sub-matter experts, experts on peace and conflict studies, and practitioners in crisis management. A total of eighteen speakers explored the effectiveness of international assistance to the four African examples from different perspectives, drawing a rather pessimistic picture of the current......One round-table event was organised within the framework of Work Package III, part of the IECEU project. The events focused on the WP3’s four case studies: Libya, CAR, South Sudan and DRC. This report provides information on the round-table event and presents the main points of discussion...... that emerged during it. The round-table discussion and the subsequent seminar on the Effectiveness of International Assistance and Local Ownership in the four case studies was organised by the Royal Danish Defence College on 31 October-1. November 2016. The round-table participants included experts on Africa...

Decision-Making of Patients With Implantable Cardioverter-Defibrillators at End of Life: Family Members' Experiences.

Science.gov (United States)

Lee, Mei Ching; Sulmasy, Daniel P; Gallo, Joseph; Kub, Joan; Hughes, Mark T; Russell, Stuart; Kellogg, Anela; Owens, Sharon G; Terry, Peter; Nolan, Marie T

2017-07-01

Many patients with advanced heart failure (HF) experience the life-extending benefits of implantable cardioverter-defibrillators (ICD), but at the end stage of HF, patients may experience shocks with increasing frequency and change the plan for end-of-life (EOL) care including the deactivation of the ICD. This report describes family members' experiences of patients with ICD making decisions at EOL. Understanding the decision-making of patients with ICD at EOL can promote informed decision-making and improve the quality of EOL care. This pilot study used a mixed methods approach to test the effects of a nurse-guided discussion in decision-making about ICD deactivation (turning off the defibrillation function) at the EOL. Interviews were conducted, audiotaped, and transcribed in 2012 to 2013 with 6 family members of patients with advanced HF and ICDs. Three researchers coded the data and identified themes in 2014. Three main themes described family members' experiences related to patients having HF with ICDs making health-care decision at EOL: decision-making preferences, patients' perception on ICD deactivation, and communication methods. Health-care providers need to have knowledge of patients' decision-making preferences. Preferences for decision-making include the allowing of appropriate people to involve and encourages direct conversation with family members even when advance directives is completed. Information of ICD function and the option of deactivation need to be clearly delivered to patients and family members. Education and guidelines will facilitate the communication of the preferences of EOL care.

Management and Stewardship of Airborne Observational Data for the NSF/NCAR HIAPER (GV) and NSF/NCAR C-130 at the National Center for Atmospheric Research (NCAR) Earth Observing Laboratory (EOL)

Science.gov (United States)

Aquino, J.

2014-12-01

The National Science Foundation (NSF) provides the National Center for Atmospheric Research (NCAR) Earth Observing Laboratory (EOL) funding for the operation, maintenance and upgrade of two research aircraft: the NSF/NCAR High-performance Instrumented Airborne Platform for Environmental Research (HIAPER) Gulfstream V and the NSF/NCAR Hercules C-130. A suite of in-situ and remote sensing airborne instruments housed at the EOL Research Aviation Facility (RAF) provide a basic set of measurements that are typically deployed on most airborne field campaigns. In addition, instruments to address more specific research requirements are provided by collaborating participants from universities, industry, NASA, NOAA or other agencies. The data collected are an important legacy of these field campaigns. A comprehensive metadata database and integrated cyber-infrastructure, along with a robust data workflow that begins during the field phase and extends to long-term archival (current aircraft data holdings go back to 1967), assures that: all data and associated software are safeguarded throughout the data handling process; community standards of practice for data stewardship and software version control are followed; simple and timely community access to collected data and associated software tools are provided; and the quality of the collected data is preserved, with the ultimate goal of supporting research and the reproducibility of published results. The components of this data system to be presented include: robust, searchable web access to data holdings; reliable, redundant data storage; web-based tools and scripts for efficient creation, maintenance and update of data holdings; access to supplemental data and documentation; storage of data in standardized data formats; comprehensive metadata collection; mature version control; human-discernable storage practices; and procedures to inform users of changes. In addition, lessons learned, shortcomings, and desired upgrades

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

OpenAIRE

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

2016-01-01

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...

Impact of Oncologists’ Attitudes Toward End-of-Life Care on Patients’ Access to Palliative Care

Science.gov (United States)

Cerana, Maria Agustina; Park, Minjeong; Hess, Kenneth; Bruera, Eduardo

2016-01-01

Background. It is unclear how oncologists’ attitudes toward end-of-life (EOL) care affect the delivery of care. The present study examined the association between oncologists’ EOL care attitudes and (a) timely specialist palliative care referral, (b) provision of supportive care, and (c) EOL cancer treatment decisions. Methods. We randomly surveyed 240 oncology specialists at our tertiary care cancer center to assess their attitudes toward EOL care using a score derived from the Jackson et al. qualitative conceptual framework (0 = uncomfortable and 8 = highly comfortable with EOL care). We determined the association between this score and clinicians’ report of specialist palliative care referral, provision of supportive care, and EOL cancer treatment decisions. Results. Of the 182 respondents (response rate of 76%), the median composite EOL care score was 6 (interquartile range, 5–7). A higher EOL score was significantly associated with solid tumor oncology (median 7 vs. 6 for hematologic oncology; p = .003), a greater willingness to refer patients with newly diagnosed cancer to specialist palliative care (median, 7 vs. 6; p = .01), greater comfort with symptom management (median, 6 vs. 5; p = .01), and provision of counseling (median, 7 vs. 4; p EOL care was associated with higher rates of specialist palliative care referral and self-reported primary palliative care delivery. More support and education are needed for oncologists who are less comfortable with EOL care. Implications for Practice: In the present survey of oncology specialists, most reported that they were comfortable with end-of-life (EOL) care, which was in turn, associated with greater provision of primary palliative care and higher rates of referral to specialist palliative care. The results of the present study highlight the need for more support and education for oncologists less comfortable with EOL care because their patients might receive lower levels of both primary and secondary

Palliative care at the end-of-life in glioma patients.

Science.gov (United States)

Koekkoek, Johan A F; Chang, Susan; Taphoorn, Martin J B

2016-01-01

The end-of-life (EOL) phase of patients with a glioma starts when symptom prevalence increases and antitumor treatment is no longer effective. During the EOL phase, care is primarily aimed at reducing symptom burden while maintaining quality of life as long as possible without inappropriate prolongation of life. Palliative care during the EOL phase also involves complex medical decisions for the prevention and relief of suffering. We discuss the prevalence and treatment of the most common EOL symptoms, decision making in the EOL phase, the organization of EOL care, and the role of the patient's caregiver. Treating disease-specific symptoms, such as impaired consciousness, seizures, focal neurologic deficits and cognitive disturbances, is a major concern during the EOL phase, as these symptoms may interfere with EOL decision making. Advance care planning is aimed at reaching consensus about possible EOL decisions between all participants, respecting the values of patients and their informal caregivers. In order to prevent the possibility that the patient becomes incompetent to make informed decisions, we recommend initiating EOL conversations at a relatively early stage in the disease course. © 2016 Elsevier B.V. All rights reserved.

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

Science.gov (United States)

Ferrão, Paulo; Ribeiro, Paulo; Silva, Paulo

2008-01-01

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

Death in the Digital Age: A Systematic Review of Information and Communication Technologies in End-of-Life Care.

Science.gov (United States)

Ostherr, Kirsten; Killoran, Peter; Shegog, Ross; Bruera, Eduardo

2016-04-01

End-of-life (EOL) communication plays a critical role in ensuring that patients receive care concordant with their wishes and experience high quality of life. As the baby boomer population ages, scalable models of end-of-life communication will be needed to ensure that patients receive appropriate care. Information and communication technologies (ICTs) may help address the needs of this generation; however, few resources exist to guide the use of ICTs in EOL care. The primary objective was to identify the ICTs being used in EOL communication. The secondary objective was to compare the effectiveness of different ICTs in EOL communication. The study was a systematic review, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We systematically searched seven databases for experimental and observational studies on EOL communication between doctors and patients using ICTs, published in 1997-2013. The review identified 38 relevant articles. Eleven types of technology were identified: video, website, telephone, videoconferencing, e-mail, telemonitoring, Internet search, compact disc, fax, PalmPilot, and short message service (SMS) text messaging. ICTs were most commonly used to provide information or education, serve as decision aids, promote advance care planning (ACP), and relieve physical symptom distress. The use of ICTs in EOL care is a small but growing field of research. Additional research is needed to adapt older, analog technologies for use in the digital age. Many of the interventions discussed in this review do not take full advantage of the affordances of mobile, connected health ICTs. The growing evidence base for e-health applications in related fields should guide future interventions in EOL care.

Novice Nurses' Experiences With Palliative and End-of-Life Communication.

Science.gov (United States)

Hendricks-Ferguson, Verna L; Sawin, Kathleen J; Montgomery, Kitty; Dupree, Claretta; Phillips-Salimi, Celeste R; Carr, Barb; Haase, Joan E

2015-01-01

Health care providers recognize that delivery of effective communication with family members of children with life-threatening illnesses is essential to palliative and end-of-life care (PC/EOL). Parents value the presence of nurses during PC/EOL of their dying child. It is vital that nurses, regardless of their years of work experience, are competent and feel comfortable engaging family members of dying children in PC/EOL discussions. This qualitative-descriptive study used focus groups to explore the PC/EOL communication perspectives of 14 novice pediatric oncology nurses (eg, with less than 1 year of experience). Audio-taped focus group discussions were reviewed to develop the following 6 theme categories: (a) Sacred Trust to Care for the Child and Family, (b) An Elephant in the Room, (c) Struggling with Emotional Unknowns, (d) Kaleidoscope of Death: Patterns and Complexity, (e) Training Wheels for Connectedness: Critical Mentors during PC/EOL of Children, and (f) Being Present with an Open Heart: Ways to Maintain Hope and Minimize Emotional Distress. To date, this is the first study to focus on PC/EOL communication perspectives of novice pediatric oncology nurses. © 2015 by Association of Pediatric Hematology/Oncology Nurses.

Clinical priorities, barriers and solutions in end-of-life cancer care research across Europe. Report from a workshop

DEFF Research Database (Denmark)

Sigurdardottir, Katrin Ruth; Haugen, Dagny Faksvåg; van der Rijt, Carin C D

2010-01-01

The PRISMA project is aiming to co-ordinate research priorities, measurement and practice in end-of-life (EOL) care in Europe. As part of PRISMA we undertook a questionnaire survey and a subsequent workshop to (1) identify clinical priorities for EOL care research in Europe and propose a future...... research agenda and (2) identify barriers to EOL care research, and possibilities and solutions to improve the research....

BOL and EOL Characterization of Azur 3G Lilt Solar Cells for ESA Juice Mission

Directory of Open Access Journals (Sweden)

Khorenko Victor

2017-01-01

Full Text Available In the present paper, we describe the results of electrical characterization of AZUR SPACE triple-junction solar cells at a sun light intensity of 3.7% AM0 and temperatures down to −150°C. At these conditions, which are relevant for the anticipated ESA JUICE mission, the cell efficiency reaches 33.5 % at BOL. Special attention has been paid to the establishing of an in-situ characterization procedure for defining EOL cell characteristics after electron and proton irradiation at low temperature low intensity condition. It was shown that solar cells irradiated at low temperature exhibit a strong recovery effect within short time after stopping the irradiation whereas the absolute value of the recovery depends on the irradiation fluence and particle type. Further on, it was demonstrated that the degradation of the maximum power, Pmp, is much stronger than the degradation of Isc and Voc values. Experimentally defined remaining factors for electron and proton irradiation and the quantification of the observed recovery effects allow a realistic prediction of the solar cell performance at JUICE mission conditions and are essential for the planned solar cell qualification activities.

Impact of a Simulation-Based Communication Workshop on Resident Preparedness for End-of-Life Communication in the Intensive Care Unit

Directory of Open Access Journals (Sweden)

Abraham Markin

2015-01-01

Full Text Available Introduction. Although residents frequently lead end-of-life (EOL discussions in the intensive care unit (ICU, training in EOL care during residency has been required only recently, and few educational interventions target EOL communication in the ICU. This study evaluated a simulation-based intervention designed to improve resident EOL communication skills with families in the ICU. Methods. Thirty-four second-year internal medicine residents at a large urban teaching hospital participated in small group sessions with faculty trained in the “VitalTalk” method. A Likert-type scale questionnaire measured self-assessed preparedness before, immediately following, and approximately 9 months after intervention. Data were analyzed using Wilcoxon rank-sum analysis. Results. Self-assessed preparedness significantly improved for all categories surveyed (preintervention mean; postintervention mean; p value, including discussing bad news (3.3; 4.2; p<0.01, conducting a family conference (3.1; 4.1; p<0.01, discussing treatment options (3.2; 3.9; p<0.01, discussing discontinuing ICU treatments (2.9; 3.5; p<0.01, and expressing empathy (3.9; 4.5; p<0.01. Improvement persisted at follow-up for all items except “expressing empathy.” Residents rated the educational quality highly. Conclusion. This study provides evidence that brief simulation-based interventions can produce lasting improvements in residents’ confidence to discuss EOL care with family members of patients in the ICU.

Prediction Model and Principle of End-of-Life Threshold for Lithium Ion Batteries Based on Open Circuit Voltage Drifts

International Nuclear Information System (INIS)

Cui, Yingzhi; Yang, Jie; Du, Chunyu; Zuo, Pengjian; Gao, Yunzhi; Cheng, Xinqun; Ma, Yulin; Yin, Geping

2017-01-01

Highlights: •Open circuit voltage evolution over ageing of lithium ion batteries is deciphered. •The mechanism responsible for the end-of-life (EOL) threshold is elaborated. •A new prediction model of EOL threshold with improved accuracy is developed. •This EOL prediction model is promising for the applications in electric vehicles. -- Abstract: The end-of-life (EOL) of a lithium ion battery (LIB) is defined as the time point when the LIB can no longer provide sufficient power or energy to accomplish its intended function. Generally, the EOL occurs abruptly when the degradation of a LIB reaches the threshold. Therefore, current prediction methods of EOL by extrapolating the early degradation behavior often result in significant errors. To address this problem, this paper analyzes the reason for the EOL threshold of a LIB with shallow depth of discharge. It is found that the sudden appearance of EOL threshold results from the drift of open circuit voltage (OCV) at the end of both shallow depth and full discharges. Further, a new EOL threshold prediction model with highly improved accuracy is developed based on the OCV drifts and their evolution mechanism, which can effectively avoid the misjudgment of EOL threshold. The accuracy of this EOL threshold prediction model is verified by comparing with experimental results. The EOL threshold prediction model can be applied to other battery chemistry systems and its possible application in electric vehicles is finally discussed.

December 7, 2000. General framework: the European and French contexts. Results of the Eole 2005 program: the lessons; 7 decembre 2000. Cadrage general: les contextes europeens et francais. Resultats du programme Eole 2005: les enseignements

Energy Technology Data Exchange (ETDEWEB)

Bal, J.L.; Chabot, B. [Agence de l' Environnement et de la Maitrise de l' Energie, ADEME, 75 - Paris (France); Grandidier, J.Y. [Association de l' Energie Eolienne en France, 11 - Narbonne (France); Germa, Ph. [IENA Environnement, France (France); Argenson, A.; Dugue, Ch. [Cabinet GERMA, 34 - Montpellier (France); Fassi Fihri, M.A. [Office National de l' Electricite (Morocco); Wagner, A. [Enron Wind Corp. (Germany); Krogsgaard, P. [BTM Consult ApS, Ringkbing (Denmark); Gonzalvez, C.H. [Institute for Diversification and Energy Saving (IDAE), Madrid (Spain)

2001-03-01

This first day of conference was organized in two parts: the first part was devoted to a presentation of the French and European contexts of the development of wind power. After a general presentation of the aims of the colloquium, a round table was organized about the European context of development of wind energy with its application to France in the framework of the new organization of the electric power industry. Testimonies about the means used by governments for the sustain of wind energy development were presented with the examples of Spain and Germany. The second part of the day was devoted to the presentation of the results of the French wind energy program 'Eole 2005' and of the lessons gained: detailed presentation of the sustain program for a minimum of 5000 MW installed power in 2010, strategic analysis of the program (projects, R and D actions, companies), the economical workability of wind power projects (tariffs, point-of-view of French and European operators), the export development prospects for the 2000-2005 era and the main international markets at the 2005-2010 vista (examples of Denmark, Portugal and Morocco). (J.S.)

End-of-Life in Disney and Pixar Films: An opportunity for Engaging in Difficult Conversation.

Science.gov (United States)

Tenzek, Kelly E; Nickels, Bonnie M

2017-01-01

This study expanded upon previous scholarship by examining end-of-life (EOL) depictions and messages of death within Disney and Pixar animated films. We argue Disney and Pixar depictions of EOL and death can provide critical opportunities for discussing death and dying processes with children and adults alike. A content analysis of 57 movies resulted in a total of 71 character deaths. These instances of death became the discourse used for analysis. The EOL discourse was coded based on five categories (character status, depiction of death, death status, emotional reaction, and causality). After quantitative analysis, the films were qualitatively analyzed. Four themes emerged from analysis, unrealistic moments, managing EOL, intentions to kill, and transformation and spiritual connection. Discussion of results, limitations, and directions for future research are included.

Measuring health-related quality of life in high-grade glioma patients at the end of life using a proxy-reported retrospective questionnaire

NARCIS (Netherlands)

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

2014-01-01

To develop, validate, and report on the use of a retrospective proxy-reported questionnaire measuring health-related quality of life (HRQoL) in the end-of-life (EOL) phase of high-grade glioma (HGG) patients. Items relevant for the defined construct were selected using existing questionnaires,

Oncology nurses' communication challenges with patients and families: A qualitative study.

Science.gov (United States)

Banerjee, Smita C; Manna, Ruth; Coyle, Nessa; Shen, Megan Johnson; Pehrson, Cassandra; Zaider, Talia; Hammonds, Stacey; Krueger, Carol A; Parker, Patricia A; Bylund, Carma L

2016-01-01

The benefits of effective communication in an oncology setting are multifold and include the overall well-being of patients and health professionals, adherence to treatment regimens, psychological functioning, and improvements in quality of life. Nevertheless, there are substantial barriers and communication challenges reported by oncology nurses. This study was conducted to present a summary of communication challenges faced by oncology nurses. From November 2012 to March 2014, 121 inpatient nurses working in the oncology setting participated in an online pre-training qualitative survey that asked nurses to describe common communication challenges in communicating empathy and discussing death, dying, and end-of-life (EOL) goals of care. The results revealed six themes that describe the challenges in communicating empathically: dialectic tensions, burden of carrying bad news, lack of skills for providing empathy, perceived institutional barriers, challenging situations, and perceived dissimilarities between the nurse and the patient. The results for challenges in discussing death, dying and EOL goals of care revealed five themes: dialectic tensions, discussing specific topics related to EOL, lack of skills for providing empathy, patient/family characteristics, and perceived institutional barriers. This study emphasizes the need for institutions to provide communication skills training to their oncology nurses for navigating through challenging patient interactions. Copyright © 2015 Elsevier Ltd. All rights reserved.

Preferences for Life-Sustaining Treatments and Associations With Accurate Prognostic Awareness and Depressive Symptoms in Terminally Ill Cancer Patients' Last Year of Life.

Science.gov (United States)

Tang, Siew Tzuh; Wen, Fur-Hsing; Hsieh, Chia-Hsun; Chou, Wen-Chi; Chang, Wen-Cheng; Chen, Jen-Shi; Chiang, Ming-Chu

2016-01-01

The stability of life-sustaining treatment (LST) preferences at end of life (EOL) has been established. However, few studies have assessed preferences more than two times. Furthermore, associations of LST preferences with modifiable variables of accurate prognostic awareness, physician-patient EOL care discussions, and depressive symptoms have been investigated in cross-sectional studies only. To explore longitudinal changes in LST preferences and their associations with accurate prognostic awareness, physician-patient EOL care discussions, and depressive symptoms in terminally ill cancer patients' last year. LST preferences (cardiopulmonary resuscitation, intensive care unit [ICU] care, intubation, and mechanical ventilation) were measured approximately every two weeks. Changes in LST preferences and their associations with independent variables were examined by hierarchical generalized linear modeling with logistic regression. Participants (n = 249) predominantly rejected cardiopulmonary resuscitation, ICU care, intubation, and mechanical ventilation at EOL without significant changes as death approached. Patients with inaccurate prognostic awareness were significantly more likely than those with accurate understanding to prefer ICU care, intubation, and mechanical ventilation than to reject these LSTs. Patients with more severe depressive symptoms were less likely to prefer ICU care and to be undecided about wanting ICU care and mechanical ventilation than to reject such LSTs. LST preferences were not associated with physician-patient EOL care discussions, which were rare in our sample. LST preferences are stable in cancer patients' last year. Facilitating accurate prognostic awareness and providing adequate psychological support may counteract the increasing trend for aggressive EOL care and minimize emotional distress during EOL care decisions. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights

Affective science and avoidant end-of-life communication: Can the science of emotion help physicians talk with their patients about the end of life?

Science.gov (United States)

Soodalter, Jesse A; Siegle, Greg J; Klein-Fedyshin, Michele; Arnold, Robert; Schenker, Yael

2018-05-01

Despite believing end-of-life (EOL) discussions with patients are important, doctors often do not have them. Multiple factors contribute to this shortfall, which interventions including reimbursement changes and communication skills training have not significantly improved to date. One commonly cited but under-researched reason for physician avoidance of EOL discussion is emotional difficulty. High occupational demand for frequent difficult discussions may overload physicians' normal emotional functioning, leading to avoidance or failure. We propose that cognitive, behavioral, and neuroscience evidence from affective science may offer helpful insights into this problem. Data from other populations show that strong emotion impairs cognitive performance and multiple demands can overload cognitive resources. We discuss several affective processes that may apply to physicians attempting EOL discussions. We then discuss selected interventions that have been shown to modify some of these processes and associated behavioral outcomes. Evidence for change in behavioral outcomes of interest includes performance and mood enhancement in healthy populations. We suggest that such mechanistically-targeted interventions may be hypothesized to help decrease physician avoidance of EOL discussion. Physicians may be motivated to adopt such interventions in order to enhance normal emotional functioning to meet supra-normal occupational demand. We propose this as a promising area of future study. Copyright © 2017 Elsevier B.V. All rights reserved.

Automatic detection and classification of EOL-concrete and resulting recovered products by hyperspectral imaging

Science.gov (United States)

Palmieri, Roberta; Bonifazi, Giuseppe; Serranti, Silvia

2014-05-01

The recovery of materials from Demolition Waste (DW) represents one of the main target of the recycling industry and the its characterization is important in order to set up efficient sorting and/or quality control systems. End-Of-Life (EOL) concrete materials identification is necessary to maximize DW conversion into useful secondary raw materials, so it is fundamental to develop strategies for the implementation of an automatic recognition system of the recovered products. In this paper, HyperSpectral Imaging (HSI) technique was applied in order to detect DW composition. Hyperspectral images were acquired by a laboratory device equipped with a HSI sensing device working in the near infrared range (1000-1700 nm): NIR Spectral Camera™, embedding an ImSpector™ N17E (SPECIM Ltd, Finland). Acquired spectral data were analyzed adopting the PLS_Toolbox (Version 7.5, Eigenvector Research, Inc.) under Matlab® environment (Version 7.11.1, The Mathworks, Inc.), applying different chemometric methods: Principal Component Analysis (PCA) for exploratory data approach and Partial Least Square- Discriminant Analysis (PLS-DA) to build classification models. Results showed that it is possible to recognize DW materials, distinguishing recycled aggregates from contaminants (e.g. bricks, gypsum, plastics, wood, foam, etc.). The developed procedure is cheap, fast and non-destructive: it could be used to make some steps of the recycling process more efficient and less expensive.

High burnup fuel onset conditions in dry storage. Prediction of EOL rod internal pressure

Energy Technology Data Exchange (ETDEWEB)

Feria, F.; Herranz, L.E.

2015-07-01

During dry storage, cladding resistance to failure can be affected by several degrading mechanisms like creep or hydrides radial reorientation. The driving force of these effects is the stress at which the cladding is submitted. The maximum stress in the cladding is determined by the end-of-reactor-life (EOL) rod internal pressure, PEOL, at the maximum temperature attained during dry storage. Thus, PEOL sets the initial conditions of storage for potential time-dependent changes in the cladding. Based on FRAPCON-3.5 calculations, the aim of this work is to analyse the PEOL of a PWR fuel rod irradiated to burnups greater than 60 GWd/tU, where limited information is available. In order to be conservative, demanding irradiation histories have been used with a peak linear power of 44 kW/m. FRAPCON-3.5 results show an increasing exponential trend of PEOL with burnup, from which a simple correlation has been derived. The comparison with experimental data found in the literature confirms the enveloping nature of the predicted curve. Based on that, a conservative prediction of cladding stress in dry storage has been obtained. The comparison with a critical stress threshold related to hydrides embrittlement seems to point out that this issue should not be a concern at burnups below 65 GWd/tU. (Author)

Egypt--United States cooperative energy assessment: report on preliminary discussions

Energy Technology Data Exchange (ETDEWEB)

1978-04-01

Egyptian and U.S. Government representatives met in Cairo during the period of February 14-22, 1978 to discuss a cooperative Egypt-U.S. assessment of the energy demand and supply options available to Egypt. This report summarizes those preliminary discussions. The discussions accomplished the following: the background and objectives of the U.S. initiative for a cooperative energy assessment with Egypt were explained; Egyptian electric energy activities and their priorities were presented; methods under consideration for the systematic identification and assessment of energy options available to Egypt were explained; the cooperation of Egyptian energy resource and planning organizations was assured; and arrangements to carry out the cooperative assessment were planned.

Establishing end-of-life boards for palliative care of patients with advanced diseases.

Science.gov (United States)

Masel, Eva K; Unseld, Matthias; Adamidis, Feroniki; Roider-Schur, Sophie; Watzke, Herbert H

2018-04-01

Interdisciplinary tumor board decisions improve the quality of oncological therapies, while no such boards exist for end-of-life (EOL) decisions. The aim of this study was to assess the willingness of hemato-oncological and palliative care professionals to develop and participate in EOL boards. An aim of an EOL board would be to establish an interdisciplinary and comprehensive care for the remaining lifetime of patients suffering from advanced incurable diseases. Staff from the interdisciplinary teams of all hemato-oncological and palliative care wards in Vienna were invited to anonymously participate in an online survey. 309 professionals responded. 91% respondents reported a need to establish an EOL board, 63% expressed their willingness to actively participate in an EOL board, and 25% were indecisive. Regarding patient presence, 50% voted for an EOL board in the presence of the patients, and 36% voted for an EOL board in the absence of the patients. 95% had the opinion that an EOL board could improve patient care in the last phase of life. 64% stated that the development of an EOL board would be worthwhile, while 28% did not see enough resources available at their institutions. Regarding the desired type of documentation, 61% voted for a centrally available EOL decision, and 31% supported an in-house-based documentation. 94% voted for the availability of an information folder about EOL care. The willingness of professionals to establish an EOL board was very high. Further steps should be taken to implement such boards to improve EOL care.

Associations between Race and Dementia Status and the Quality of End-of-Life Care.

Science.gov (United States)

Luth, Elizabeth A; Prigerson, Holly G

2018-04-05

Non-Hispanic black and dementia patients receive more invasive and futile treatment at end of life (EOL) relative to others. Little is known about the relationship between race/ethnicity, dementia, and EOL care quality. Identify the relationship between race/ethnicity, dementia, and proxy reporters' evaluation of EOL care quality in older adults. Latent class analysis (LCA) of national survey data. 1588 deceased Medicare beneficiaries age 65 and older from the National Health and Aging Trends Study (2011-2016). LCA identified three types of quality EOL care using nine measures of symptom management, quality of healthcare encounters, and dignified treatment. Race and dementia were primary predictors of EOL care quality type. Adjusted models controlled for decedent education, sex, marital status, age, number of illnesses, number of hospitalizations, self-rated health, place of death, hospice involvement, and proxy relationship to decedent and familiarity with care. Over 20% of proxies report that dying individuals experienced suboptimal EOL care quality, characterized by pain, sadness, poor communication, and inattention to personal care needs. In adjusted analyses, proxies for non-Hispanic black decedents were less likely to provide negative care assessments than proxies for non-Hispanic white decedents (adjusted odds ratio [AOR]: 0.58; 95% confidence interval [CI]: 0.40-0.86). Proxies for decedents with dementia were less likely to provide negative assessments than proxies for decedents without dementia (AOR: 0.70; 95% CI: 0.51-0.97). Efforts to improve EOL care quality are needed. More positive EOL care quality assessments for non-Hispanic Black and dementia decedents appear counterintuitive given research demonstrating that these groups of individuals are likely to have received suboptimal EOL care. Because caregiver expectations for care may differ by decedent race and dementia status, research is needed to explore the role of caregiver expectations for EOL care

A Comparison of the Influence of Anticipated Death Trajectory and Personal Values on End-of-Life Care Preferences: A Qualitative Analysis.

Science.gov (United States)

Supiano, Katherine P; McGee, Nancy; Dassel, Kara B; Utz, Rebecca

2017-08-17

We examined anticipated preferences for end-of-life (EOL) care in healthy older adults in the context of various terminal disease scenarios to explore the relationship between personal values and diseases and conditions that would influence EOL care choices. Qualitative Descriptive Analysis was used to derive themes and the relationship between EOL preference themes and personal value themes in 365 respondents in a national sample of healthy older adults who completed a survey on their anticipated preferences for end-of-life (EOL) care. Reluctance to burden close others was the most frequently voiced personal value across all conditions affecting EOL preferences, followed by the personal value of quality of life. Concern about whether one's wishes would be honored was more commonly voiced in the context of hypothetical, prospective terminal cancer than in neurological conditions. Respondents who voiced desire for autonomy in how they would die clearly attributed extreme pain as the primary influence on EOL preferences. Comprehensive assessment of patient personal values should include consideration of particular chronic disease scenarios and death trajectories to fully inform EoL preferences. Because personal values do influence EOL preferences, care should be taken to ascertain patient values when presenting diagnoses, prognoses, and treatment options. In particular, patients and families of patients with progressive neurological diseases will likely face a time when the patient cannot self-represent EOL wishes. Early discussion of values and preferences, particularly in the context of cognitive disease is vital to assure patient-directed care.

Physician and parent perceptions of prognosis and end-of-life experience in children with advanced heart disease.

Science.gov (United States)

Balkin, Emily M; Wolfe, Joanne; Ziniel, Sonja I; Lang, Peter; Thiagarajan, Ravi; Dillis, Shay; Fynn-Thompson, Francis; Blume, Elizabeth D

2015-04-01

Little is known about how physician and parent perspectives compare regarding the prognosis and end-of-life (EOL) experience of children with advanced heart disease (AHD). The study's objective was to describe and compare parent and physician perceptions regarding prognosis and EOL experience in children with AHD. This was a cross-sectional survey study of cardiologists and bereaved parents. Study subjects were parents and cardiologists of children with primary cardiac diagnoses who died in a tertiary care pediatric hospital between January 2007 and December 2009. Inclusion required both physician and parent to have completed surveys respective to the same patient. A total of 31 parent/physician pairs formed the analytic sample. Perceptions were measured of cardiologists and bereaved parents regarding the EOL experience of children with AHD. Nearly half of parents and physicians felt that patients suffered 'a great deal,' 'a lot,' or 'somewhat' at EOL, but there was no agreement between them. At diagnosis, parents more often expected complete repair and normal lifespan while the majority of physicians expected shortened lifespan without normal quality of life. Parents who expected complete repair with normal life were more likely to report 'a lot' of suffering at EOL (p=0.002). In 43% of cases, physicians reported that the parents were prepared for the way in which their child died, while the parents reported feeling unprepared. Both parents and physicians perceive suffering at EOL in patients who die of AHD. Moreover, parent expectations at diagnosis may influence perceptions of suffering at EOL. Physicians overestimate the degree of parent preparedness for their child's death.

Exploring Health Care Providers' Views About Initiating End-of-Life Care Communication.

Science.gov (United States)

Nedjat-Haiem, Frances R; Carrion, Iraida V; Gonzalez, Krystana; Ell, Kathleen; Thompson, Beti; Mishra, Shiraz I

2017-05-01

Numerous factors impede effective and timely end-of-life (EOL) care communication. These factors include delays in communication until patients are seriously ill and/or close to death. Gaps in patient-provider communication negatively affect advance care planning and limit referrals to palliative and hospice care. Confusion about the roles of various health care providers also limits communication, especially when providers do not coordinate care with other health care providers in various disciplines. Although providers receive education regarding EOL communication and care coordination, little is known about the roles of all health care providers, including nonphysician support staff working with physicians to discuss the possibility of dying and help patients prepare for death. This study explores the perspectives of physicians, nurses, social workers, and chaplains on engaging seriously ill patients and families in EOL care communication. Qualitative data were from 79 (medical and nonmedical) providers practicing at 2 medical centers in Central Los Angeles. Three themes that describe providers' perceptions of their roles and responsibility in talking with seriously ill patients emerged: (1) providers' roles for engaging in EOL discussions, (2) responsibility of physicians for initiating and leading discussions, and (3) need for team co-management patient care. Providers highlighted the importance of beginning discussions early by having physicians lead them, specifically due to their medical training and need to clarify medical information regarding patients' prognosis. Although physicians are a vital part of leading EOL communication, and are at the center of communication of medical information, an interdisciplinary approach that involves nurses, social workers, and chaplains could significantly improve patient care.

Democratic discussion in newspaper reporting of the Australia-United States Free Trade Agreement.

Science.gov (United States)

Sykes, Robbie

2008-10-01

This article presents a Habermasian analysis of newspaper reporting of the debate surrounding the effect of the Australia-United States Free Trade Agreement (the FTA) on access to medicines through Australian patent law. Habermas's concept of the public sphere is utilised in determining whether discussion within the print media adequately conveyed complex legal issues to the public and facilitated democratic discussion. It was found that newspaper reporting generally failed to meet this standard.

Integrity assessment of TAPS reactor pressure vessel at extended EOL using surveillance test results

International Nuclear Information System (INIS)

Chatterjee, S.; Shah, Priti Kotak

2008-05-01

Integrity assessment of pressure vessels of nuclear reactors (RPV) primarily concentrates on the prevention of brittle failure and conditions are defined under which brittle failure can be excluded. Accordingly, two approaches based on Transition Temperature Concept and Fracture Mechanics Concept were adopted using the impact test results of three credible surveillance data sets obtained from the surveillance specimens of Tarapur Atomic Power Station. RT NDT data towards end of life (EOL) were estimated from the impact test results in accordance with the procedures of USNRC Regulatory Guide 1.99, Rev. 2 and were used as primary input for assessment of the vessel integrity. SA302B (nickel modified) steel cladded with stainless steel is used as the pressure vessel material for the two 210 MWe boiling water reactors of the Tarapur Atomic Power Station (TAPS). The reactors were commissioned during the year 1969. The chemical compositions of SA302B (modified) steel used in fabricating the vessel and the specified tensile property and the Charpy impact property requirements of the steel broadly meet ASME specified requirements. Therefore, the pressure temperature limit curves prescribed by General Electric (G.E.) were compared with those as obtained using procedures of ASME Section XII, Appendix G. The tensile and the Charpy impact properties at 60 EFPY of vessel operation as derived from the surveillance specimens even fulfilled the specified requirements for the virgin material of ASME. Integrity assessment carried out using the two approaches indicated the safety of the vessel for continued operation up to 60 EFPY. (author)

Medical practice and legal background of decisions for severely ill newborn infants: viewpoints from seven European countries.

Science.gov (United States)

Sauer, P J J; Dorscheidt, J H H M; Verhagen, A A E; Hubben, J H

2013-02-01

To comparing attitudes towards end-of-life (EOL) decisions in newborn infants between seven European countries. One paediatrician and one lawyer from seven European countries were invited to attend a conference to discuss the practice of EOL decisions in newborn infants and the legal aspects involved. All paediatricians/neonatologists indicated that the best interest of the child should be the leading principle in all decisions. However, especially when discussing cases, important differences in attitude became apparent, although there are no significant differences between the involved countries with regard to national legal frameworks. Important differences in attitude towards neonatal EOL decisions between European countries exist, but they cannot be explained solely by medical or legal reasons. ©2012 The Author(s)/Acta Paediatrica ©2012 Foundation Acta Paediatrica.

Primary care physicians' reported use of pre-screening discussions for prostate cancer screening: a cross-sectional survey

Directory of Open Access Journals (Sweden)

Cooper Crystale P

2009-03-01

Full Text Available Abstract Background Professional medical organizations recommend individualized patient decision making about prostate cancer screening. Little is known about primary care physicians' use of pre-screening discussions to promote informed decision making for prostate cancer screening. The aim of this study is to explore physicians' use of pre-screening discussions and reasons why physicians would or would not try to persuade patients to be screened if they initially refuse testing. Methods Primary care physicians completed a self-administered survey about prostate cancer screening practices for informed decision making. Results Sixty-six physicians (75.9% completed the survey, and 63 were used in the analysis. Thirteen physicians (20.6% reported not using prescreening discussions, 45 (71.4% reported the use of prescreening discussions, and 3 (4.8% reported neither ordering the PSA test nor discussing it with patients. Sixty-nine percent of physicians who reported not having discussions indicated they were more likely to screen African American patients for prostate cancer, compared to 50% of physicians who reported the use of discussions (Chi-square(1 = 1.62, p = .20. Similarly, 91% of physicians who reported not having discussions indicated they are more likely to screen patients with a family history of prostate cancer, compared to 46% of those who reported the use of discussion (Chi-square(1 = 13.27, p Conclusion Although guidelines recommend discussing the risks and benefits of prostate cancer screening, physicians report varying practice styles. Future research needs to consider the nature of discussions and the degree to which informed decision making is being achieved in clinical practice.

Discussion of some issues in environmental impact reports of nuclear and radiation facilities

International Nuclear Information System (INIS)

Pan Ziqiang

1995-01-01

The author discusses some issues in compilation and evaluation of environmental impact reports of nuclear and radiation facilities which should be noticeable. Some recommendations are made to improve the quality of the reports as well

Primary care physicians' reported use of pre-screening discussions for prostate cancer screening: a cross-sectional survey.

Science.gov (United States)

Linder, Suzanne K; Hawley, Sarah T; Cooper, Crystale P; Scholl, Lawrence E; Jibaja-Weiss, Maria; Volk, Robert J

2009-03-18

Professional medical organizations recommend individualized patient decision making about prostate cancer screening. Little is known about primary care physicians' use of pre-screening discussions to promote informed decision making for prostate cancer screening. The aim of this study is to explore physicians' use of pre-screening discussions and reasons why physicians would or would not try to persuade patients to be screened if they initially refuse testing. Primary care physicians completed a self-administered survey about prostate cancer screening practices for informed decision making. Sixty-six physicians (75.9%) completed the survey, and 63 were used in the analysis. Thirteen physicians (20.6%) reported not using prescreening discussions, 45 (71.4%) reported the use of prescreening discussions, and 3 (4.8%) reported neither ordering the PSA test nor discussing it with patients. Sixty-nine percent of physicians who reported not having discussions indicated they were more likely to screen African American patients for prostate cancer, compared to 50% of physicians who reported the use of discussions (Chi-square(1) = 1.62, p = .20). Similarly, 91% of physicians who reported not having discussions indicated they are more likely to screen patients with a family history of prostate cancer, compared to 46% of those who reported the use of discussion (Chi-square(1) = 13.27, p practice styles. Future research needs to consider the nature of discussions and the degree to which informed decision making is being achieved in clinical practice.

What can we learn from simulation-based training to improve skills for end-of-life care? Insights from a national project in Israel.

Science.gov (United States)

Brezis, Mayer; Lahat, Yael; Frankel, Meir; Rubinov, Alan; Bohm, Davina; Cohen, Matan J; Koslowsky, Meni; Shalomson, Orit; Sprung, Charles L; Perry-Mezare, Henia; Yahalom, Rina; Ziv, Amitai

2017-11-06

Simulation-based training improves residents' skills for end-of-life (EOL) care. In the field, staff providers play a significant role in handling those situations and in shaping practice by role modeling. We initiated an educational intervention to train healthcare providers for improved communication skills at EOL using simulation of sensitive encounters with patients and families. Hospital physicians and nurses (n = 1324) attended simulation-based workshops (n = 100) in a national project to improve EOL care. We analyzed perceptions emerging from group discussions following simulations, from questionnaires before and after each workshop, and from video-recorded simulations using a validated coding system. We used the simulation setting as a novel tool for action research. We used a participatory inquiry paradigm, with repetitive cycles of exploring barriers and challenges with participants in an iterative pattern of observation, discussion and reflection - including a description of our own responses and evolution of thought as well as system effects. The themes transpiring included lack of training, knowledge and time, technology overuse, uncertainty in decision-making, poor skills for communication and teamwork. Specific scenarios demonstrated lack of experience at eliciting preferences for EOL care and at handling conflicts or dilemmas. Content analysis of simulations showed predominance of cognitive utterances - by an order of magnitude more prevalent than emotional expressions. Providers talked more than actors did and episodes of silence were rare. Workshop participants acknowledged needs to improve listening skills, attention to affect and teamwork. They felt that the simulation-based workshop is likely to ameliorate future handling of EOL situations. We observed unanticipated consequences from our project manifested as a field study of preparedness to EOL in nursing homes, followed by a national survey on quality of care, leading to expansion of

End-of-life care in COPD: A survey carried out with Portuguese Pulmonologists

Directory of Open Access Journals (Sweden)

C. Gaspar

2014-05-01

Full Text Available Introduction: End-of-life (EoL care is a major component in the management of patients with advanced COPD. Patient-physician communication is essential in this process. Aim: To evaluate the practice of Portuguese Pulmonologists in EoL communication and palliative care in COPD. Methods: An on-line survey was sent to physicians affiliated to the Portuguese Pneumology Society. Results: We obtained 136 answers from 464 eligible participants (29.3%. About half of the physicians reported that they have rarely introduced EoL discussions with their COPD patients (48.5%. Most had never/rarely suggested decision-making on the use of invasive mechanical ventilation (68.4%. Discussions were described as occurring mostly during/after a major exacerbation (53.7%. Only 37.5% of participants reported treating dyspnoea with opioids frequently/always. Only 9.6% stated that they never/rarely treated anxiety/depression. Most participants perceive the discussion of EoL issues as being difficult/very difficult (89.0%. The reasons most frequently given were feeling that patients were not prepared for this discussion (70.0%, fear of taking away a patient's hope (58.0% and lack of training (51.0%. Conclusion: Patient and medical staff EoL communication in COPD is still not good enough. Training in this area and the creation of formal protocols to initiate EoL have been identified as major factors for improvement. Resumo: Introdução: Os cuidados terminais (EoL são um componente importante do tratamento de doentes com doença pulmonar obstrutiva crónica (DPOC avançada. A comunicação entre o doente e o médico é fundamental neste processo. Objetivo: Avaliar a prática dos pneumologistas portugueses na comunicação sobre o fim de vida e os cuidados paliativos na DPOC. Métodos: Foi enviado um inquérito online para os médicos sócios da Sociedade Portuguesa de Pneumologia. Resultados: Recebemos 136 respostas dos 464 participantes elegíveis (29,3%. Cerca de metade

National objectives and flexible mechanisms: A discussions report

International Nuclear Information System (INIS)

Johansson, Bengt

2003-01-01

The Swedish climate policy has the target that the national emissions of greenhouse gases should be reduced 4%, compared to the 1990 level. But according to the EU common policy in line with the Kyoto agreement, Sweden has the right to increase the emissions by 4%. The Kyoto obligations could also be fulfilled by acting through the flexible mechanisms. In the present report the following issues are discussed: Why did Sweden set so ambitious targets; How can you handle the interconnection between national targets and flexible mechanisms; Methods to determine the amounts of the emissions rights that should be allocated to the trading sectors; Are there alternative means for achieving the targets that the national objectives have set

A knowledge synthesis of culturally- and spiritually-sensitive end-of-life care: findings from a scoping review.

Science.gov (United States)

Fang, Mei Lan; Sixsmith, Judith; Sinclair, Shane; Horst, Glen

2016-05-18

Multiple factors influence the end-of-life (EoL) care and experience of poor quality services by culturally- and spiritually-diverse groups. Access to EoL services e.g. health and social supports at home or in hospices is difficult for ethnic minorities compared to white European groups. A tool is required to empower patients and families to access culturally-safe care. This review was undertaken by the Canadian Virtual Hospice as a foundation for this tool. To explore attitudes, behaviours and patterns to utilization of EoL care by culturally and spiritually diverse groups and identify gaps in EoL care practice and delivery methods, a scoping review and thematic analysis of article content was conducted. Fourteen electronic databases and websites were searched between June-August 2014 to identify English-language peer-reviewed publications and grey literature (including reports and other online resources) published between 2004-2014. The search identified barriers and enablers at the systems, community and personal/family levels. Primary barriers include: cultural differences between healthcare providers; persons approaching EoL and family members; under-utilization of culturally-sensitive models designed to improve EoL care; language barriers; lack of awareness of cultural and religious diversity issues; exclusion of families in the decision-making process; personal racial and religious discrimination; and lack of culturally-tailored EoL information to facilitate decision-making. This review highlights that most research has focused on decision-making. There were fewer studies exploring different cultural and spiritual experiences at the EoL and interventions to improve EoL care. Interventions evaluated were largely educational in nature rather than service oriented.

Engaging Physician Learners Through a Web-Based Platform: Individualized End-of-Life Education.

Science.gov (United States)

Bergman, Jonathan; Ballon-Landa, Eric; Lerman, Steven E; Kwan, Lorna; Bennett, Carol J; Litwin, Mark S

2016-09-01

Web-based modules provide a convenient and low-cost education platform, yet should be carefully designed to ensure that learners are actively engaged. In order to improve attitudes and knowledge in end-of-life (EOL) care, we developed a web-based educational module that employed hyperlinks to allow users access to auxiliary resources: clinical guidelines and seminal research papers. Participants took pre-test evaluations of attitudes and knowledge regarding EOL care prior to accessing the educational module, and a post-test evaluation following the module intervention. We recorded the type of hyperlinks (guideline or paper) accessed by learners, and stratified participants into groups based on link type accessed (none, either, or both). We used demographic and educational data to develop a multivariate mixed-effects regression analysis to develop adjusted predictions of attitudes and knowledge. 114 individuals participated. The majority had some professional exposure to EOL care (prior instruction 62%; EOL referral 53%; EOL discussion 56%), though most had no family (68%) or personal experience (51%). On bivariate analysis, non-partnered (p = .04), medical student training level (p = .03), prior palliative care referral (p = .02), having a family member (p = .02) and personal experience of EOL care (p improvements. Auxiliary resources accessible by hyperlink are an effective adjunct to web-based learning in end-of-life care. © The Author(s) 2015.

Nursing Home Physicians' Assessments of Barriers and Strategies for End-of-Life Care in Norway and The Netherlands.

Science.gov (United States)

Fosse, Anette; Zuidema, Sytse; Boersma, Froukje; Malterud, Kirsti; Schaufel, Margrethe Aase; Ruths, Sabine

2017-08-01

Working conditions in nursing homes (NHs) may hamper teamwork in providing quality end-of-life (EOL) care, especially the participation of NH physicians. Dutch NH physicians are specialists or trainees in elderly care medicine with NHs as the main workplace, whereas in Norway, family physicians usually work part time in NHs. Thus, we aimed at assessing and comparing NH physicians' perspectives on barriers and strategies for providing EOL care in NHs in Norway and in The Netherlands. A cross-sectional study using an electronic questionnaire was conducted in 2015. All NH physicians in Norway (approximately 1200-1300) were invited to participate; 435 participated (response rate approximately 35%). Of the total 1664 members of the Dutch association of elderly care physicians approached, 244 participated (response rate 15%). We explored NH physicians' perceptions of organizational, educational, financial, legal, and personal prerequisites for quality EOL care. Differences between the countries were compared using χ 2 test and t-test. Most respondents in both countries reported inadequate staffing, lack of skills among nursing personnel, and heavy time commitment for physicians as important barriers; this was more pronounced among Dutch respondents. Approximately 30% of the respondents in both countries reported their own lack of interest in EOL care as an important barrier. Suggested improvement strategies were routines for involvement of patients' family, pain- and symptom assessment protocols, EOL care guidelines, routines for advance care planning, and education in EOL care for physicians and nursing staff. Inadequate staffing levels, as well as lack of competence, time, and interest emerge as important barriers to quality EOL care according to Dutch and Norwegian NH physicians. Their perspectives were mostly similar, despite large educational and organizational differences. Key strategies for improving EOL care in their facilities comprise education and

Nursing Home Physicians' Assessments of Barriers and Strategies for End-of-Life Care in Norway and The Netherlands

DEFF Research Database (Denmark)

Fosse, Anette; Zuidema, Sytse; Boersma, Froukje

2017-01-01

of patients’ family, pain- and symptom assessment protocols, EOL care guidelines, routines for advance care planning, and education in EOL care for physicians and nursing staff. Conclusions: Inadequate staffing levels, as well as lack of competence, time, and interest emerge as important barriers to quality...... physicians usually work part time in NHs. Thus, we aimed at assessing and comparing NH physicians’ perspectives on barriers and strategies for providing EOL care in NHs in Norway and in The Netherlands. Design: A cross-sectional study using an electronic questionnaire was conducted in 2015. Setting...... physicians’ perceptions of organizational, educational, financial, legal, and personal prerequisites for quality EOL care. Differences between the countries were compared using χ2 test and t-test. Results: Most respondents in both countries reported inadequate staffing, lack of skills among nursing personnel...

Application of Master Curve fracture toughness for reactor pressure vessel integrity assessment in the USA

International Nuclear Information System (INIS)

Server, William; Rosinski, Stan; Lott, Randy; Kim, Charles; Weakland, Dennis

2002-01-01

The Master Curve fracture toughness approach has been used in the USA for better defining the transition temperature fracture toughness of irradiated reactor pressure vessel (RPV) steels for end-of-life (EOL) and EOL extension (EOLE) time periods. The first application was for the Kewaunee plant in which the life-limiting material was a circumferential weld metal. Fracture toughness testing of this weld metal corresponding to EOL and beyond EOLE was used to reassess the PTS screening value, RT PTS , and to develop new operating pressure-temperature curves. The NRC has approved this application using a shift-based methodology and higher safety margins than those proposed by the utility and its contractors. Beaver Valley Unit 1, a First Energy nuclear plant, has performed similar fracture toughness testing, but none of the testing has been conducted at EOL or EOLE at this time. Therefore, extrapolation of the life-limiting plate data to higher fluences is necessary, and the projections will be checked in the next decade by Master Curve fracture toughness testing of all of the Beaver Valley Unit 1 beltline materials (three plates and three welds) at fluences near or greater than EOLE. A supplemental surveillance capsule has been installed in the sister plant, Beaver Valley Unit 2, which has the capability of achieving a higher lead factor while operating under essentially the same environment. The Beaver Valley Unit 1 evaluation has been submitted to the NRC. This paper reviews the shift-based approach taken for the Beaver Valley Unit 1 RPV and presents the use of the RT T 0 methodology (which evolved out of the Master Curve testing and endorsed through two ASME Code Cases). The applied margin accounts for uncertainties in the various material parameters. Discussion of a direct measurement of RT T 0 approach, as originally submitted for the Kewaunee case, is also presented

Paramedic knowledge, attitudes, and training in end-of-life care.

Science.gov (United States)

Stone, Susan C; Abbott, Jean; McClung, Christian D; Colwell, Chris B; Eckstein, Marc; Lowenstein, Steven R

2009-01-01

Paramedics often are asked to care for patients at the end of life. To do this, they must communicate effectively with family and caregivers, understand their legal obligations, and know when to withhold unwanted interventions. The objectives of this study were to ascertain paramedics' attitudes toward end-of-life (EOL) situations and the frequency with which they encounter them; and to compare paramedics' preparation during training for a variety of EOL care skills. A written survey was administered to a convenience sample of paramedics in two cities: Denver, Colorado and Los Angeles, California. Questions addressed: (1) attitudes toward EOL decision-making in prehospital settings; (2) experience (number of EOL situations experienced in the past two years); (3) importance of various EOL tasks in clinical practice (pronouncing and communicating death, ending resuscitation, honoring advance directives (ADs)); and (4) self-assessed preparation for these EOL tasks. For each task, importance and preparation were measured using a four-point Likert scale. Proportions were compared using McNemar chi-square statistics to identify areas of under- or over-preparation. Two hundred thirty-six paramedics completed the survey. The mean age was 39 years (range 22-59 years), and 222 (94%) were male. Twenty percent had >20 years of experience. Almost all participants (95%; 95% CI = 91-97%) agreed that prehospital providers should honor field ADs, and more than half (59%; 95% CI = 52-65%) felt that providers should honor verbal wishes to limit resuscitation at the scene. Ninety-eight percent of the participants (95% CI = 96-100%) had questioned whether specific life support interventions were appropriate for patients who appeared to have a terminal disease. Twenty-six percent (95% CI = 20-32%) reported to have used their own judgment during the past two years to withhold or end resuscitation in a patient who appeared to have a terminal disease. Significant discrepancies between the

Survey of neonatologists' attitudes toward limiting life-sustaining treatments in the neonatal intensive care unit.

Science.gov (United States)

Feltman, D M; Du, H; Leuthner, S R

2012-11-01

To understand neonatologists' attitudes toward end-of-life (EOL) management in clinical scenarios, EOL ethical concepts and resource utilization. American Academy of Pediatrics (AAP) Perinatal section members completed an anonymous online survey. Respondents indicated preferences in limiting life-sustaining treatments in four clinical scenarios, ranked agreement with EOL-care ethics statements, indicated outside resources previously used and provided demographic information. In all, 451 surveys were analyzed. Across clinical scenarios and as general ethical concepts, withdrawal of mechanical ventilation in severely affected patients was most accepted by respondents; withdrawal of artificial nutrition and hydration was least accepted. One-third of neonatologists did not agree that non-initiation of treatment is ethically equivalent to withdrawal. Around 20% of neonatologists would not defer care if uncomfortable with a parent's request. Respondents' resources included ethics committees, AAP guidelines and legal counsel/courts. Challenges to providing just, unified EOL care strategies are discussed, including deferring care, limiting artificial nutrition/hydration and conditions surrounding ventilator withdrawal.

Caring Decisions: The Development of a Written Resource for Parents Facing End-of-Life Decisions

OpenAIRE

Xafis, Vicki; Gillam, Lynn; Hynson, Jenny; Sullivan, Jane; Cossich, Mary; Wilkinson, Dominic

2015-01-01

Background: Written resources in adult intensive care have been shown to benefit families facing end of life (EoL) decisions. There are few resources for parents making EoL decisions for their child and no existing resources addressing ethical issues. TheCaring Decisionshandbook and website were developed to fill these gaps. Aim: We discuss the development of the resources, modification after reviewer feedback and findings from initial pilot implementation. Design: A targeted...

Training Community Clergy in Serious Illness: Balancing Faith and Medicine.

Science.gov (United States)

Koss, Sarah E; Weissman, Ross; Chow, Vinca; Smith, Patrick T; Slack, Bethany; Voytenko, Vitaliy; Balboni, Tracy A; Balboni, Michael J

2018-06-06

Community-based clergy are highly engaged in helping seriously ill patients address spiritual concerns at the end of life (EOL). While they desire EOL training, no data exist in guiding how to conceptualize a clergy-training program. The objective of this study was used to identify best practices in an EOL training program for community clergy. As part of the National Clergy Project on End-of-Life Care, the project conducted key informant interviews and focus groups with active clergy in five US states (California, Illinois, Massachusetts, New York, and Texas). A diverse purposive sample of 35 active clergy representing pre-identified racial, educational, theological, and denominational categories hypothesized to be associated with more intensive utilization of medical care at the EOL. We assessed suggested curriculum structure and content for clergy EOL training through interviews and focus groups for the purpose of qualitative analysis. Thematic analysis identified key themes around curriculum structure, curriculum content, and issues of tension. Curriculum structure included ideas for targeting clergy as well as lay congregational leaders and found that clergy were open to combining resources from both religious and health-based institutions. Curriculum content included clergy desires for educational topics such as increasing their medical literacy and reviewing pastoral counseling approaches. Finally, clergy identified challenging barriers to EOL training needing to be openly discussed, including difficulties in collaborating with medical teams, surrounding issues of trust, the role of miracles, and caution of prognostication. Future EOL training is desired and needed for community-based clergy. In partnering together, religious-medical training programs should consider curricula sensitive toward structure, desired content, and perceived clergy tensions.

Still Searching: A Meta-Synthesis of a Good Death from the Bereaved Family Member Perspective

Directory of Open Access Journals (Sweden)

Kelly E. Tenzek

2017-04-01

Full Text Available The concept of a good death continues to receive attention in end-of-life (EOL scholarship. We sought to continue this line of inquiry related to a good death by conducting a meta-synthesis of published qualitative research studies that examined a good death from the bereaved family member’s perspective. Results of the meta-synthesis included 14 articles with 368 participants. Based on analysis, we present a conceptual model called The Opportunity Model for Presence during the EOL Process. The model is framed in socio-cultural factors, and major themes include EOL process engagement with categories of healthcare participants, communication and practical issues. The second theme, (discontinuity of care, includes categories of place of care, knowledge of family member dying and moment of death. Both of these themes lead to perceptions of either a good or bad death, which influences the bereavement process. We argue the main contribution of the model is the ability to identify moments throughout the interaction where family members can be present to the EOL process. Recommendations for healthcare participants, including patients, family members and clinical care providers are offered to improve the quality of experience throughout the EOL process and limitations of the study are discussed.

Retrotracheal Extraskeletal Ewing's Sarcoma: Case Report and Discussion on Airway Management.

Science.gov (United States)

Van Der Meer, Graeme; Linkhorn, Hannah; Gruber, Maayan; Mahadevan, Murali; Barber, Colin

2017-03-01

Extraskeletal Ewing's sarcoma is a rare tumor, and the management of airway compromise in case of cervical Ewing's sarcoma has not been established. This report describes the case of a patient with retrotracheal Ewing's sarcoma and discusses a successful approach to airway management. A 12-year-old male presented with a 2-week history of sore throat and sleep-disordered breathing and 48 hours of stridor. Imaging confirmed a retrotracheal soft tissue mass with airway compromise. A planned and controlled approach to his airway management resulted in a secure airway prior to definitive treatment.

Practice and Perceived Importance of Advance Care Planning and Difficulties in Providing Palliative Care in Geriatric Health Service Facilities in Japan: A Nationwide Survey.

Science.gov (United States)

Yokoya, Shoji; Kizawa, Yoshiyuki; Maeno, Takami

2018-03-01

The provision of end-of-life (EOL) care by geriatric health service facilities (GHSFs) in Japan is increasing. Advance care planning (ACP) is one of the most important issues to provide quality EOL care. This study aimed to clarify the practice and perceived importance of ACP and the difficulties in providing palliative care in GHSFs. A self-report questionnaire was mailed to head nurses at 3437 GHSFs nationwide. We asked participants about their practices regarding ACP, their recognition of its importance, and their difficulties in providing palliative care. We also analyzed the relationship between these factors and EOL care education. Among 844 respondents (24.5% response rate), approximately 69% to 81% of head nurses confirmed that GHSF residents and their families understood disease conditions and goals of care. There was a large discrepancy between the actual practice of ACP components and the recognition of their importance (eg, asking residents about existing advance directive [AD; 27.5% practiced it, while 79.6% considered it important]; recommending completion of an AD [18.1% vs 68.4%], and asking for designation of a health-care proxy [30.4% vs 76.8%]). The EOL care education was provided at 517 facilities (61.3%). Head nurses working at EOL care education-providing GHSFs practiced ACP significantly more frequently and had significantly fewer difficulties in providing palliative care. A large discrepancy was found between GHSF nurses' practice of ACP and their recognition of its importance. Providing EOL care education in GHSFs may increase ACP practices and enhance respect for resident's preferences concerning EOL care.

How Community Clergy Provide Spiritual Care: Toward a Conceptual Framework for Clergy End-of-Life Education.

Science.gov (United States)

LeBaron, Virginia T; Smith, Patrick T; Quiñones, Rebecca; Nibecker, Callie; Sanders, Justin J; Timms, Richard; Shields, Alexandra E; Balboni, Tracy A; Balboni, Michael J

2016-04-01

Community-based clergy are highly engaged in helping terminally ill patients address spiritual concerns at the end of life (EOL). Despite playing a central role in EOL care, clergy report feeling ill-equipped to spiritually support patients in this context. Significant gaps exist in understanding how clergy beliefs and practices influence EOL care. The objective of this study was to propose a conceptual framework to guide EOL educational programming for community-based clergy. This was a qualitative, descriptive study. Clergy from varying spiritual backgrounds, geographical locations in the U.S., and race/ethnicities were recruited and asked about optimal spiritual care provided to patients at the EOL. Interviews were audio taped, transcribed, and analyzed following principles of grounded theory. A final set of themes and subthemes were identified through an iterative process of constant comparison. Participants also completed a survey regarding experiences ministering to the terminally ill. A total of 35 clergy participated in 14 individual interviews and two focus groups. Primary themes included Patient Struggles at EOL and Clergy Professional Identity in Ministering to the Terminally Ill. Patient Struggles at EOL focused on existential questions, practical concerns, and difficult emotions. Clergy Professional Identity in Ministering to the Terminally Ill was characterized by descriptions of Who Clergy Are ("Being"), What Clergy Do ("Doing"), and What Clergy Believe ("Believing"). "Being" was reflected primarily by manifestations of presence; "Doing" by subthemes of religious activities, spiritual support, meeting practical needs, and mistakes to avoid; "Believing" by subthemes of having a relationship with God, nurturing virtues, and eternal life. Survey results were congruent with interview and focus group findings. A conceptual framework informed by clergy perspectives of optimal spiritual care can guide EOL educational programming for clergy. Copyright �

Discussing compliance. Summary report from discussions with Robert Bernero and Chris Whipple regarding compliance with the Swedish HLW Regulations from meetings in Stockholm May 3 and 4, 1999

Energy Technology Data Exchange (ETDEWEB)

Jensen, Mikael

1999-06-01

Summary report from discussions with Robert Bernero and Chris Whipple regarding compliance with the Swedish HLW Regulations from meetings in Stockholm. The report also contains bibliographical information and preliminary observations made by Robert Bernero and Chris Whipple.

Discussing compliance. Summary report from discussions with Robert Bernero and Chris Whipple regarding compliance with the Swedish HLW Regulations from meetings in Stockholm May 3 and 4, 1999

International Nuclear Information System (INIS)

Jensen, Mikael

1999-06-01

Summary report from discussions with Robert Bernero and Chris Whipple regarding compliance with the Swedish HLW Regulations from meetings in Stockholm. The report also contains bibliographical information and preliminary observations made by Robert Bernero and Chris Whipple

Are life-extending treatments for terminal illnesses a special case? Exploring choices and societal viewpoints.

Science.gov (United States)

McHugh, Neil; van Exel, Job; Mason, Helen; Godwin, Jon; Collins, Marissa; Donaldson, Cam; Baker, Rachel

2018-02-01

Criteria used by the National Institute for Health and Care Excellence (NICE) to assess life-extending, end-of-life (EoL) treatments imply that health gains from such treatments are valued more than other health gains. Despite claims that the policy is supported by societal values, evidence from preference elicitation studies is mixed and in-depth research has shown there are different societal viewpoints. Few studies elicit preferences for policies directly or combine different approaches to understand preferences. Survey questions were designed to investigate support for NICE EoL guidance at national and regional levels. These 'Decision Rule' and 'Treatment Choice' questions were administered to an online sample of 1496 UK respondents in May 2014. The same respondents answered questions designed to elicit their agreement with three viewpoints (previously identified and described) in relation to provision of EoL treatments for terminally ill patients. We report the findings of these choice questions and examine how they relate to each other and respondents' viewpoints. The Decision Rule questions described three policies: DA - a standard 'value for money' test, applied to all health technologies; DB - giving special consideration to all treatments for terminal illnesses; and DC - giving special consideration to specific categories of treatments for terminal illnesses e.g. life extension (as in NICE EoL guidance) or those that improve quality-of-life (QoL). Three Treatment Choices were presented: TA - improving QoL for patients with a non-terminal illness; TB - extending life for EoL patients; and TC - improving QoL at the EoL. DC received most support (45%) with most respondents giving special consideration to EoL only when treatments improved QoL. The most commonly preferred treatment choices were TA (51%) and TC (43%). Overall, this study challenges claims about public support for NICE's EoL guidance and the focus on life extension at EoL and substantiates

Evolution of Atmosphere and Ocean Boundary Layers from Aircraft Observations and Coupled COAMPS/NCOM

Science.gov (United States)

2012-09-01

the NCAR EOL C-130 Investigator Handbook [Available at http://www.eol.ucar.edu/instrumentation/aircraft/C-130/documentation/c- 130-investigator...sensors are summarized in Table 1. Additional details are described in the NCAR EOL C-130 Investigator Handbook, Chapter 6 (NCAR EOL , 2012). The...during the GOTEX experiment. Additional information is available in the NCAR EOL C-130 Investigator Handbook [Available at http://www.eol.ucar.edu

A 40-Year History of End-of-Life Offerings in US Medical Schools: 1975-2015.

Science.gov (United States)

Dickinson, George E

2017-07-01

The purpose of this longitudinal study of US medical schools over a 40-year period was to ascertain their offerings on end-of-life (EOL) issues. At 5-year intervals, beginning in 1975, US medical schools were surveyed via a questionnaire to determine their EOL offerings. Data were reported with frequency distributions. The Institute of Medicine has encouraged more emphasis on EOL issues over the past 2 decades. Findings revealed that undergraduate medical students in the United States are now exposed to death and dying, palliative care, and geriatric medicine. The inclusion of EOL topics has definitely expanded over the 40-year period as findings reveal that US undergraduate medical students are currently exposed in over 90% of programs to death and dying, palliative care, and geriatric medicine, with the emphasis on these topics varying with the medical programs. Such inclusion should produce future favorable outcomes for undergraduate medical students, patients, and their families.

Meaning and Practice of Palliative Care for Hospitalized Older Adults with Life Limiting Illnesses

Directory of Open Access Journals (Sweden)

Bethel Ann Powers

2011-01-01

Full Text Available Objective. To illustrate distinctions and intersections of palliative care (PC and end-of-life (EOL services through examples from case-centered data of older adults cared for during a four-year ethnographic study of an acute care hospital palliative care consultation service. Methods. Qualitative narrative and thematic analysis. Results. Description of four practice paradigms (EOL transitions, prognostic uncertainty, discharge planning, and patient/family values and preferences and identification of the underlying structure and communication patterns of PC consultation services common to them. Conclusions. Consistent with reports by other researchers, study data support the need to move beyond equating PC with hospice or EOL care and the notion that EOL is a well-demarcated period of time before death. If professional health care providers assume that PC services are limited to assisting with and helping patients and families prepare for dying, they miss opportunities to provide care considered important to older individuals confronting life-limiting illnesses.

A pan-European survey of research in end-of-life cancer care.

Science.gov (United States)

Sigurdardottir, Katrin Ruth; Haugen, Dagny Faksvåg; Bausewein, Claudia; Higginson, Irene J; Harding, Richard; Rosland, Jan Henrik; Kaasa, Stein

2012-01-01

To date, there is no coordinated strategy for end-of-life (EOL) cancer care research in Europe. The PRISMA (Reflecting the Positive Diversities of European Priorities for Research and Measurement in End-of-life Care) project is aiming to develop a programme integrating research and measurement in EOL care. This survey aimed to map and describe present EOL cancer care research in Europe and to identify priorities and barriers. A questionnaire of 62 questions was developed and 201 researchers in 41 European countries were invited to complete it online in May 2009. An open invitation to participate was posted on the internet. Invited contacts in 36 countries sent 127 replies; eight additional responses came through websites. A total of 127 responses were eligible for analysis. Respondents were 69 male and 58 female, mean age 49 (28-74) years; 85% of the scientific team leaders were physicians. Seventy-one of 127 research groups were located in a teaching hospital or cancer centre. Forty-five percent of the groups had only one to five members and 28% six to ten members. Sixty-three of 92 groups reported specific funding for EOL care research. Seventy-five percent of the groups had published papers in journals with impact factor ≤ 5 in the last 3 years; 8% had published in journals with impact factor >10. Forty-four out of 90 groups reported at least one completed Ph.D. in the last 3 years. The most frequently reported active research areas were pain, assessment and measurement tools, and last days of life and quality of death. Very similar areas--last days of life and quality of death, pain, fatigue and cachexia, and assessment and measurement tools--were ranked as the most important research priorities. The most important research barriers were lack of funding, lack of time, and insufficient knowledge/expertise. Most research groups in EOL care are small. The few large groups (14%) had almost half of the reported publications, and more than half of the current Ph

End-of-life flows of multiple cycle consumer products

International Nuclear Information System (INIS)

Tsiliyannis, C.A.

2011-01-01

Explicit expressions for the end-of-life flows (EOL) of single and multiple cycle products (MCPs) are presented, including deterministic and stochastic EOL exit. The expressions are given in terms of the physical parameters (maximum lifetime, T, annual cycling frequency, f, number of cycles, N, and early discard or usage loss). EOL flows are also obtained for hi-tech products, which are rapidly renewed and thus may not attain steady state (e.g. electronic products, passenger cars). A ten-step recursive procedure for obtaining the dynamic EOL flow evolution is proposed. Applications of the EOL expressions and the ten-step procedure are given for electric household appliances, industrial machinery, tyres, vehicles and buildings, both for deterministic and stochastic EOL exit, (normal, Weibull and uniform exit distributions). The effect of the physical parameters and the stochastic characteristics on the EOL flow is investigated in the examples: it is shown that the EOL flow profile is determined primarily by the early discard dynamics; it also depends strongly on longevity and cycling frequency: higher lifetime or early discard/loss imply lower dynamic and steady state EOL flows. The stochastic exit shapes the overall EOL dynamic profile: Under symmetric EOL exit distribution, as the variance of the distribution increases (uniform to normal to deterministic) the initial EOL flow rise becomes steeper but the steady state or maximum EOL flow level is lower. The steepest EOL flow profile, featuring the highest steady state or maximum level, as well, corresponds to skew, earlier shifted EOL exit (e.g. Weibull). Since the EOL flow of returned products consists the sink of the reuse/remanufacturing cycle (sink to recycle) the results may be used in closed loop product lifecycle management operations for scheduling and sizing reverse manufacturing and for planning recycle logistics. Decoupling and quantification of both the full age EOL and of the early discard flows is

Discussing study limitations in reports of biomedical studies- the need for more transparency.

Science.gov (United States)

Puhan, Milo A; Akl, Elie A; Bryant, Dianne; Xie, Feng; Apolone, Giovanni; ter Riet, Gerben

2012-02-23

Unbiased and frank discussion of study limitations by authors represents a crucial part of the scientific discourse and progress. In today's culture of publishing many authors or scientific teams probably balance 'utter honesty' when discussing limitations of their research with the risk of being unable to publish their work. Currently, too few papers in the medical literature frankly discuss how limitations could have affected the study findings and interpretations. The goals of this commentary are to review how limitations are currently acknowledged in the medical literature, to discuss the implications of limitations in biomedical studies, and to make suggestions as to how to openly discuss limitations for scientists submitting their papers to journals. This commentary was developed through discussion and logical arguments by the authors who are doing research in the area of hedging (use of language to express uncertainty) and who have extensive experience as authors and editors of biomedical papers. We strongly encourage authors to report on all potentially important limitations that may have affected the quality and interpretation of the evidence being presented. This will not only benefit science but also offers incentives for authors: If not all important limitations are acknowledged readers and reviewers of scientific articles may perceive that the authors were unaware of them. Authors should take advantage of their content knowledge and familiarity with the study to prevent misinterpretations of the limitations by reviewers and readers. Articles discussing limitations help shape the future research agenda and are likely to be cited because they have informed the design and conduct of future studies. Instead of perceiving acknowledgment of limitations negatively, authors, reviewers and editors should recognize the potential of a frank and unbiased discussion of study limitations that should not jeopardize acceptance of manuscripts.

Discussing study limitations in reports of biomedical studies- the need for more transparency

Directory of Open Access Journals (Sweden)

Puhan Milo A

2012-02-01

Full Text Available Abstract Unbiased and frank discussion of study limitations by authors represents a crucial part of the scientific discourse and progress. In today's culture of publishing many authors or scientific teams probably balance 'utter honesty' when discussing limitations of their research with the risk of being unable to publish their work. Currently, too few papers in the medical literature frankly discuss how limitations could have affected the study findings and interpretations. The goals of this commentary are to review how limitations are currently acknowledged in the medical literature, to discuss the implications of limitations in biomedical studies, and to make suggestions as to how to openly discuss limitations for scientists submitting their papers to journals. This commentary was developed through discussion and logical arguments by the authors who are doing research in the area of hedging (use of language to express uncertainty and who have extensive experience as authors and editors of biomedical papers. We strongly encourage authors to report on all potentially important limitations that may have affected the quality and interpretation of the evidence being presented. This will not only benefit science but also offers incentives for authors: If not all important limitations are acknowledged readers and reviewers of scientific articles may perceive that the authors were unaware of them. Authors should take advantage of their content knowledge and familiarity with the study to prevent misinterpretations of the limitations by reviewers and readers. Articles discussing limitations help shape the future research agenda and are likely to be cited because they have informed the design and conduct of future studies. Instead of perceiving acknowledgment of limitations negatively, authors, reviewers and editors should recognize the potential of a frank and unbiased discussion of study limitations that should not jeopardize acceptance of

Congenital duodenal obstruction with situs inversus totalis: Report of a rare association and discussion

Directory of Open Access Journals (Sweden)

Sharma Satendra

2008-01-01

Full Text Available This report is to present and discuss an extremely rare association of situs inversus with duodenal atresia in an 11-day-old male neonate born full term and weighing 1.9 kg. The baby presented with recurrent bilious vomiting. Babygram revealed situs inversus and duodenal obstruction. Echocardiography showed dextrocardia with a small ASD. Exploration confirmed a duodenal diaphragm with a central perforation between the third and fourth part of the duodenum and situs inversus. The literature search revealed 20 cases reported so far.

Special Collections in ARL Libraries: A Discussion Report from the ARL Working Group on Special Collections

Science.gov (United States)

Association of Research Libraries, 2009

2009-01-01

This discussion report identifies key issues in the management of special collections material in the 21st century. The report uses a broad definition of "special collections," which encompasses distinctive material in all media and attendant library services. The group's main focus was on 19th- and 20th-century materials, including…

General Assembly discusses progress report from IAEA

Energy Technology Data Exchange (ETDEWEB)

NONE

1959-01-15

According to its Statute and the Relationship Agreement with the United Nations, the International Atomic Energy Agency reports annually to the General Assembly of the United Nations on its activities during the past year. The Report is prepared for the approval of the General Conference by the Board of Governors. The second of these reports was presented by the Director General, Mr. Sterling Cole, on behalf of the Agency on October 30th 1958; delegates from thirteen countries took part in the ensuing debate. The Report covers the period 1 November 1957 to the end of June 1958 with some more recent developments mentioned briefly in the Preface. (author)

Emotional discussions reduce memory recall.

Science.gov (United States)

Soleti, Emanuela; Wright, Daniel B; Curci, Antonietta

2017-05-01

People often discuss events they have seen and these discussions can influence later recollections. We investigated the effects of factual, emotional, and free retelling discussion on memory recollections of individuals who have witnessed an event. Participants were shown a video, made an initial individual recall, participated in one of the three retelling conditions (emotional versus factual versus free) or a control condition, and then recalled the event individually again. Participants in the factual and free retelling conditions reported more items not previously recalled than participants in the control condition did, while the emotional condition did not show the same advantage. Participants in all three retelling conditions failed to report more previously recalled items as compared with the control condition. Finally, a memory conformity effect was observed for all three retelling conditions. These findings suggest that eyewitnesses' discussions may influence the accuracy of subsequent memory reports, especially when these discussions are focused on emotional details and thoughts.

Aeolus or Pluton?; Eole ou pluton?

Energy Technology Data Exchange (ETDEWEB)

Anon.

2003-07-01

In the next years the french government will have to take great decisions in matter of energy and specifically electric power. This report aims to give an estimation of wind power channel in France supposing financial possibilities equivalent to those implemented for the EPR (European Pressurized Reactor) channel. After a presentation of the electric power industry in France, the two channels are compared. (A.L.B.)

Escalating Health Care Expenditures in Cancer Decedents' Last Year of Life: A Decade of Evidence from a Retrospective Population-Based Cohort Study in Taiwan.

Science.gov (United States)

Hung, Yen-Ni; Liu, Tsang-Wu; Wen, Fur-Hsing; Chou, Wen-Chi; Tang, Siew Tzuh

2017-04-01

No population-based longitudinal studies on end-of-life (EOL) expenditures were found for cancer decedents. This population-based, retrospective cohort study examined health care expenditures from 2001 to 2010 among 339,546 Taiwanese cancer decedents' last year of life. Individual patient-level data were linked from administrative datasets. Health care expenditures were converted from Taiwan dollars to U.S. dollars by health-specific purchasing power parity conversions to account for different health-purchasing powers. Associations of patient, physician, hospital, and regional factors with EOL care expenditures were evaluated by multilevel linear regression model by generalized estimating equation method. Mean annual EOL care expenditures for Taiwanese cancer decedents increased from 2000 to 2010 from U.S. $49,591 to U.S. $68,773, respectively, with one third of spending occurring in the patients' last month. Increased EOL care expenditures were associated with male gender, younger age, being married, diagnosed with hematological malignancies and cancers other than lung, gastric, and hepatic-pancreatic cancers, and dying within 7-24 months of diagnosis. Patients spent less at EOL when they had higher comorbidities and metastatic disease, died within 6 months of diagnosis, were under care of oncologists, gastroenterologists, and intensivists, and received care at a teaching hospital with more terminally ill cancer patients. Higher EOL care expenditures were associated with greater EOL care intensity at the primary hospital and regional levels. Taiwanese cancer decedents consumed considerable National Health Insurance disbursements at EOL, totaling more than was consumed in six developed non-U.S. countries surveyed in 2010. To slow increasing cost and improve EOL cancer care quality, interventions to ensure appropriate EOL care provision should target hospitals and clinicians less experienced in providing EOL care and those who tend to provide aggressive EOL care to

SaskEnergy small volume customers - direct gas purchase stakeholder discussion and public input report

International Nuclear Information System (INIS)

Davidson, M. A.

1998-01-01

With the approval of the Provincial Government of Saskatchewan, SaskEnergy, the provincial utility decided to extend the premise of natural gas deregulation to all sizes of customers by opening the core market for natural gas commodity sales to private sector natural gas agents, brokers and marketers (ABMs). SaskEnergy will continue to provide natural gas transportation and storage related services. Before doing so, the Utility sought to discuss with various stakeholders the terms and conditions that would need to be met by industry to enter into the Saskatchewan market. To assure a balanced interest during the discussions that would include a perspective on consumer protection requirements, the Utility contracted KPMG Regina to chair the stakeholders discussion table and facilitate a public input process for interested individuals to channel comments and seek responses to questions. This report contains the edited summary of the four meetings held by stakeholders. The stakeholders were successful in providing SaskEnergy with insight and suggestions to ensure that a direct purchase market will be developed in Saskatchewan, and that consumers will have objective information to make informed choices about their natural gas purchase options. The meetings also produced an ABMs Code of Conduct, a Direct Purchase 'Enrollment Agreement' and a 'Disclosure Agreement' and delivery terms and conditions for the core market that are similar to industry requirements in the rest of Canada. Copies of the draft forms are included in appendices to this summary report

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

Science.gov (United States)

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

2013-01-01

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.

The Effect of Uncertain End-of-Life Product Quality and Consumer Incentives on Partial Disassembly Sequencing in Value Recovery Operations

OpenAIRE

Rickli, Jeremy Lewis

2013-01-01

This dissertation addresses gaps in the interaction between End-of-Life (EoL) product acquisition systems and disassembly sequencing. The research focuses on two remanufacturing research problems; 1) modeling uncertain EoL product quality, quantity, and timing in regards to EoL product acquisition and disassembly sequencing and 2) designing EoL product acquisition schemes considering EoL product uncertainty. The main research objectives within these areas are; analyzing, predicting, and contr...

Stable curcumin-loaded polymeric micellar formulation for enhancing cellular uptake and cytotoxicity to FLT3 overexpressing EoL-1 leukemic cells.

Science.gov (United States)

Tima, Singkome; Anuchapreeda, Songyot; Ampasavate, Chadarat; Berkland, Cory; Okonogi, Siriporn

2017-05-01

The present study aims to develop a stable polymeric micellar formulation of curcumin (CM) with improved solubility and stability, and that is suitable for clinical applications in leukemia patients. CM-loaded polymeric micelles (CM-micelles) were prepared using poloxamers. The chemical structure of the polymers influenced micellar properties. The best formulation of CM-micelles, namely CM-P407, was obtained from poloxamer 407 at drug to polymer ratio of 1:30 and rehydrated with phosphate buffer solution pH 7.4. CM-P407 exhibited the smallest size of 30.3±1.3nm and highest entrapment efficiency of 88.4±4.1%. When stored at -80°C for 60days, CM-P407 retained high protection of CM and had no significant size change. In comparison with CM solution in dimethyl sulfoxide (CM-DMSO), CM kinetic degradation in both formulations followed a pseudo-first-order reaction, but the half-life of CM in CM-P407 was approx. 200 times longer than in CM-DMSO. Regarding the activity against FLT3 overexpressing EoL-1 leukemic cells, CM-P407 showed higher cytotoxicity than CM-DMSO. Moreover, intracellular uptake to leukemic cells of CM-P407 was 2-3 times greater than that of CM-DMSO. These promising results for CM-P407 will be further investigated in rodents and in clinical studies for leukemia treatment. Copyright © 2017 Elsevier B.V. All rights reserved.

Alpine Windharvest: development of information base regarding potentials and the necessary technical, legal and socio-economic conditions for expanding wind energy in the Alpine Space - Alpine Space wind map - Modeling approach

Energy Technology Data Exchange (ETDEWEB)

Schaffner, B.; Remund, J. [Meteotest, Berne (Switzerland)

2005-07-01

This report presents describes the development work carried out by the Swiss meteorology specialists of the company METEOTEST as part of a project carried out together with the Swiss wind-energy organisation 'Suisse Eole'. The framework for the project is the EU Interreg IIIB Alpine Space Programme, a European Community Initiative Programme funded by the European Regional Development Fund. The project investigated the use of digital relief-analysis. The series of reports describes the development and use of a basic information system to aid the investigation of the technical, legal and socio-economical conditions for the use of wind energy in the alpine area. This report discusses two modelling approaches investigated for use in the definition of a wind map for the alpine area. The method chosen and its application are discussed. The various sources of information for input to the model are listed and discussed.

End of life care in sub-Saharan Africa: a systematic review of the qualitative literature

Directory of Open Access Journals (Sweden)

Pool Robert

2011-03-01

Full Text Available Abstract Background End of life (EoL care in sub-Saharan Africa still lacks the sound evidence-base needed for the development of effective, appropriate service provision. It is essential to make evidence from all types of research available alongside clinical and health service data, to ensure that EoL care is ethical and culturally appropriate. This article aims to synthesize qualitative research on EoL care in sub-Saharan Africa to inform policy, practice and further research. It seeks to identify areas of existing research; describe findings specifically relevant to the African context; and, identify areas lacking evidence. Methods Relevant literature was identified through eight electronic databases: AMED, British Nursing Index & Archive, CINAHL, EMBASE, IBSS, MEDLINE, PsycINFO, and the Social Sciences Citation Index; and hand searches. Inclusion criteria were: published qualitative or mixed-method studies in sub-Saharan Africa, about EoL care. Study quality was assessed using a standard grading scale. Relevant data including findings and practice recommendations were extracted and compared in tabular format. Results Of the 407 articles initially identified, 51 were included in the qualitative synthesis. Nineteen came from South Africa and the majority (38 focused on HIV/AIDS. Nine dealt with multiple or unspecified conditions and four were about cancer. Study respondents included health professionals, informal carers, patients, community members and bereaved relatives. Informal carers were typically women, the elderly and children, providing total care in the home, and lacking support from professionals or the extended family. Twenty studies focused on home-based care, describing how programmes function in practice and what is needed to make them effective. Patients and carers were reported to prefer institutional care but this needs to be understood in context. Studies focusing on culture discussed good and bad death, culture

The Encyclopedia of Life v2: Providing Global Access to Knowledge About Life on Earth

Science.gov (United States)

2014-01-01

Abstract The Encyclopedia of Life (EOL, http://eol.org) aims to provide unprecedented global access to a broad range of information about life on Earth. It currently contains 3.5 million distinct pages for taxa and provides content for 1.3 million of those pages. The content is primarily contributed by EOL content partners (providers) that have a more limited geographic, taxonomic or topical scope. EOL aggregates these data and automatically integrates them based on associated scientific names and other classification information. EOL also provides interfaces for curation and direct content addition. All materials in EOL are either in the public domain or licensed under a Creative Commons license. In addition to the web interface, EOL is also accessible through an Application Programming Interface. In this paper, we review recent developments added for Version 2 of the web site and subsequent releases through Version 2.2, which have made EOL more engaging, personal, accessible and internationalizable. We outline the core features and technical architecture of the system. We summarize milestones achieved so far by EOL to present results of the current system implementation and establish benchmarks upon which to judge future improvements. We have shown that it is possible to successfully integrate large amounts of descriptive biodiversity data from diverse sources into a robust, standards-based, dynamic, and scalable infrastructure. Increasing global participation and the emergence of EOL-powered applications demonstrate that EOL is becoming a significant resource for anyone interested in biological diversity. PMID:24891832

End-of-life chemotherapy is associated with poor survival and aggressive care in patients with small cell lung cancer.

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Zhu, Yingming; Tang, Ke; Zhao, Fen; Zang, Yuanwei; Wang, Xiaodong; Li, Zhenxiang; Sun, Xindong; Yu, Jinming

2018-05-29

Concerns regarding end-of-life (EOL) chemotherapy are being increasingly raised. Tumor chemosensitivity may influence the decision for aggressive chemotherapy near the EOL. Data on EOL chemotherapy in highly chemosensitive tumors, such as small cell lung cancer (SCLC), are scarce. A total of 143 SCLC decedents were consecutively included. Data about clinical factors and treatment modalities were obtained from the electronic medical records. The relationships among EOL chemotherapy, clinical features, overall survival (OS), and aggressive care were investigated. About 64% of patients had chemosensitive disease. In total, 30.8 and 16.1% of patients received EOL chemotherapy within the last 1 and 2 months of life, respectively. Younger age was associated with a higher rate of EOL chemotherapy. We determined that EOL chemotherapy was related to inferior OS not only in the entire group, but also in the chemosensitive subgroup. Furthermore, more intensive care was observed among patients who underwent EOL chemotherapy compared with those who did not. EOL chemotherapy was correlated with shorter survival and more aggressive care in patients with SCLC. More research is needed to develop indications for terminating palliative chemotherapy, to help physicians and patients with their difficult choices.

A retrospective study of end-of-life care decisions in the critically Ill in a surgical intensive care unit

Directory of Open Access Journals (Sweden)

Yi Lin Lee

2018-01-01

Full Text Available Aim: Progress in medical care and technology has led to patients with more advanced illnesses being admitted to the Intensive Care Unit (ICU. The practice of approaching end-of-life (EOL care decisions and limiting care is well documented in Western literature but unknown in Singapore. We performed a retrospective cohort study to describe the practice of EOL care in patients dying in a Singapore surgical ICU (SICU. The surgical critical care population was chosen as it is unique because surgeons are frequently involved in the EOL process. Methods: All consecutive patients aged 21 and above admitted to the SICU from July 2011 to March 2012, and who passed away in the ICU or within 7 days of discharge from the ICU (to account for transferred patients out of the ICU after end-of life care decisions were made and subsequently passed away were included in the study. Results: There were 473 SICU admissions during this period, out of which 53 were included with a mean age of 67.2 ± 11.1 years. EOL discussions were held in 81.1% of patients with a median time from admission to first discussion at 1 day (IQR 0–2.75 and a median number of ICU discussion of 1 (IQR 1–2. As most patients lacked decision-making capacity (inability to retain and process information secondary to the underlying disease pathology or sedative use, a surrogate was involved: group decision in 27.9%, child in 25.6% and an unclear family nominated member in 20.9%. 28.3% of patients were managed as for full active with resuscitation, 39.6% nonescalation of care, and 32.1% for withdrawal. The main reasons for conservative management (nonescalation and withdrawal of care were certain death in 52.3%, medical futility with minimal response to maximal care (27.3%, and the presence of underlying malignancy (18.2%. There was no significant difference between race or religion among patients for active or conservative management. Conclusion: 71.7% of patients who passed away in the ICU or

Escalating Health Care Expenditures in Cancer Decedents' Last Year of Life: A Decade of Evidence from a Retrospective Population‐Based Cohort Study in Taiwan

Science.gov (United States)

Hung, Yen‐Ni; Liu, Tsang‐Wu; Wen, Fur‐Hsing; Chou, Wen‐Chi

2017-01-01

Abstract Background. No population‐based longitudinal studies on end‐of‐life (EOL) expenditures were found for cancer decedents. Methods. This population‐based, retrospective cohort study examined health care expenditures from 2001 to 2010 among 339,546 Taiwanese cancer decedents' last year of life. Individual patient‐level data were linked from administrative datasets. Health care expenditures were converted from Taiwan dollars to U.S. dollars by health‐specific purchasing power parity conversions to account for different health‐purchasing powers. Associations of patient, physician, hospital, and regional factors with EOL care expenditures were evaluated by multilevel linear regression model by generalized estimating equation method. Results. Mean annual EOL care expenditures for Taiwanese cancer decedents increased from 2000 to 2010 from U.S. $49,591 to U.S. $68,773, respectively, with one third of spending occurring in the patients' last month. Increased EOL care expenditures were associated with male gender, younger age, being married, diagnosed with hematological malignancies and cancers other than lung, gastric, and hepatic‐pancreatic cancers, and dying within 7–24 months of diagnosis. Patients spent less at EOL when they had higher comorbidities and metastatic disease, died within 6 months of diagnosis, were under care of oncologists, gastroenterologists, and intensivists, and received care at a teaching hospital with more terminally ill cancer patients. Higher EOL care expenditures were associated with greater EOL care intensity at the primary hospital and regional levels. Conclusion. Taiwanese cancer decedents consumed considerable National Health Insurance disbursements at EOL, totaling more than was consumed in six developed non‐U.S. countries surveyed in 2010. To slow increasing cost and improve EOL cancer care quality, interventions to ensure appropriate EOL care provision should target hospitals and clinicians less experienced in

Overcoming barriers in care for the dying: Theoretical analysis of an innovative program model.

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Wallace, Cara L

2016-08-01

This article explores barriers to end-of-life (EOL) care (including development of a death denying culture, ongoing perceptions about EOL care, poor communication, delayed access, and benefit restrictions) through the theoretical lens of symbolic interactionism (SI), and applies general systems theory (GST) to a promising practice model appropriate for addressing these barriers. The Compassionate Care program is a practice model designed to bridge gaps in care for the dying and is one example of a program offering concurrent care, a recent focus of evaluation though the Affordable Care Act. Concurrent care involves offering curative care alongside palliative or hospice care. Additionally, the program offers comprehensive case management and online resources to enrollees in a national health plan (Spettell et al., 2009).SI and GST are compatible and interrelated theories that provide a relevant picture of barriers to end-of-life care and a practice model that might evoke change among multiple levels of systems. These theories promote insight into current challenges in EOL care, as well as point to areas of needed research and interventions to address them. The article concludes with implications for policy and practice, and discusses the important role of social work in impacting change within EOL care.

Impacts of care-giving and sources of support: a comparison of end-of-life and non-end-of-life caregivers in Canada.

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Williams, Allison M; Wang, Li; Kitchen, Peter

2016-03-01

This is the second in a series of papers that deal with care-giving in Canada, as based on data available from the Canadian General Social Survey (2007). Building on the first paper, which reviewed the differences between short-term, long-term and end-of-life (EOL) caregivers, this paper uniquely examines the caregiver supports employed by EOL caregivers when compared to non-EOL caregivers (short-term and long-term caregivers combined). Both papers employ data from Statistics Canada's General Social Survey (GSS Cycle 21: 2007). The GSS includes three modules, where respondents were asked questions about the unpaid home care assistance that they had provided in the last 12 months to someone at EOL or with either a long-term health condition or a physical limitation. The objective of this research paper was to investigate the link between the impact of the care-giving experience and the caregiver supports received, while also examining the differences in these across EOL and non-EOL caregivers. By way of factor analysis and regression modelling, we examine differences between two types of caregivers: (i) EOL and (ii) non-EOL caregivers. The study revealed that with respect to socio-demographic characteristics, health outcomes and caregiver supports, EOL caregivers were consistently worse off. This suggests that although all non-EOL caregivers are experiencing negative impacts from their care-giving role, comparatively greater supports are needed for EOL caregivers. © 2015 The Authors. Health and Social Care in the Community Published by John Wiley & Sons Ltd.

Reflections on using biographical approaches in end-of-life care: dignity therapy as example.

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Lindqvist, Olav; Threlkeld, Guinever; Street, Annette F; Tishelman, Carol

2015-01-01

The therapeutic potential of nonpharmacologic interventions using biographical approaches at the end of life (EoL) is being increasingly recognized, but less attention is paid to processes impeding realization of this potential. In this article, Swedish and Australian researchers reflect on and problematize experiences using one biographical approach, dignity therapy (DT), in EoL care in Sweden. We use this as an example, focusing on critical examination of the process of applying DT in practice, examining frictions experienced in recruiting participants, collecting the data, and creating a biography. We discuss issues regarding agency, which became evident in the recruitment process and choices made about participation, and the power differentials manifested in the interactive process of eliciting stories and crafting them into a final product. We also raise salient questions about how research and practice with biographical approaches in EoL care might better build on and further existing knowledge to better reflect the complexities of everyday life. © The Author(s) 2014.

Environmental Design for End-of-Life Care: An Integrative Review on Improving the Quality of Life and Managing Symptoms for Patients in Institutional Settings.

Science.gov (United States)

Sagha Zadeh, Rana; Eshelman, Paul; Setla, Judith; Kennedy, Laura; Hon, Emily; Basara, Aleksa

2018-03-01

The environment in which end-of-life (EOL) care is delivered can support or detract from the physical, psychological, social, and spiritual needs of patients, their families, and their caretakers. This review aims to organize and analyze the existing evidence related to environmental design factors that improve the quality of life and total well-being of people involved in EOL care and to clarify directions for future research. This integrated literature review synthesized and summarized research evidence from the fields of medicine, environmental psychology, nursing, palliative care, architecture, interior design, and evidence-based design. This synthesis analyzed 225 documents, including nine systematic literature reviews, 40 integrative reviews, three randomized controlled trials, 118 empirical research studies, and 55 anecdotal evidence. Of the documents, 192 were peer-reviewed, whereas 33 were not. The key environmental factors shown to affect EOL care were those that improved 1) social interaction, 2) positive distractions, 3) privacy, 4) personalization and creation of a home-like environment, and 5) the ambient environment. Possible design interventions relating to these topics are discussed. Examples include improvement of visibility and line of sight, view of nature, hidden medical equipment, and optimization of light and temperature. Studies indicate several critical components of the physical environment that can reduce total suffering and improve quality of life for EOL patients, their families, and their caregivers. These factors should be considered when making design decisions for care facilities to improve physical, psychological, social, and spiritual needs at EOL. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Diversity in Defining End of Life Care: An Obstacle or the Way Forward?

Science.gov (United States)

Gysels, Marjolein; Evans, Natalie; Meñaca, Arantza; Higginson, Irene J.; Harding, Richard; Pool, Robert

2013-01-01

Aim The terms used to describe care at the end of life (EoL), and its definitions, have evolved over time and reflect the changes in meaning the concept has undergone as the field develops. We explore the remit of EoL care as defined by experts in EoL care, from across Europe and beyond, to understand its current usage and meanings. Method A qualitative survey attached to a call for expertise on cultural issues in EoL care was sent to experts in the field identified through the literature, European EoL care associations, and conferences targeted at EoL care professionals. Respondents were asked to identify further contacts for snowball recruitment.The responses were analysed using content and discourse analysis. Results Responses were received from 167 individuals (33% response rate), mainly from academics (39%) and clinical practitioners working in an academic context (23%) from 19 countries in Europe and beyond. 29% of respondents said explicitly that there was no agreed definition of EoL care in practice and only 14% offered a standard definition (WHO, or local institution). 2% said that the concept of EoL care was not used in their country, and 5% said that there was opposition to the concept for religious or cultural reasons. Two approaches were identified to arrive at an understanding of EoL care: exclusively by drawing boundaries through setting time frames, and inclusively by approaching its scope in an integrative way. This led to reflections about terminology and whether defining EoL care is desirable. Conclusion The global expansion of EoL care contributes to the variety of interpretations of what it means. This complicates the endeavour of defining the field. However, when diversity is taken seriously it can open up new perspectives to underpin the ethical framework of EoL care. PMID:23844145

Encouraging Classroom Discussion

Directory of Open Access Journals (Sweden)

Robert Joseph McKee

2014-10-01

Full Text Available Classroom discussion has the potential to enhance the learning environment and encourages students to become active participants in the educational process. Student participation in classroom discussion has been shown to significantly improve the student learning experience. Research suggests that classroom discussion is an effective method for encouraging student classroom participation and for motivating student learning beyond the classroom. Participation in classroom discussion encourages students to become active collaborators in the learning process, while at the same time providing instructors with a practical method of assessing student learning. Classroom discussion is an effective tool for developing higher-level cognitive skills like critical thinking. Despite the potential discussion holds for student learning, many in academia lament the lack of participation in the classroom. The lack of student participation in classroom discussion is not a recent problem; it is one that has frustrated instructors for decades. Instructors report that some of the more current methods for encouraging classroom discussion can be exasperating and at times non-productive. This two-year study of 510 college and university students provides insight into the reasons why some students do not participate in classroom discussion. This study, which also elicited input from sixteen college and university professors and two high school teachers, offers some suggestions for creating and encouraging an environment conducive to student participation in the classroom.

Is Shared Decision Making for End-of-Life Decisions Associated With Better Outcomes as Compared to Other Forms of Decision Making? A Systematic Literature Review

Directory of Open Access Journals (Sweden)

Negin Hajizadeh MD, MPH

2016-07-01

Full Text Available Background: Whether shared decision making (SDM has been evaluated for end-of-life (EOL decisions as compared to other forms of decision making has not been studied. Purpose: To summarize the evidence on SDM being associated with better outcomes for EOL decision making, as compared to other forms of decision making. Data Sources: PubMed, Web of Science, Cochrane Central Register of Controlled Trials, EMBASE, PsycINFO, and CINAHL databases were searched through April 2014. Study Selection: Studies were selected that evaluated SDM, compared to any other decision making style, for an EOL decision. Data Extraction: Components of SDM tested, comparators to SDM, EOL decision being assessed, and outcomes measured. Data Synthesis: Seven studies met the inclusion criteria (three experimental and four observational studies. Results were analyzed using narrative synthesis. All three experimental studies compared SDM interventions to usual care. The four observational studies compared SDM to doctor-controlled decision making, or reported the correlation between level of SDM and outcomes. Components of SDM specified in each study differed widely, but the component most frequently included was presenting information on the risks/benefits of treatment choices (five of seven studies. The outcome most frequently measured was communication, although with different measurement tools. Other outcomes included decisional conflict, trust, satisfaction, and “quality of dying.” Limitations: We could not analyze the strength of evidence for a given outcome due to heterogeneity in the outcomes reported and measurement tools. Conclusions: There is insufficient evidence supporting SDM being associated with improved outcomes for EOL decisions as opposed to other forms of decision making. Future studies should describe which components of SDM are being tested, outline the comparator decision making style, and use validated tools to measure outcomes.

Palliative and end of life care communication as emerging priorities in postgraduate medical education

Science.gov (United States)

Roze des Ordons, Amanda; Ajjawi, Rola; Macdonald, John; Sarti, Aimee; Lockyer, Jocelyn; Hartwick, Michael

2016-01-01

Background Reliance on surveys and qualitative studies of trainees to guide postgraduate education about palliative and end of life (EOL) communication may lead to gaps in the curriculum. We aimed to develop a deeper understanding of internal medicine trainees’ educational needs for a palliative and EOL communication curriculum and how these needs could be met. Methods Mixed methods, including a survey and focus groups with trainees, and interviews with clinical faculty and medical educators, were applied to develop a broader perspective on current experiences and needs for further education. Quantitative descriptive and thematic analyses were conducted. Results Surveyed trainees were least confident and least satisfied with teaching in counseling about the emotional impact of emergencies and discussing organ donation. Direct observation with feedback, small group discussion, and viewing videos of personal consultations were perceived as effective, yet infrequently identified as instructional methods. Focus groups and interviews identified goals of care conversations as the highest educational priority, with education adapted to learner needs and accompanied by feedback and concurrent clinical and organizational support. Conclusions Our work expands on previous research describing needs for postgraduate education in palliative and EOL communication to include the importance of support, culture change, and faculty development, and provides insight into why such needs exist. PMID:27103952

Examining End-of-Life Case Management: Systematic Review

Directory of Open Access Journals (Sweden)

Roger E. Thomas

2014-01-01

Full Text Available Case management was initiated in the 1970s to reduce care discontinuity. A literature review focused on end-of-life (EOL case management identified 17 research articles, with content analysis revealing two themes: (a seeking to determine or establish the value of EOL case management and (b identifying ways to improve EOL case management. The evidence, although limited, suggests that EOL case management is helpful to dying individuals and their families. Research is needed to more clearly illustrate its usefulness or outcomes and the extent of need for it and actual availability. Among other benefits, EOL case management may help reduce hospital utilization, a major concern with the high cost of hospital-based care and the increased desire for home-based EOL care.

Emergency Nurses' Perceptions of Providing End-of-Life Care in a Hong Kong Emergency Department: A Qualitative Study.

Science.gov (United States)

Tse, Johnson Wai Keung; Hung, Maria Shuk Yu; Pang, Samantha Mei Che

2016-05-01

Provision of end-of-life (EOL) care in the emergency department has improved globally in recent years and has a different scope of interventions than traditional emergency medicine. In 2010, a regional hospital established the first ED EOL service in Hong Kong. The aim of this study was to understand emergency nurses' perceptions regarding the provision of EOL care in the emergency department. A qualitative approach was used with purposive sampling of 16 nurses who had experience in providing EOL care. Semi-structured, face-to-face interviews were conducted from May to October, 2014. All the interviews were transcribed verbatim for content analysis. Four themes were identified: (1) doing good for the dying patients, (2) facilitating family engagement and involvement, (3) enhancing personal growth and professionalism, and (4) expressing ambiguity toward resource deployment. Provision of EOL care in the emergency department can enhance patients' last moment of life, facilitate the grief and bereavement process of families, and enhance the professional development of staff in emergency department. It is substantiated that EOL service in the emergency department enriches EOL care in the health care system. Findings from this study integrated the perspectives on ED EOL services from emergency nurses. The integration of EOL service in other emergency departments locally and worldwide is encouraged. Copyright © 2016 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

Feasibility Study and System Architecture of Radioisotope Thermoelectric Generation Power Systems for USMC Forward Operating Bases

Science.gov (United States)

2013-06-01

33 d. Initial Pure Mass to Produce 300W Power at EOL ...............33 e. Initial Compound Mass to Produce 300W Power at EOL ....34 f...Estimated Cost to Produce 300W Power at EOL ...................34 2. Estimated Cost and Weight Data...energy at beginning of life (BOL), and after 10 years ( EOL ) was calculated, along with the estimated cost associated with the purchase of each

Factors related to the provision of home-based end-of-life care among home-care nursing, home help, and care management agencies in Japan.

Science.gov (United States)

Igarashi, Ayumi; Kurinobu, Takeshi; Ko, Ayako; Okamoto, Yuko; Matsuura, Shino; Feng, Mei; Yamamoto-Mitani, Noriko

2015-09-12

To promote home death, it is necessary to clarify the institutional barriers to conducting end-of-life (EOL) care and consider strategies to deal with this process. This study aims to clarify institution-related factors associated with the provision of home-based EOL care cases, and to compare them among three different types of home-care agencies. We administered a cross-sectional survey throughout Japan to investigate the number and characteristics of EOL cases of home-care nursing (HN), home-help (HH) and care management (CM) agencies. Bivariate and multivariate analyses were performed for each type of agency to examine factors related to the provision of EOL care. 378 HN agencies, 274 HH agencies, and 452 CM agencies responded to the distributed questionnaire. HN agencies had on average 2.1 (SD = 4.0; range 0-60) home-based EOL cases in the last 3 months, while HH agencies had 0.9 (SD = 1.3; range 0-7) and CM agencies had 1.5 (SD = 2.2; range 0-18) in the last 6 months. In a multivariable analysis of HN agencies, a large number of staff (OR: 1.52; p EOL care; in HH agencies, accepting EOL clients in the agency (OR: 3.29; p EOL care; in CM agencies, the number of staff (OR: 1.21; p = 0.037), the number of collaborating HH agencies (OR: 1.07; p = 0.032), and whether home-care nurses and home helpers visit clients together (OR: 1.89; p = 0.007) were positively associated with the provision of EOL care. The agency's size and the inter-agency collaborative system seemed most important among HN agencies and CM agencies, while institutional preparedness for EOL was most important for HH agencies. These findings represent important new information for targeting different effective strategies in the promotion of home-based EOL care, depending on the agency type.

Discussion on Papers 8 - 10

International Nuclear Information System (INIS)

Walker, R.; Wilson, E.A.; Gibson, P.

1992-01-01

Questions raised in the discussion are reported. These concerned: the Treasury discount rate for the construction of such a project; the CO 2 benefits of tidal schemes in developing countries; the criteria for deciding the total installed capacity of the scheme; the Government review of the cost-benefit analysis; the benefit arising from the elimination of nitrogen and sulphur oxides; security of supply; carbon tax projections. The only response reported is on the question of criteria for deciding the total installed capacity. Separate abstracts have been prepared on the three papers under discussion. (UK)

33 CFR 240.5 - Discussion.

Science.gov (United States)

2010-07-01

... CREDIT FOR FLOOD CONTROL § 240.5 Discussion. Discussion of this legislation is contained in the Conference Report, H.R. Rpt. No. 99-1013, which accompanies H.R. 6. The House passed version of the bill... compatible work completed by local interests. The Senate passed version authorized crediting of compatible...

Effects of Lippia sidoides essential oil, thymol, p-cymene, myrcene and caryophyllene on rat sciatic nerve excitability

Directory of Open Access Journals (Sweden)

R. Barbosa

2017-10-01

Full Text Available Lippia sidoides Cham is a typical herb species of Northeast Brazil with widespread use in folk medicine. The major constituents of the essential oil of L. sidoides (EOLs are thymol, p-cymene, myrcene, and caryophyllene. Several studies have shown that the EOLs and its constituents have pharmacological effects, including antibacterial, anti-inflammatory, antioxidant and neuroprotective activity. Therefore, this work aimed to investigate the effects of the EOLs and their main constituents on rat sciatic nerve excitability. The sciatic nerves of adult Wistar rats were dissected and mounted in a moist chamber. Nerves were stimulated by square wave pulses, with an amplitude of 40 V, duration of 100 μs to 0.2 Hz. Both EOLs and thymol inhibited compound action potential (CAP in a concentration-dependent manner. Half maximal inhibitory concentration for CAP peak-to-peak amplitude blockade were 67.85 and 40 µg/mL for EOLs and thymol, respectively. CAP peak-to-peak amplitude was significantly reduced by concentrations ≥60 µg/mL for EOLs and ≥30 µg/mL for thymol. EOLs and thymol in the concentration of 60 µg/mL significantly increased chronaxie and rheobase. The conduction velocities of 1st and 2nd CAP components were also concentration-dependently reduced by EOLs and thymol in the range of 30-100 µg/mL. Differently from EOLs and thymol, p-cymene, myrcene and caryophyllene did not reduce CAP in the higher concentrations of 10 mM. These data demonstrated that EOLs and thymol inhibited neuronal excitability and were promising agents for the development of new drugs for therapeutic use.

“This is Our Last Stop”: Negotiating End of Life Transitions in Assisted Living

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Ball, Mary M.; Kemp, Candace L.; Hollingsworth, Carole; Perkins, Molly M.

2014-01-01

Where people die has important implications for end-of-life (EOL) care. Assisted living (AL) increasingly is becoming a site of EOL care and a place where people die. AL residents are moving in older and sicker and with more complex care needs, yet AL remains largely a non-medical care setting that subscribes to a social rather than medical model of care. The aims of this paper are to add to the limited knowledge of how EOL is perceived, experienced, and managed in AL and to learn how individual, facility, and community factors influence these perceptions and experiences. Using qualitative methods and a grounded theory approach to study eight diverse AL settings, we present a preliminary model for how EOL care transitions are negotiated in AL that depicts the range of multilevel intersecting factors that shape EOL processes and events in AL. Facilities developed what we refer to as an EOL presence, which varied across and within settings depending on multiple influences, including, notably, the dying trajectories and care arrangements of residents at EOL, the prevalence of death and dying in a facility, and the attitudes and responses of individuals and facilities towards EOL processes and events, including how deaths were communicated and formally acknowledged and the impact of death and dying on residents and staff. Our findings indicate that in the majority of cases, EOL care must be supported by collaborative arrangements of care partners and that hospice care is a critical component. PMID:24984903

The end of life treatment of second generation mobile phone networks: Strategies to reduce the environmental impact

International Nuclear Information System (INIS)

Scharnhorst, Wolfram; Althaus, Hans-Joerg; Classen, Mischa; Jolliet, Olivier; Hilty, Lorenz M.

2005-01-01

A life cycle assessment was carried out based on a detailed life cycle inventory for a typical GSM 900 mobile phone network and related End of Life (EOL) treatment infrastructure. The environmental relevance of the three life cycle phases: production, use and EOL treatment was analysed using IMPACT2002+. The environmentally preferable EOL treatment alternative was identified on the basis of six previously developed EOL treatment scenarios. The results indicate that the environmental impacts attributable to the use phase dominate the environmental impacts incurred over the entire life cycle of the network. The impacts of the production phase are primarily attributable to the energy intensive manufacturing of printed wiring boards (PWB). The EOL phase dominates the impacts on ecosystem quality. In particular the long-term emissions of heavy metals have critical effects. Detailed analysis of the EOL phase shows that recycling of network materials in general leads to a two fold reduction of environmental impacts: in the EOL phase itself as well as by means of the avoided primary production of materials recovered in the EOL phase. An increase in the material quality of the secondary precious and rare materials leads to a significant reduction in the impacts on human health

Intertextuality in Text-Based Discussions

Science.gov (United States)

Ismail, Hamidah Mohd; Majid, Faizah Abd

2011-01-01

One of the main issues often discussed among academics is how to encourage active participation by students during classroom discussions. This applies particularly to students at the tertiary level who are expected to possess creative and critical thinking skills. Hence, this paper reports on a study that examined how these skills were…

Editorial research and the publication process in biomedicine and health: Report from the Esteve Foundation Discussion Group, December 2012

Science.gov (United States)

Marušić, Ana; Malički, Mario; von Elm, Erik

2014-01-01

Despite the fact that there are more than twenty thousand biomedical journals in the world, research into the work of editors and publication process in biomedical and health care journals is rare. In December 2012, the Esteve Foundation, a non-profit scientific institution that fosters progress in pharmacotherapy by means of scientific communication and discussion organized a discussion group of 7 editors and/or experts in peer review biomedical publishing. They presented findings of past editorial research, discussed the lack of competitive funding schemes and specialized journals for dissemination of editorial research, and reported on the great diversity of misconduct and conflict of interest policies, as well as adherence to reporting guidelines. Furthermore, they reported on the reluctance of editors to investigate allegations of misconduct or increase the level of data sharing in health research. In the end, they concluded that if editors are to remain gatekeepers of scientific knowledge they should reaffirm their focus on the integrity of the scientific record and completeness of the data they publish. Additionally, more research should be undertaken to understand why many journals are not adhering to editorial standards, and what obstacles editors face when engaging in editorial research. PMID:24969914

Interaction of Typhoon and Ocean Project ITOP Data Management and Operations Support

Science.gov (United States)

2013-09-30

EOL ) by Scot Loehrer and Steve Williams with input from Jim Moore (also EOL ) and Eric D’Asaro (University of Washington). The web page is the...central location for all ITOP-related information. It contains links to the data archives at EOL and the Monterey Bay Aquarium Research Institute (MBARI...the field catalogs from ITOP “dry run” 2009 and 2010 field deployments, meetings, publications, and documents. For all of the ITOP meetings, EOL

Interaction of Typhoon and Ocean Project (ITOP) Data Management and Operations Support

Science.gov (United States)

2012-09-30

EOL ) by Scot Loehrer and Steve Williams with input from Jim Moore (also EOL ) and Eric D’Asaro (University of Washington). The web page is the central...location for all ITOP-related information. It contains links to the data archives at EOL and the Monterey Bay Aquarium Research Institute (MBARI...the field catalogs from ITOP “dry run” 2009 and 2010 field deployments, meetings, publications, and documents. For all of the ITOP meetings, EOL

Is death our business? Philosophical conflicts over the end-of-life in old age psychiatry.

Science.gov (United States)

McKellar, Duncan; Ng, Felicity; Chur-Hansen, Anna

2016-01-01

Old age psychiatrists work with end-of-life (EOL) issues and encounter patient deaths, but death and dying have received limited focus in old age psychiatry training and research. This qualitative study explores old age psychiatrists' experience of and approach to working with patients at the EOL. Australian old age psychiatrists were purposively sampled and interviewed in-depth. Data saturation was achieved after nine participant interviews. Verbatim transcripts were analysed for themes, which were independently verified. Two dichotomous overarching themes were identified. Death is not our business reflected participants' experience of working in a mental health framework and incorporated four themes: death should not occur in psychiatry; working in a psychiatric treatment model; keeping a distance from death and unexpected death is a negative experience. Death is our business reflected participants' experience of working in an aged care context and incorporated four themes: death is part of life; encountering the EOL through dementia care; doing EOL work and expected death is a positive experience. Participants reported conflict because of the contradictory domains in which they work. They were comfortable working with patients at the EOL when death was expected, particularly in dementia. By contrast, they struggled with death as an adverse outcome in circumstances influenced by mental health culture, which was characterised by risk management, suicide prevention and a focus on recovery. This study has implications for models of care underpinning old age psychiatry. An integrated person-centred model of care may provide a contextually appropriate approach for practice.

End-of-life care in pediatric neuro-oncology.

Science.gov (United States)

Vallero, Stefano Gabriele; Lijoi, Stefano; Bertin, Daniele; Pittana, Laura Stefania; Bellini, Simona; Rossi, Francesca; Peretta, Paola; Basso, Maria Eleonora; Fagioli, Franca

2014-11-01

The management of children with cancer during the end-of-life (EOL) period is often difficult and requires skilled medical professionals. Patients with tumors of the central nervous system (CNS) with relapse or disease progression might have additional needs because of the presence of unique issues, such as neurological impairment and altered consciousness. Very few reports specifically concerning the EOL period in pediatric neuro-oncology are available. Among all patients followed at our center during the EOL, we retrospectively analyzed data from 39 children and adolescents with brain tumors, in order to point out on their peculiar needs. Patients were followed-up for a median time of 20.1 months. Eighty-two percent were receiving only palliative therapy before death. Almost half the patients (44%) died at home, while 56% died in a hospital. Palliative sedation with midazolam was performed in 58% of cases; morphine was administered in 51.6% of cases. No patient had uncontrolled pain. The EOL in children with advanced CNS cancer is a period of active medical care. Patients may develop complex neurological symptoms and often require long hospitalization. We organized a network-based collaboration among the reference pediatric oncology center, other pediatric hospitals and domiciliary care personnel, with the aim to ameliorate the quality of care during the EOL period. In our cohort, palliative sedation was widely used while no patients died with uncontrolled pain. A precise process of data collection and a better sharing of knowledge are necessary in order to improve the management of such patients. © 2014 Wiley Periodicals, Inc.

Seeking and Accepting: U.S. Clergy Theological and Moral Perspectives Informing Decision Making at the End of Life.

Science.gov (United States)

Sanders, Justin J; Chow, Vinca; Enzinger, Andrea C; Lam, Tai-Chung; Smith, Patrick T; Quiñones, Rebecca; Baccari, Andrew; Philbrick, Sarah; White-Hammond, Gloria; Peteet, John; Balboni, Tracy A; Balboni, Michael J

2017-10-01

People with serious illness frequently rely on religion/spirituality to cope with their diagnosis, with potentially positive and negative consequences. Clergy are uniquely positioned to help patients consider medical decisions at or near the end of life within a religious/spiritual framework. We aimed to examine clergy knowledge of end-of-life (EOL) care and beliefs about the role of faith in EOL decision making for patients with serious illness. Key informant interviews, focus groups, and survey. A purposive sample of 35 active clergy in five U.S. states as part of the National Clergy End-of-Life Project. We assessed participant knowledge of and desire for further education about EOL care. We transcribed interviews and focus groups for the purpose of qualitative analysis. Clergy had poor knowledge of EOL care; 75% desired more EOL training. Qualitative analysis revealed a theological framework for decision making in serious illness that balances seeking life and accepting death. Clergy viewed comfort-focused treatments as consistent with their faith traditions' views of a good death. They employed a moral framework to determine the appropriateness of EOL decisions, which weighs the impact of multiple factors and upholds the importance of God-given free will. They viewed EOL care choices to be the primary prerogative of patients and families. Clergy described ambivalence about and a passive approach to counseling congregants about decision making despite having defined beliefs regarding EOL care. Poor knowledge of EOL care may lead clergy to passively enable congregants with serious illness to pursue potentially nonbeneficial treatments that are associated with increased suffering.

End-of-Life Care for People With Cancer From Ethnic Minority Groups: A Systematic Review.

Science.gov (United States)

LoPresti, Melissa A; Dement, Fritz; Gold, Heather T

2016-04-01

Ethnic/racial minorities encounter disparities in healthcare, which may carry into end-of-life (EOL) care. Advanced cancer, highly prevalent and morbid, presents with worsening symptoms, heightening the need for supportive and EOL care. To conduct a systematic review examining ethnic/racial disparities in EOL care for cancer patients. We searched four electronic databases for all original research examining EOL care use, preferences, and beliefs for cancer patients from ethnic/racial minority groups. Twenty-five studies were included: 20 quantitative and five qualitative. All had a full-text English language article and focused on the ethnic/racial minority groups of African Americans, Hispanics Americans, or Asian Americans. Key themes included EOL decision making processes, family involvement, provider communication, religion and spirituality, and patient preferences. Hospice was the most studied EOL care, and was most used among Whites, followed by use among Hispanics, and least used by African and Asian Americans. African Americans perceived a greater need for hospice, yet more frequently had inadequate knowledge. African Americans preferred aggressive treatment, yet EOL care provided was often inconsistent with preferences. Hispanics and African Americans less often documented advance care plans, citing religious coping and spirituality as factors. EOL care differences among ethnic/racial minority cancer patients were found in the processes, preferences, and beliefs regarding their care. Further steps are needed to explore the exact causes of differences, yet possible explanations include religious or cultural differences, caregiver respect for patient autonomy, access barriers, and knowledge of EOL care options. © The Author(s) 2014.

Occupational Variation in End-of-Life Care Intensity.

Science.gov (United States)

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

2018-03-01

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

Critical Care Nurses' Suggestions to Improve End-of-Life Care Obstacles: Minimal Change Over 17 Years.

Science.gov (United States)

Beckstrand, Renea L; Hadley, Kacie Hart; Luthy, Karlen E; Macintosh, Janelle L B

Critical-care nurses (CCNs) provide end-of-life (EOL) care on a daily basis as 1 in 5 patients dies while in intensive care units. Critical-care nurses overcome many obstacles to perform quality EOL care for dying patients. The purposes of this study were to collect CCNs' current suggestions for improving EOL care and determine if EOL care obstacles have changed by comparing results to data gathered in 1998. A 72-item questionnaire regarding EOL care perceptions was mailed to a national, geographically dispersed, random sample of 2000 members of the American Association of Critical-Care Nurses. One of 3 qualitative questions asked CCNs for suggestions to improve EOL care. Comparative obstacle size (quantitative) data were previously published. Of the 509 returned questionnaires, 322 (63.3%) had 385 written suggestions for improving EOL care. Major themes identified were ensuring characteristics of a good death, improving physician communication with patients and families, adjusting nurse-to-patient ratios to 1:1, recognizing and avoiding futile care, increasing EOL education, physicians who are present and "on the same page," not allowing families to override patients' wishes, and the need for more support staff. When compared with data gathered 17 years previously, major themes remained the same but in a few cases changed in order and possible causation. Critical-care nurses' suggestions were similar to those recommendations from 17 years ago. Although the order of importance changed minimally, the number of similar themes indicated that obstacles to providing EOL care to dying intensive care unit patients continue to exist over time.

Academic and Resident Radiation Oncologists' Attitudes and Intentions Regarding Radiation Therapy near the End of Life.

Science.gov (United States)

Lloyd, Shane; Dosoretz, Arie P; Yu, James B; Evans, Suzanne B; Decker, Roy H

2016-02-01

There has been increasing scrutiny about cancer treatment for patients very near the end of life (EoL), yet a substantial number receive palliative radiation therapy (RT) in this setting. Our aim was to document the attitudes and intentions of thought leaders and trainees in giving RT near the EoL. We distributed an anonymous survey to 473 radiation oncologists and residents. The survey examined the clinical and psychosocial factors considered as well as intentions and expectations in the delivery of RT near the EoL. Factors surrounding unfinished treatment courses, and the formative factors that shape opinions about RT at the EoL were also explored. We received 139 responses (29%). Eighty-nine percent of respondents worked at academic institutions. The factors that respondents most often consider very or extremely important to offer RT near the EoL were the preference of the patient to be treated (94%), the ability to tolerate treatment (88%), and palliative intent (70%). After instances when their patients were unable to complete treatment near the EoL, 42% of respondents said they would prescribe a shorter treatment the next time they see a similar patient. Personal experience (71%) was most often listed as very or extremely important in shaping their opinions about RT near the EoL. Survey respondents, 89% of whom were academic radiation oncologists, have a positive view of palliative RT near the EoL. They favor shorter fractionation for patients near the EoL. Personal experience is most important in shaping practices and attitudes.

Cultural and ethical considerations for cardiopulmonary resuscitation in chinese patients with cancer at the end of life.

Science.gov (United States)

Zhang, Zhe; Chen, Meng-Lei; Gu, Xiao-Li; Liu, Ming-Hui; Cheng, Wen-Wu

2015-03-01

End-of-life (EOL) decision making is based on the values and wishes of terminally ill patients. However, little is known on the extent to which cultural factors affect personal attitudes toward life-sustaining treatments (LSTs) such as cardiopulmonary resuscitation (CPR) in China. This study evaluated the cultural and ethical considerations during EOL decisions and assessed the factors that affect pursuing LSTs in China. We used a case-control study design and compared their baseline characteristics with the provided EOL care and treatments. The CPR treatment among patients with cancer at EOL was affected by Chinese family traditions and Western influences. Our results reflect the need to improve EOL care and treatment in China. © The Author(s) 2014.

Worldwide end-of-life practice for patients in ICUs.

Science.gov (United States)

Wong, Wai-Tat; Phua, Jason; Joynt, Gavin M

2018-04-01

Published data and practice recommendations on end-of-life (EOL) generally reflect Western practice frameworks. Understanding worldwide practices is important because improving economic conditions are promoting rapid expansion of intensive care services in many previously disadvantaged regions, and increasing migration has promoted a new cultural diversity previously predominantly unicultural societies. This review explores current knowledge of similarities and differences in EOL practice between regions and possible causes and implications of these differences. Recent observational and survey data shows a marked variability in the practice of withholding and withdrawing life sustaining therapy worldwide. Some evidence supports the view that culture, religion, and socioeconomic factors influence EOL practice, and individually or together account for differences observed. There are also likely to be commonly desired values and expectations for EOL practice, and recent attempts at establishing where worldwide consensus may lie have improved our understanding of shared values and practices. Awareness of differences, understanding their likely complex causes, and using this knowledge to inform individualized care at EOL is likely to improve the quality of care for patients. Further research should clarify the causes of EOL practice variability, monitor trends, and objectively evaluate the quality of EOL practice worldwide.

Ethical considerations in protecting the environment from the effects of ionizing radiation. A report for discussion

Energy Technology Data Exchange (ETDEWEB)

NONE

2002-02-01

In recent years awareness of the vulnerability of the environment has increased and the need to protect it against the effects of industrial pollutants has been recognized. This trend is reflected in new and developing international policies for environmental protection. In the context of protection of the environment against ionizing radiation, the existing international approach is based on providing for the protection of humans. The current recommendations of the International Commission on Radiological Protection (ICRP) include the statement that {sup t}he standard of environmental control needed to protect man to the degree currently thought desirable will ensure that other species are not put at risk... {sup .} In the light of the new focus of concern for the environment, this statement is being critically reviewed in several international fora. The IAEA has, over many years, sponsored studies of the effects of ionizing radiation on species other than humans. Most recently it published a discussion report as IAEA-TECDOC-1091 (1999) in which the need for developing a system for protecting the environment against the effects of ionizing radiation was elaborated and in which various related technical and philosophical issues for resolution were discussed. The current report explores the ethical principles that could underlie a system of environmental protection. It is intended as one step in the development of a framework for the protection of the environment from the effects of ionizing radiation, and is being published in order to promote awareness of the current developments in this field as well as to encourage discussion amongst those involved.

Ethical considerations in protecting the environment from the effects of ionizing radiation. A report for discussion

International Nuclear Information System (INIS)

2002-02-01

In recent years awareness of the vulnerability of the environment has increased and the need to protect it against the effects of industrial pollutants has been recognized. This trend is reflected in new and developing international policies for environmental protection. In the context of protection of the environment against ionizing radiation, the existing international approach is based on providing for the protection of humans. The current recommendations of the International Commission on Radiological Protection (ICRP) include the statement that t he standard of environmental control needed to protect man to the degree currently thought desirable will ensure that other species are not put at risk... . In the light of the new focus of concern for the environment, this statement is being critically reviewed in several international fora. The IAEA has, over many years, sponsored studies of the effects of ionizing radiation on species other than humans. Most recently it published a discussion report as IAEA-TECDOC-1091 (1999) in which the need for developing a system for protecting the environment against the effects of ionizing radiation was elaborated and in which various related technical and philosophical issues for resolution were discussed. The current report explores the ethical principles that could underlie a system of environmental protection. It is intended as one step in the development of a framework for the protection of the environment from the effects of ionizing radiation, and is being published in order to promote awareness of the current developments in this field as well as to encourage discussion amongst those involved

Culturally Relevant Palliative and End-of-Life Care for U.S. Indigenous Populations: An Integrative Review.

Science.gov (United States)

Isaacson, Mary J; Lynch, Anna R

2018-03-01

American Indians/Alaska Natives (AIs/ANs) have higher rates of chronic illness and lack access to palliative/end-of-life (EOL) care. This integrative review ascertained the state of the science on culturally acceptable palliative/EOL care options for Indigenous persons in the United States. Databases searched: CINAHL, PubMed/MEDLINE, SocINDEX, PsycINFO, PsycARTICLES, ERIC, Health Source: Nursing/Academic Edition, and EBSCO Discovery Service 1880s-Present. Key terms used: palliative care, EOL care, and AI/AN. peer-reviewed articles published in English. Findings/Results: Twenty-nine articles were identified, 17 remained that described culturally specific palliative/EOL care for AIs/ANs. Synthesis revealed four themes: Communication, Cultural Awareness/Sensitivity, Community Guidance for Palliative/EOL Care Programs, Barriers and two subthemes: Trust/Respect and Mistrust. Limitations are lack of research funding, geographic isolation, and stringent government requirements. Palliative/EOL care must draw on a different set of skills that honor care beyond cure provided in a culturally sensitive manner.

Caring Decisions: The Development of a Written Resource for Parents Facing End-of-Life Decisions.

Science.gov (United States)

Xafis, Vicki; Gillam, Lynn; Hynson, Jenny; Sullivan, Jane; Cossich, Mary; Wilkinson, Dominic

2015-11-01

Written resources in adult intensive care have been shown to benefit families facing end of life (EoL) decisions. There are few resources for parents making EoL decisions for their child and no existing resources addressing ethical issues. The Caring Decisions handbook and website were developed to fill these gaps. We discuss the development of the resources, modification after reviewer feedback and findings from initial pilot implementation. A targeted literature review-to identify resources and factors that impact on parental EoL decision-making; development phase-guided by the literature and the researchers' expertise; consultation process-comprised a multi-disciplinary panel of experts and parents; pilot evaluation study-hard-copy handbook was distributed as part of routine care at an Australian Children's Hospital. Twelve experts and parents formed the consultation panel. Eight parents of children with life-limiting conditions and clinicians were interviewed in the pilot study. Numerous factors supporting/impeding EoL decisions were identified. Caring Decisions addressed issues identified in the literature and by the multidisciplinary research team. The consultation panel provided overwhelmingly positive feedback. Pilot study parents found the resources helpful and comforting. Most clinicians viewed the resources as very beneficial to parents and identified them as ideal for training purposes. The development of the resources addressed many of the gaps in existing resources. The consultation process and the pilot study suggest these resources could be of significant benefit to parents and clinicians.

77 FR 53923 - Biweekly Notice;

Science.gov (United States)

2012-09-04

... life (EOL) moderator temperature coefficient (MTC) surveillance requirement (SR) to allow [] the... request would change the near EOL MTC SR to allow [] the required MTC measurement [to be eliminated] under.... This amendment request would change the near EOL MTC SR to allow [] the required MTC measurement to be...

Healthcare professionals' perspectives on delivering end-of-life care within acute hospital trusts: a qualitative study.

Science.gov (United States)

Reid, Colette; Gibbins, Jane; Bloor, Sophia; Burcombe, Melanie; McCoubrie, Rachel; Forbes, Karen

2015-12-01

The quality of end-of-life (EOL) care in acute hospitals is variable and interventions to improve this care, such as EOL care pathways, are not always used. The underlying reasons for this variability are not fully understood. We explored healthcare professionals' views on delivering EOL care within an acute hospital trust in the South West of England. We employed qualitative methods (focus groups, in-depth interviews and questerviews) within a study investigating the impact of a simple EOL tool on the care of dying patients. We invited a range of staff of all grades with experience in caring for dying patients from medicine, surgery and care of the elderly teams to participate. Six focus groups, seven interviews and five questerviews were conducted. Two main themes emerged: (a) delays (difficulties and avoidance) in diagnosing dying and (b) the EOL tool supporting staff in caring for the dying. Staff acknowledged that the diagnosis of dying was often made late; this was partly due to prognostic uncertainty but compounded by a culture that did not acknowledge death as a possible outcome until death was imminent. Both the medical and nursing staff found the EOL tool useful as a means of communicating ceilings of care, ensuring appropriate prescribing for EOL symptoms, and giving nurses permission to approach the bedside of a dying patient. The culture of avoiding death and dying in acute hospitals remains a significant barrier to providing EOL care, even when EOL tools are available and accepted by staff. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Summary of group discussions

International Nuclear Information System (INIS)

2009-01-01

A key aspect of the workshop was the interaction and exchange of ideas and information among the 40 participants. To facilitate this activity the workshop participants were divided into five discussions groups. These groups reviewed selected subjects and reported back to the main body with summaries of their considerations. Over the 3 days the 5 discussion groups were requested to focus on the following subjects: the characteristics and capabilities of 'good' organisations; how to ensure sufficient resources; how to ensure competence within the organisation; how to demonstrate organisational suitability; the regulatory oversight processes - including their strengths and weaknesses. A list of the related questions that were provided to the discussion groups can be found in Appendix 3. Also included in Appendix 3 are copies of the slides the groups prepared that summarised their considerations

Lunch to discuss IDRC's programming

International Development Research Centre (IDRC) Digital Library (Canada)

chantal Taylor

Page 1. Description: Lunch to discuss IDRC's programming. Date: 2017-02-10. Attendees: 2 (IDRC 1). Location: Ottawa. Total: $79.92. Comments: 2016-2017 Hospitality Expense. Reports for Jean Lebel, President.

End of Life: An Overview

Science.gov (United States)

Toner, Mary Ann; Shadden, Barbara B.

2012-01-01

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

Residential aged care residents and components of end of life care in an Australian hospital.

Science.gov (United States)

Leong, Laurence Jee Peng; Crawford, Gregory Brian

2018-06-09

With ageing of Australians, the numbers of residential aged care (RAC) residents is rising. This places a spotlight on decisions about appropriate care for this population, including hospitalisation and end-of-life (EOL) care. The aim was to study a sample of RAC residents who attended and died in hospital, to quantify measurable components of EOL care so as to describe the extent of palliative care required. A retrospective case-note review of hospital records was conducted in Adelaide, Australia. Participants were 109 RAC residents who attended from July 2013 to June 2014 and died in hospital. Measurements were advance care planning, health care input from the RAC facilities to hospital and components of EOL care. Residents with and without advanced dementia were compared. Advance care directives (ACDs) were present from 11 to 50%, and advance care plans (ACPs) at 60%. There were more ACPs, resuscitation orders (for/against) and do-not-hospitalise orders in residents with advanced dementia than those without. General practitioner (GP) and extended care paramedic (ECP) input on decisions for hospital transfer were 30% and 1 %. Mean hospital stay to death was 5.2 days. For residents admitted under non-palliative care teams, specialist palliative care (SPC) was needed for phone advice in 5%, consultation in 45%, transfer to palliative care unit in 37%, and takeover by SPC team in 19%. Mean number of documented goals-of-care discussions with family/caregiver was 1.7. In the last 3 days of life, the mean daily number of doses of EOL medications was 4.2. Continuous subcutaneous infusion was commenced in 35%. Staff in RAC need to be adequately resourced to make complex decisions about whether to transfer to hospital. RAC nurses are mainly making these decisions as GP and ECP input were suboptimal. Ways to support nurses and optimise decision-making are needed. Advance care planning can be improved, especially documentation of EOL wishes and hospitalisation orders. By

Discussion paper 'Natural Gas for Sale'

International Nuclear Information System (INIS)

1995-04-01

The information in this report must support a discussion on policy starting points for the structure of natural gas tariffs in the Netherlands. The discussion will be held within EnergieNed (the association for energy distribution companies in the Netherlands) in the light of recent developments in the energy distribution sector in Europe

A duplication of the mouth associated with a dysontogenic cyst: a case report and discussion of theories of origin.

Science.gov (United States)

Mews, Lorissa; Isaac, Andre; Leonard, Norma; Lacson, Atilano G; AlQudehy, Zeinab Ali; El-Hakim, Hamdy

2014-05-01

IMPORTANCE Diprosopus is a medical condition that refers to full or partial craniofacial duplication. A particular subset of this condition, duplication of the mouth, is an exceedingly rare condition, with 7 reported cases in the medical literature. The embryogenesis and mechanism of disease are not well understood. The objective of this report was to describe a case of partial facial duplication with a discussion of the previous literature, leading to a proposed theory of embryogenesis for this rare anomaly. OBSERVATIONS We present a rare case of duplication of the mouth associated with an intraoral dysontogenic cyst, which presented with upper airway obstruction. The diagnostic and management strategies are discussed, as well as the histopathological features and theories of embryogenesis. CONCLUSIONS AND RELEVANCE On the basis of our findings, we propose the mechanism of origin for duplication of the mouth to be duplication of the first branchial arch. This case offers a deeper understanding of the mechanism of this disease than previously reported. Additional basic science and clinical research is needed to corroborate this theory.

Preparedness for End of Life-a Survey of Jerusalem District Nursing Homes.

Science.gov (United States)

Shaulov, Adir; Frankel, Meir; Rubinow, Alan; Maaravi, Yoram; Brezis, Mayer

2015-10-01

To evaluate the quality of end-of-life (EOL) care in nursing homes. Survey and semistructured interviews. Jerusalem district nursing homes. Staff members of 28 long-term care and skilled nursing facilities in the Jerusalem area in Israel of various ethnic, religious, and administrative affiliations (N = 207). Qualitative analysis of semistructured interviews and statistical analysis of questionnaires. Most staff members reported that EOL preferences were unknown for more than 90% of residents and that fewer than 10% had a healthcare proxy. Most staff members recalled conducting fewer than five EOL conversations over the past year with residents or family members and could recall fewer than five cases in which a resident was allowed to die in the nursing home. According to staff opinions the prevalence of tube feeding was estimated at greater than 10%, initiated because of aspiration, malnutrition, and understaffing, often against family's preferences. More than 25% of staff members believed that pain management was inadequate. Knowledge about management of chronic pain was poor in half of nurses and nearly one-third of physicians. Most staff would rather not receive the treatments they administered to residents. Nursing homes in Jerusalem lack competency for quality EOL care, and there are multiple psychological, training, and policy challenges to improvement. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

Decision Making Regarding the Place of End-of-Life Cancer Care: The Burden on Bereaved Families and Related Factors.

Science.gov (United States)

Yamamoto, Sena; Arao, Harue; Masutani, Eiko; Aoki, Miwa; Kishino, Megumi; Morita, Tatsuya; Shima, Yasuo; Kizawa, Yoshiyuki; Tsuneto, Satoru; Aoyama, Maho; Miyashita, Mitsunori

2017-05-01

Decision making regarding the place of end-of-life (EOL) care is an important issue for patients with terminal cancer and their families. It often requires surrogate decision making, which can be a burden on families. To explore the burden on the family of patients dying from cancer related to the decisions they made about the place of EOL care and investigate the factors affecting this burden. This was a cross-sectional mail survey using a self-administered questionnaire. Participants were 700 bereaved family members of patients with cancer from 133 palliative care units in Japan. The questionnaire covered decisional burdens, depression, grief, and the decision-making process. Participants experienced emotional pressure as the highest burden. Participants with a high decisional burden reported significantly higher scores for depression and grief (both P decision making without knowing the patient's wishes and values (P making the decision because of a due date for discharge from a former facility or hospital (P = 0.005). Decision making regarding the place of EOL care was recalled as burdensome for family decision makers. An early decision-making process that incorporates sharing patients' and family members' values that are relevant to the desired place of EOL care is important. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Culture and end of life care: a scoping exercise in seven European countries.

Directory of Open Access Journals (Sweden)

Marjolein Gysels

Full Text Available AIM: Culture is becoming increasingly important in relation to end of life (EoL care in a context of globalization, migration and European integration. We explore and compare socio-cultural issues that shape EoL care in seven European countries and critically appraise the existing research evidence on cultural issues in EoL care generated in the different countries. METHODS: We scoped the literature for Germany, Norway, Belgium, The Netherlands, Spain, Italy and Portugal, carrying out electronic searches in 16 international and country-specific databases and handsearches in 17 journals, bibliographies of relevant papers and webpages. We analysed the literature which was unearthed, in its entirety and by type (reviews, original studies, opinion pieces and conducted quantitative analyses for each country and across countries. Qualitative techniques generated themes and sub-themes. RESULTS: A total of 868 papers were reviewed. The following themes facilitated cross-country comparison: setting, caregivers, communication, medical EoL decisions, minority ethnic groups, and knowledge, attitudes and values of death and care. The frequencies of themes varied considerably between countries. Sub-themes reflected issues characteristic for specific countries (e.g. culture-specific disclosure in the southern European countries. The work from the seven European countries concentrates on cultural traditions and identities, and there was almost no evidence on ethnic minorities. CONCLUSION: This scoping review is the first comparative exploration of the cultural differences in the understanding of EoL care in these countries. The diverse body of evidence that was identified on socio-cultural issues in EoL care, reflects clearly distinguishable national cultures of EoL care, with differences in meaning, priorities, and expertise in each country. The diverse ways that EoL care is understood and practised forms a necessary part of what constitutes best evidence for

Culture and End of Life Care: A Scoping Exercise in Seven European Countries

Science.gov (United States)

Gysels, Marjolein; Evans, Natalie; Meñaca, Arantza; Andrew, Erin; Toscani, Franco; Finetti, Sylvia; Pasman, H. Roeline; Higginson, Irene; Harding, Richard; Pool, Robert

2012-01-01

Aim Culture is becoming increasingly important in relation to end of life (EoL) care in a context of globalization, migration and European integration. We explore and compare socio-cultural issues that shape EoL care in seven European countries and critically appraise the existing research evidence on cultural issues in EoL care generated in the different countries. Methods We scoped the literature for Germany, Norway, Belgium, the Netherlands, Spain, Italy and Portugal, carrying out electronic searches in 16 international and country-specific databases and handsearches in 17 journals, bibliographies of relevant papers and webpages. We analysed the literature which was unearthed, in its entirety and by type (reviews, original studies, opinion pieces) and conducted quantitative analyses for each country and across countries. Qualitative techniques generated themes and sub-themes. Results A total of 868 papers were reviewed. The following themes facilitated cross-country comparison: setting, caregivers, communication, medical EoL decisions, minority ethnic groups, and knowledge, attitudes and values of death and care. The frequencies of themes varied considerably between countries. Sub-themes reflected issues characteristic for specific countries (e.g. culture-specific disclosure in the southern European countries). The work from the seven European countries concentrates on cultural traditions and identities, and there was almost no evidence on ethnic minorities. Conclusion This scoping review is the first comparative exploration of the cultural differences in the understanding of EoL care in these countries. The diverse body of evidence that was identified on socio-cultural issues in EoL care, reflects clearly distinguishable national cultures of EoL care, with differences in meaning, priorities, and expertise in each country. The diverse ways that EoL care is understood and practised forms a necessary part of what constitutes best evidence for the improvement of EoL

Culture and end of life care: a scoping exercise in seven European countries.

Science.gov (United States)

Gysels, Marjolein; Evans, Natalie; Meñaca, Arantza; Andrew, Erin; Toscani, Franco; Finetti, Sylvia; Pasman, H Roeline; Higginson, Irene; Harding, Richard; Pool, Robert

2012-01-01

Culture is becoming increasingly important in relation to end of life (EoL) care in a context of globalization, migration and European integration. We explore and compare socio-cultural issues that shape EoL care in seven European countries and critically appraise the existing research evidence on cultural issues in EoL care generated in the different countries. We scoped the literature for Germany, Norway, Belgium, The Netherlands, Spain, Italy and Portugal, carrying out electronic searches in 16 international and country-specific databases and handsearches in 17 journals, bibliographies of relevant papers and webpages. We analysed the literature which was unearthed, in its entirety and by type (reviews, original studies, opinion pieces) and conducted quantitative analyses for each country and across countries. Qualitative techniques generated themes and sub-themes. A total of 868 papers were reviewed. The following themes facilitated cross-country comparison: setting, caregivers, communication, medical EoL decisions, minority ethnic groups, and knowledge, attitudes and values of death and care. The frequencies of themes varied considerably between countries. Sub-themes reflected issues characteristic for specific countries (e.g. culture-specific disclosure in the southern European countries). The work from the seven European countries concentrates on cultural traditions and identities, and there was almost no evidence on ethnic minorities. This scoping review is the first comparative exploration of the cultural differences in the understanding of EoL care in these countries. The diverse body of evidence that was identified on socio-cultural issues in EoL care, reflects clearly distinguishable national cultures of EoL care, with differences in meaning, priorities, and expertise in each country. The diverse ways that EoL care is understood and practised forms a necessary part of what constitutes best evidence for the improvement of EoL care in the future.

Creating a palliative and end-of-life program in a cure-oriented pediatric setting: the zig-zag method.

Science.gov (United States)

Harper, Joann; Hinds, Pamela S; Baker, Justin N; Hicks, Judy; Spunt, Sheri L; Razzouk, Bassem I

2007-01-01

Children living with and dying of advanced-stage cancer suffer physically, emotionally, and spiritually. Relief of their suffering requires comprehensive, compassionate palliative and end-of-life (EoL) care.However, an EoL care program might appear inconsistent with the mission of a pediatric oncology research center committed to seeking cures. Here the authors describe the methods used to achieve full institutional commitment to their EoL care program and those used to build the program's philosophical, research, and educational foundations after they received approval. The authors convened 10 focus groups to solicit staff perceptions of the hospital's current palliative and EoL care. They also completed baseline medical record reviews of 145 patient records to identify key EoL characteristics. The authors then crafted a vision statement and a strategic plan, implemented new research protocols,and established publication and funding trajectories. They conclude that establishing a state-of-the-art palliative and EoL program in a cure-oriented pediatric setting is achievable via consensus building and recruitment of diverse institutional resources.

Best Friends’ Discussions of Social Dilemmas

Science.gov (United States)

McDonald, Kristina L.; Malti, Tina; Killen, Melanie; Rubin, Kenneth H.

2013-01-01

Peer relationships, particularly friendships, have been theorized to contribute to how children and adolescents think about social and moral issues. The current study examined how young adolescent best friends (191 dyads; 53.4% female) reason together about multifaceted social dilemmas and how their reasoning is related to friendship quality. Mutually-recognized friendship dyads were videotaped discussing dilemmas entailing moral, social-conventional and prudential/pragmatic issues. Both dyad members completed a self-report measure of friendship quality. Dyadic data analyses guided by the Actor-Partner Interdependence Model indicated that adolescent and friend's reports of friendship qualities were related to the forms of reasoning used during discussion. Friends who both reported that they could resolve conflicts in a constructive way were more likely to use moral reasoning than friends who reported that their conflict resolution was poor or disagreed on the quality of their conflict resolution. The findings provide evidence for the important role that friendship interaction may play in adolescents’ social and moral development. PMID:23666555

Best friends' discussions of social dilemmas.

Science.gov (United States)

McDonald, Kristina L; Malti, Tina; Killen, Melanie; Rubin, Kenneth H

2014-02-01

Peer relationships, particularly friendships, have been theorized to contribute to how children and adolescents think about social and moral issues. The current study examined how young adolescent best friends (191 dyads; 53.4% female) reason together about multifaceted social dilemmas and how their reasoning is related to friendship quality. Mutually-recognized friendship dyads were videotaped discussing dilemmas entailing moral, social-conventional and prudential/pragmatic issues. Both dyad members completed a self-report measure of friendship quality. Dyadic data analyses guided by the Actor-Partner Interdependence Model indicated that adolescent and friend reports of friendship qualities were related to the forms of reasoning used during discussion. Friends who both reported that they could resolve conflicts in a constructive way were more likely to use moral reasoning than friends who reported that their conflict resolution was poor or disagreed on the quality of their conflict resolution. The findings provide evidence for the important role that friendship interaction may play in adolescents' social and moral development.

Diversity in Defining End of Life Care: An Obstacle or the Way Forward?

NARCIS (Netherlands)

Gysels, M.; Evans, N.C.; Menaca, A.; Higginson, I.J.; Harding, R.; Pool, R.

2013-01-01

Aim:The terms used to describe care at the end of life (EoL), and its definitions, have evolved over time and reflect the changes in meaning the concept has undergone as the field develops. We explore the remit of EoL care as defined by experts in EoL care, from across Europe and beyond, to

Diversity in defining end of life care: an obstacle or the way forward?

NARCIS (Netherlands)

Gysels, M.; Evans, N.; Meñaca, A.; Higginson, I.J.; Harding, R; Pool, R.

2013-01-01

Aim: The terms used to describe care at the end of life (EoL), and its definitions, have evolved over time and reflect the changes in meaning the concept has undergone as the field develops. We explore the remit of EoL care as defined by experts in EoL care, from across Europe and beyond, to

Self-Perceived End-of-Life Care Competencies of Health-Care Providers at a Large Academic Medical Center.

Science.gov (United States)

Montagnini, Marcos; Smith, Heather M; Price, Deborah M; Ghosh, Bidisha; Strodtman, Linda

2018-01-01

In the United States, most deaths occur in hospitals, with approximately 25% of hospitalized patients having palliative care needs. Therefore, the provision of good end-of-life (EOL) care to these patients is a priority. However, research assessing staff preparedness for the provision of EOL care to hospitalized patients is lacking. To assess health-care professionals' self-perceived competencies regarding the provision of EOL care in hospitalized patients. Descriptive study of self-perceived EOL care competencies among health-care professionals. The study instrument (End-of-Life Questionnaire) contains 28 questions assessing knowledge, attitudes, and behaviors related to the provision of EOL care. Health-care professionals (nursing, medicine, social work, psychology, physical, occupational and respiratory therapist, and spiritual care) at a large academic medical center participated in the study. Means were calculated for each item, and comparisons of mean scores were conducted via t tests. Analysis of variance was used to identify differences among groups. A total of 1197 questionnaires was completed. The greatest self-perceived competency was in providing emotional support for patients/families, and the least self-perceived competency was in providing continuity of care. When compared to nurses, physicians had higher scores on EOL care attitudes, behaviors, and communication. Physicians and nurses had higher scores on most subscales than other health-care providers. Differences in self-perceived EOL care competencies were identified among disciplines, particularly between physicians and nurses. The results provide evidence for assessing health-care providers to identify their specific training needs before implementing educational programs on EOL care.

Report on a visit to Canada to discuss tritium instrumentation and radiological protection

International Nuclear Information System (INIS)

Gibson, J.A.B.

1984-10-01

A report is presented of a visit to Canada on behalf of the CEC DG II/Fusion between the 8th to 13th April 1984. Discussions were arranged by the Canadian Fusion-Fuels Technology Project near Toronto and covered all aspects of tritium technology but especially radiological protection. Visits included the CFFTP Centre, Pickering Nuclear Generating Section, Ontario Hydro's Head Office, Safety Services Department and Research Division, Scintrex Ltd (tritium instrument manufacturers) and the Atomic Energy of Canada (AECL) Chalk River Nuclear laboratories (CRNL). There are clearly many areas for the use of Canadian Technology in Europe, particularly with CRNL and Scintrex on the development of 3 H 2 / 3 H 2 O discriminating monitors. There is some doubt whether these development will be in time for applications at the JET laboratory and the JRC at ISPRA but this collaboration will be pursued. (author)

Family communication and decision making at the end of life: a literature review.

Science.gov (United States)

Wallace, Cara L

2015-06-01

Patients and families coping with a terminal illness are faced with a number of decisions over the course of their disease. The role that family communication plays in the process of decision making is an important one. The objectives for this review are to examine the current state of empirical literature on the relationship between family communication and decision making about end-of-life care, to identify gaps, and to discuss implications for policy, practice, and future research. Articles were identified using systematic keyword searches within the following relevant databases: Academic Search Complete, CINAHL Plus, Communications and Mass Media Complete, ERIC, PsychINFO, MEDLINE, SocINDEX, and ProQuest. The three bodies of relevant literature that emerged during this review include: (1) the importance of family communication at the end of life (EoL); (2) family decision making at the EoL; and (3) the interrelationship of communication (both within the family and with healthcare professionals) and decision making at the EoL. While the literature highlights the role of communication between medical professionals and the patient or family members, there is very little focus on the process of how family communication among the family members themselves contributes to decision making at the end of life. Barriers to end-of-life care are important considerations for helping patients to access timely and appropriate services. Understanding the pertinent role of family communication as it relates to the decision for EoL care is the first step in working to provide another avenue for overcoming these barriers.

Learning through synchronous electronic discussion

NARCIS (Netherlands)

Kanselaar, G.; Veerman, A.L.; Andriessen, J.E.B.

2000-01-01

This article reports a study examining university student pairs carrying out an electronic discussion task in a synchronous computer mediated communication (CMC) system (NetMeeting). The purpose of the assignment was to raise students' awareness concerning conceptions that characterise effective

Exposing barriers to end-of-life communication in heart failure: an integrative review.

Science.gov (United States)

Garland, Ella L; Bruce, Anne; Stajduhar, Kelli

2013-01-01

End-of-life (EOL) communication is lacking despite patients with heart failure (HF) and their caregivers desiring it. To review the existing literature to identify barriers that inhibit EOL communication in the HF population. We chose an integrative literature review method and began by searching CINAHL, Medline, PsychInfo, Web of Science, Health Source Nursing Academic, Evidence-Based Medicine Reviews (EBMR), dissertations and theses searches through the University of Victoria and through Proquest from 1995 to 2011. DATA EVALUATION: EOL communication regarding wishes, prognosis and options for care rarely happen. We noted that patients lacked understanding of HF, feared engaging health care professionals (HCP), did not wish to talk about EOL, or waited for HCPs to initiate the conversation. HCPs lacked communication skills, focused on curative therapies and found diagnosing and prognosticating HF difficult. Limited time and space for conversations played a role. The challenge of diagnosing and prognosticating HF, its unpredictable trajectory, HCP inexperience in recognizing nearing EOL and lack of communication skills lead to HCPs avoiding EOL conversations. Four categories of barriers to communication were identified: patient/caregiver, HCP, disease-specific and organizational challenges.

Doctors discussing religion and spirituality: A systematic literature review.

Science.gov (United States)

Best, Megan; Butow, Phyllis; Olver, Ian

2016-04-01

Discussion of religion and/or spirituality in the medical consultation is desired by patients and known to be beneficial. However, it is infrequent. We aimed to identify why this is so. We set out to answer the following research questions: Do doctors report that they ask their patients about religion and/or spirituality and how do they do it? According to doctors, how often do patients raise the issue of religion and/or spirituality in consultation and how do doctors respond when they do? What are the known facilitators and barriers to doctors asking their patients about religion and/or spirituality? A mixed qualitative/quantitative review was conducted to identify studies exploring the physician's perspective on discussion of religion and/or spirituality in the medical consultation. We searched nine databases from inception to January 2015 for original research papers reporting doctors' views on discussion of religion and/or spirituality in medical consultations. Papers were assessed for quality using QualSyst and results were reported using a measurement tool to assess systematic review guidelines. Overall, 61 eligible papers were identified, comprising over 20,044 physician reports. Religion and spirituality are discussed infrequently by physicians although frequency increases with terminal illness. Many physicians prefer chaplain referral to discussing religion and/or spirituality with patients themselves. Such discussions are facilitated by prior training and increased physician religiosity and spirituality. Insufficient time and training were the most frequently reported barriers. This review found that physician enquiry into the religion and/or spirituality of patients is inconsistent in frequency and nature and that in order to meet patient needs, barriers to discussion need to be overcome. © The Author(s) 2015.

Bayesian Framework Approach for Prognostic Studies in Electrolytic Capacitor under Thermal Overstress Conditions

Science.gov (United States)

2012-09-01

make end of life ( EOL ) and remaining useful life (RUL) estimations. Model-based prognostics approaches perform these tasks with the help of first...in parameters Degradation Modeling Parameter estimation Prediction Thermal / Electrical Stress Experimental Data State Space model RUL EOL ...distribution at given single time point kP , and use this for multi-step predictions to EOL . There are several methods which exits for selecting the sigma

Superlattice Intermediate Band Solar Cell on Gallium Arsenide

Science.gov (United States)

2015-02-09

13  Figure 11. (a) Contour plot of device EOL efficiency as a function of emitter and i-region thickness for a 1MeV electron...fluence dose of 2x1015cm-2 (b) EOL I-V characteristic of the device...expanded our simulations to include the effect of radiation degradation to assess the end of life ( EOL ) efficiencies of these devices in space. Figure 10

Guidelines for Hosted Payload Integration

Science.gov (United States)

2014-06-06

reduces risk. Need to consider mass simulator to protect host launch window. Average Payload Power Both BOL and EOL . Host must consider orbit...acceptance testing. Peak Payload Power Both BOL and EOL . Host must consider orbit constraints. Typically driven by Payload operations but must...post-retirement failure might cause damage to the Spacecraft Host or its payloads. Safe conditions at EOL should consider thermal and radiation

Variability in Hurricane Boundary Layer Characteristics Observed in a Long-Term Noaa Dropsonde Archive

Science.gov (United States)

2014-06-01

Figure 6. Schematic of the NCAR GPS dropsonde identifying vital capabilities, components, and subsystems (From EOL 2014a...Archive in EOL sounding files (from Y13). ................21 Figure 9. The relative frequency of tropical cyclone categories sampled in the Long- Term...inscribed concentric circle corresponds to a radial grid increment of 200 km. Each blue point indicates the EOL estimate for dropsonde position after a

From vulnerability to passion in the end-of-life care: The lived experience of nurses.

Science.gov (United States)

Liu, Ying-Chun; Chiang, Hsien-Hsien

2017-12-01

End-of-life (EOL) care is considered to be inherently difficult and vulnerable for patients and nurses. It also seems hard to develop passion for care during these problematic times. This study elucidates how EOL nurses interpret their care experience and how they transform their experience and mindset. This study was conducted by organizing a reflective group based on the concept of group analysis for oncology and hospice nurses to share their experience. Thirteen registered nurses were enrolled from a medical center in northern Taiwan. Data drawn from the group dialogue was derived from six digitally recorded sessions and then analysed alone with the researcher's diaries and participants' feedback sheets. Interpretative Phenomenological Analysis (IPA) was used to analyze the data. The results showed that nurses who provide EOL care actually experience suffering by witnessing patients' suffering. However, the suffering authentically drives the nurses to encounter their own inner selves, to induce the shift of mindset, and then allow them to continuously provide and maintain the passion in EOL care. This study provides a new viewpoint for understanding of EOL nurses' experiences, indicating that this line of work may be recognized as a privilege. We recommend that the setting of a nurse reflective group is important and it may be considered in providing EOL care training for nurses. Hopefully the study results could shed lights for future policies regarding EOL care. Copyright © 2017 Elsevier Ltd. All rights reserved.

Damping of surface waves due to oil emulsions in application to ocean remote sensing

Science.gov (United States)

Sergievskaya, I.; Ermakov, S.; Lazareva, T.; Lavrova, O.

2017-10-01

Applications of different radar and optical methods for detection of oil pollutions based on the effect of damping of short wind waves by surface films have been extensively studied last decades. The main problem here is poor knowledge of physical characteristics of oil films, in particular, emulsified oil layers (EOL). The latter are ranged up to 70% of all pollutants. Physical characteristics of EOL which are responsible for wave damping and respectively for possibilities of their remote sensing depend on conditions of emulsification processes, e.g., mixing due to wave breaking, on percentage of water in the oil, etc. and are not well studied by now. In this paper results of laboratory studies of damping of gravity-capillary waves due to EOL on water are presented and compared to oil layers (OL). A laboratory method used previously for monomolecular films and OL, and based on measuring the damping coefficient and wavelength of parametrically generated standing waves has been applied for determination of EOL characteristics. Investigations of characteristics of crude oil, oil emulsions and crude OL and EOL have been carried out in a wide range of surface wave frequencies (from 10 to 25 Hz) and OL and EOL film thickness (from hundredths of millimeter to a few millimeters. The selected frequency range corresponds to Bragg waves for microwave, X- to Ka-band radars typically used for ocean remote sensing. An effect of enhanced wave damping due to EOL compared to non emulsified crude OL is revealed.

Case-Mix Adjustment of the Bereaved Family Survey.

Science.gov (United States)

Kutney-Lee, Ann; Carpenter, Joan; Smith, Dawn; Thorpe, Joshua; Tudose, Alina; Ersek, Mary

2018-01-01

Surveys of bereaved family members are increasingly being used to evaluate end-of-life (EOL) care and to measure organizational performance in EOL care quality. The Bereaved Family Survey (BFS) is used to monitor EOL care quality and benchmark performance in the Veterans Affairs (VA) health-care system. The objective of this study was to develop a case-mix adjustment model for the BFS and to examine changes in facility-level scores following adjustment, in order to provide fair comparisons across facilities. We conducted a cross-sectional secondary analysis of medical record and survey data from veterans and their family members across 146 VA medical centers. Following adjustment using model-based propensity weighting, the mean change in the BFS-Performance Measure score across facilities was -0.6 with a range of -2.6 to 0.6. Fifty-five (38%) facilities changed within ±0.5 percentage points of their unadjusted score. On average, facilities that benefited most from adjustment cared for patients with greater comorbidity burden and were located in urban areas in the Northwest and Midwestern regions of the country. Case-mix adjustment results in minor changes to facility-level BFS scores but allows for fairer comparisons of EOL care quality. Case-mix adjustment of the BFS positions this National Quality Forum-endorsed measure for use in public reporting and internal quality dashboards for VA leadership and may inform the development and refinement of case-mix adjustment models for other surveys of bereaved family members.

Panel Discussion : Report of the APS Ad-Hoc Committee on LGBT Issues

Science.gov (United States)

Atherton, Tim; Barthelemy, Ramon; Garmon, Savannah; Reeves, Kyle; APS Ad-Hoc Committee on LGBT Issues Team

Following the presentation of the findings and recommendations of the APS Ad-Hoc Committee on LGBT Issues (C-LGBT) by Committee Chair Michael Falk, a panel discussion will be held featuring several members of the committee. The discussion will focus on how APS can best ensure the recommendations of the committee are carried out in a timely fashion and other ideas on future APS efforts toward LGBT inclusion in physics. Discussion topics will also include the research and other input that shaped the committee's findings and recommendations.

Product family approach in e-waste management

DEFF Research Database (Denmark)

Parajuly, Keshav; Wenzel, Henrik

2017-01-01

As the need for a more circular model is being increasingly pronounced, a fundamental change in the end-of-life (EoL) management of electrical and electronic products (e-products) is required in order to prevent the resource losses and to promote the reuse of products and components with remaining...... functionality. However, the diversity of product types, design features, and material compositions pose serious challenges for the EoL managers and legislators alike. In order to address these challenges, we propose a framework that is based on the ‘product family’ philosophy, which has been used...... in the manufacturing sector for a long time. For this, the product families can be built based on intrinsic and extrinsic attributes of e-products as well as of the EoL management system. Such an approach has the potential to improve the current EoL practices and to support designers in making EoL thinking operational...

Diminishing Manufacturing Sources and Material Shortages: A Guidebook of Best Practices for Implementing a Robust DMSMS Management Program

Science.gov (United States)

2012-08-01

EOL ) notices or other indicators of potential discontinuance. DMSMS monitoring and surveil- lance should begin as early as possible during the...throughout the duration of the program, when either the program receives a new EOL notice di- rectly, or the output of the program’s predictive tools or...OEM DMSMS mitigation efforts underway • OCM part number • Sources of active manufacturing • Actual or projected EOL • Function (active versus

A Distributed Approach to System-Level Prognostics

Science.gov (United States)

2012-09-01

the end of (useful) life ( EOL ) and/or the remaining useful life (RUL) of components, subsystems, or systems. The prognostics problem itself can be...system state estimate, computes EOL and/or RUL. In this paper, we focus on a model-based prognostics approach (Orchard & Vachtse- vanos, 2009; Daigle...been focused on individual components, and determining their EOL and RUL, e.g., (Orchard & Vachtsevanos, 2009; Saha & Goebel, 2009; Daigle & Goebel

Implementation of National Space Policy on US Air Force End of Life Operations and Orbital Debris Mitigation

Science.gov (United States)

2012-06-01

Space Development and Test Directorate, Kirtland AFB, NM, 87117 Recent changes to US space policy regarding the execution of satellite End of Life ( EOL ...procedures have been driven by the rising significance of the orbital debris problem in Low Earth Orbit (LEO). Therefore current EOL plans are...considerations for writing operational EOL plans, with special applicability to military missions and focus on LEO satellites that are unable to relocate

Collaborative Oceanography and Virtual Experiments

Science.gov (United States)

2013-09-30

Observing Laboratory ( EOL ), but also contains an internal architecture which will allow it to evolve into a collaborative communication tool...an additional 50,988 "common" products were generated (241 plot types), along with 47,600 overlays (101 plot types). From 52 non- EOL sources...24,471 products were collected, and from 1486 EOL data collections, 643,263 "federated" products were indexed and made available through itop.org

Certainty and uncertainty about end of life care nursing practices in New Zealand Intensive Care Units: a mixed methods study.

Science.gov (United States)

Coombs, Maureen; Fulbrook, Paul; Donovan, Sarah; Tester, Rachel; deVries, Kay

2015-05-01

With end-of-life (EOL) central to the nursing role in intensive care, few studies have been undertaken to explore EOL care in the context of New Zealand (NZ) intensive care nursing. To investigate NZ intensive care nurses' experiences of, and attitudes towards EOL care. Sequential mixed methods study using cross sectional survey with follow-on focus groups. NZ intensive care nurses (N=465) across four large tertiary intensive care units (ICUs) were contacted to complete a 43-item web-based survey. A follow-on focus group was conducted in each of the sites to explore specific aspects of the survey findings. 203 fully completed surveys were returned (response rate 44%) from the four ICUs. Over half of nurses surveyed (55%, n=111) disagreed that withholding and withdrawing life support treatment were ethically the same. 78% (n=159) of nurses stated that withholding treatment was ethically more acceptable than withdrawing it. Whilst nurses generally supported reducing inspired oxygen to air for ventilated patients at EOL (71%, n=139) this was also an area that demonstrated one of the highest levels of uncertainty (21%, n=41). Just under a quarter of respondents were also uncertain about the use of continued nutritional support, continued passive limb exercises and use of deep sedation during EOL. The 18 nurses who participated in follow-on focus groups detailed the supportive, culturally sensitive, collaborative environment that EOL was conducted in. However diverse opinions and understandings were held on the use of passive limb and use of fluids at EOL. Whilst results from this NZ study broadly align with European studies, uncertainty about specific areas of EOL practices highlight that further guidance for nurses is required. Copyright © 2015 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

National objectives and flexible mechanisms: A discussions report; Nationella maal och flexibla mekanismer: En diskussionsrapport

Energy Technology Data Exchange (ETDEWEB)

Johansson, Bengt

2003-11-01

The Swedish climate policy has the target that the national emissions of greenhouse gases should be reduced 4%, compared to the 1990 level. But according to the EU common policy in line with the Kyoto agreement, Sweden has the right to increase the emissions by 4%. The Kyoto obligations could also be fulfilled by acting through the flexible mechanisms. In the present report the following issues are discussed: Why did Sweden set so ambitious targets; How can you handle the interconnection between national targets and flexible mechanisms; Methods to determine the amounts of the emissions rights that should be allocated to the trading sectors; Are there alternative means for achieveing the targets that the national objectives have set.

Panel discussion on the future of particle physics

CERN Multimedia

Perkins, Donald Hill; Veltman, Martinus J G; Okun, Lev Borisovich; Aymar, Robert; Weinberg, Steven; Darriulat, Pierre; Glashow, Sheldon Lee; van der Meer, S; Gianotti, F; Antoniadis, Ignatios; Schopper, Herwig Franz; Llewellyn Smith, Christopher Hubert; Telegdi, Valentine Louis; Bellettini, Giorgio; Soergel, Volker

2004-01-01

The projects that are to be undertaken by CERN in future are discussed in this paper. The discovery of Higgs at LHC and R&D at CLIC are reported. The introduction of Higgs bosons gave rise to new problems such as mass hierarchy and electroweak symmetry breaking. Solutions to the above problems using physics beyond standard model are also reported in this paper. The paper also discusses about the long-time scale associated to the projects.

Discussion on Soft Computing at FLINS '96

NARCIS (Netherlands)

Ruan, D.; Wal, A.J. van der

1998-01-01

This is a report on the discussion about soft computing (SC) during FLINS'96. The discussion is based on the five questions formulated by X. Li, viz. (1) What is SC? (2) What are the characteristics of SC? (3) What are the principal achievements of SC? (4) What are the typical problems of SC and

Preadolescents' Emotional and Prosocial Responses to Negative TV News: Investigating the Beneficial Effects of Constructive Reporting and Peer Discussion.

Science.gov (United States)

Kleemans, Mariska; Schlindwein, Luise F; Dohmen, Roos

2017-09-01

Watching news is important for preadolescents, but it may also harm their well-being. This study examined whether applying insights from positive psychology to news production can reduce this potential harm, by reducing negative emotional responses and enhancing positive emotional responses to negative news, and by encouraging prosocial intentions. Moreover, we explored whether peer discussion strengthened these effects. Preadolescents (n = 336; 9-13 years old; 48.5% female) were exposed to either constructive (solution-based news including positive emotions) or nonconstructive news. Subsequently, half of the children assigned to the constructive and the nonconstructive condition participated in a peer discussion. The findings showed that exposure to constructive news resulted in more positive emotional responses and less negative emotional responses as compared to nonconstructive news. Moreover, discussing the news with peers led to more positive and less negative emotional responses among preadolescents who watched the nonconstructive newscast, and to more prosocial intentions among preadolescents who watched constructive news. In all, constructive news reporting and peer discussion could function as tools to make negative news less harmful for preadolescents.

Multi-kanban mechanism for appliance disassembly

Science.gov (United States)

Udomsawat, Gun; Gupta, Surendra M.

2005-11-01

The use of household appliances continues to rise every year. A significant number of End-Of-Life (EOL) appliances are generated because of the introduction of newer models that are more attractive, efficient and affordable. Others are, of course, generated when they become non-functional. Many regulations encourage recycling of EOL appliances to reduce the amount of waste sent to landfills. In addition, EOL appliances offer the appliance manufacturing and remanufacturing industries a source of less expensive raw materials and components. For this reason product recovery has become a subject of interest during the past decade. In this paper, we study the disassembly line for appliance disassembly. We discuss and incorporate some of the complications that are inherent in disassembly line including product arrival, demand arrival, inventory fluctuation and production control mechanisms. We show how to overcome such complications by implementing a multi-kanban system in the appliance disassembly line setting. The multi-kanban system (MKS) relies on dynamic routing of kanbans according to the state of the system. We investigate the multi-kanban mechanism using simulation and explore the effect of product mix on performance of the traditional push system (TPS) and MKS in terms of controlling the system's inventory while attempting to achieve a decent customer service level.

The Impact of Typhoons on the Ocean in the Pacific (ITOP) Field and Data Management Support

Science.gov (United States)

2011-12-16

in October o f 2009 to develop effective sampling strategies for 20 I 0. EOL /Computing Data and Software Facil ity (CDS) supported the !TO P Dry Run...measurement strategies necessitated a dry run experiment in October of 2009 to develop effective sampling strategies for 2010. EOL /Computing Data and...contains products from 21 September through 32 October 2009. The catalog remains accessible at EOL at the above mentioned uri. The products listed by

An Approach to Prognostic Decision Making in the Aerospace Domain

Science.gov (United States)

2012-09-01

prediction of the Remaining Useful Life (RUL) and End of Life ( EOL ) as the goal of prognostics (Daigle & Goebel, 2010; Saxena et al., 2008). We believe...the drive). Either depletion of energy or com- plete component failure signify EOL . The goal of the PDM system is to reassess the original mission plan...either energy depletion or vehicle health deterioration resulted in EOL . PPG was allocated a limited number of utility function calls (UFC) to test

The Impact of Faith Beliefs on Perceptions of End-of-Life Care and Decision Making among African American Church Members.

Science.gov (United States)

Johnson, Jerry; Hayden, Tara; True, Jennifer; Simkin, Daren; Colbert, Louis; Thompson, Beverly; Stewart, Denise; Martin, Latoya

2016-02-01

African Americans underuse palliative care and hospice services because of a combination of factors including faith beliefs. As the spiritual family for many African Americans, the church presents an opportunity to improve communication about palliative care and hospice and end-of-life (EOL) decision making. We conducted a focus group study to understand the cultural and spiritual perspectives that influence decisions about palliative care and hospice among African American church members who visit and support persons with life-limiting illnesses. Our specific aims were to elicit their perceptions, beliefs, and attitudes about: (1) the relation between faith beliefs and EOL care; (2) emotional and family influences on EOL decision making; (3) palliative care and hospice resources; and (4) opportunities to improve communication among lay persons and health professionals and within families. Seven focus groups using purposeful sampling. We partnered with two African American churches. Of 51 persons, 27 were deacons or deaconesses, 17 were members of health or bereavement ministries, and 7 were other members of the congregations. We found that faith beliefs of African Americans can support discussions about palliative care and hospice. Participants perceived that many of their congregants harbor beliefs, perceptions, and feelings about death and dying that were often not communicated to family members or to health providers. Among African Americans, faith beliefs, emotional issues, family dynamics, and insufficient knowledge of palliative care and hospice are intertwined and influence decision making about palliative care and hospice. Our findings confirm the influence of faith beliefs of African Americans on decisions about palliative care and hospice and demonstrate the opportunity to improve communication about palliative care and hospice and EOL through collaborations with the African American church.

Attitudes, experiences, and beliefs affecting end-of-life decision-making among homeless individuals.

Science.gov (United States)

Tarzian, Anita J; Neal, Maggie T; O'Neil, J Anne

2005-02-01

Individuals who are homeless may encounter various barriers to obtaining quality end-of-life (EOL) care, including access barriers, multiple sources of discrimination, and lack of knowledge among health care providers (HCPs) of their preferences and decision-making practices. Planning for death with individuals who have spent so much energy surviving requires an understanding of their experiences and preferences. This study sought to increase HCPs' awareness and understanding of homeless or similarly marginalized individuals' EOL experiences and treatment preferences. Focus groups were conducted with homeless individuals using a semi-structured interview guide to elicit participants' EOL experiences, decision-making practices, and personal treatment preferences. Five focus groups were conducted with 20 inner-city homeless individuals (4 per group) at a free urban health care clinic for homeless individuals in the United States. Sixteen of the 20 participants were African American; 4 were Caucasian. None were actively psychotic. All had experienced multiple losses and drug addiction. Five main themes emerged: valuing an individual's wishes; acknowledging emotions; the primacy of religious beliefs and spiritual experience; seeking relationship-centered care; and reframing advance care planning. The narrative process of this qualitative study uncovered an approach to EOL decision-making in which participants' reasoning was influenced by emotions, religious beliefs, and spiritual experience. Relationship-centered care, characterized by compassion and respectful, two-way communication, was obvious by its described absence--reasons for this are discussed. Recommendations for reframing advance care planning include ways for HCPs to transform advance care planning from that of a legal document to a process of goal-setting that is grounded in human connection, respect, and understanding.

Summary of discussions on the next project at RCNP, Osaka University

International Nuclear Information System (INIS)

1985-01-01

A meeting was held in May 1985 to discuss what should be the next project of RCNP (Research Center for Nuclear Physics), Osaka University, in relation with other similar projects in Japanese Universities or institutes. About 70 researchers from various universities and institutes in Japan gathered and discussed new nuclear physics projects including a 300 MeV cyclotron. Before entering discussions some short reports conserning selection of machine, requirement from physical studies or political problems were presented. And some selected commentators gave short comments for active discussions. All these reports and comments are included in this collective report. (Aoki, K.)

A systematic review of religious beliefs about major end-of-life issues in the five major world religions.

Science.gov (United States)

Chakraborty, Rajshekhar; El-Jawahri, Areej R; Litzow, Mark R; Syrjala, Karen L; Parnes, Aric D; Hashmi, Shahrukh K

2017-10-01

The objective of this study was to examine the religious/spiritual beliefs of followers of the five major world religions about frequently encountered medical situations at the end of life (EoL). This was a systematic review of observational studies on the religious aspects of commonly encountered EoL situations. The databases used for retrieving studies were: Ovid MEDLINE In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, Ovid PsycINFO, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. Observational studies, including surveys from healthcare providers or the general population, and case studies were included for review. Articles written from a purely theoretical or philosophical perspective were excluded. Our search strategy generated 968 references, 40 of which were included for review, while 5 studies were added from reference lists. Whenever possible, we organized the results into five categories that would be clinically meaningful for palliative care practices at the EoL: advanced directives, euthanasia and physician-assisted suicide, physical requirements (artificial nutrition, hydration, and pain management), autopsy practices, and other EoL religious considerations. A wide degree of heterogeneity was observed within religions, depending on the country of origin, level of education, and degree of intrinsic religiosity. Our review describes the religious practices pertaining to major EoL issues and explains the variations in EoL decision making by clinicians and patients based on their religious teachings and beliefs. Prospective studies with validated tools for religiosity should be performed in the future to assess the impact of religion on EoL care.

Motivation and Strategies for Implementing Digital Object Identifiers (DOIs at NCAR’s Earth Observing Laboratory – Past Progress and Future Collaborations

Directory of Open Access Journals (Sweden)

Janine Aquino

2017-03-01

Full Text Available In an effort to lead our community in following modern data citation practices by formally citing data used in published research and implementing standards to facilitate reproducible research results and data, while also producing meaningful metrics that help assess the impact of our services, the National Center for Atmospheric Research (NCAR Earth Observing Laboratory (EOL has implemented the use of Digital Object Identifiers (DOIs (DataCite 2017 for both physical objects (e.g., research platforms and instruments and datasets. We discuss why this work is important and timely, and review the development of guidelines for the use of DOIs at EOL by focusing on how decisions were made. We discuss progress in assigning DOIs to physical objects and datasets, summarize plans to cite software, describe a current collaboration to develop community tools to display citations on websites, and touch on future plans to cite workflows that document dataset processing and quality control. Finally, we will review the status of efforts to engage our scientific community in the process of using DOIs in their research publications.

Validation of Model-Based Prognostics for Pneumatic Valves in a Demonstration Testbed

Science.gov (United States)

2014-10-02

predict end of life ( EOL ) and remaining useful life (RUL). The approach still follows the general estimation-prediction framework devel- oped in the...atmosphere, with linearly increasing leak area. kA2leak = Cleak (16) We define valve end of life ( EOL ) through open/close time limits of the valves, as in...represents end of life ( EOL ), and ∆kE represents remaining useful life (RUL). For valves, timing requirements are provided that de- fine the maximum

Discussion record of the workshop on nonlocal transport

International Nuclear Information System (INIS)

Itoh, K.; Itoh, S.-I.; Stroth, U.; Iwasaki, T.; Yagi, M.; Fukuyama, A.

1997-06-01

The discussion on the problem of the transient response and nonlocal transport is reported. Problem of the transient response is surveyed, and several approaches are reviewed. The formulation based on the nonlocal transport is discussed. Example of the analysis is presented. Future study is identified. (author)

Estimation of end of life mobile phones generation: The case study of the Czech Republic

International Nuclear Information System (INIS)

Polák, Miloš; Drápalová, Lenka

2012-01-01

Highlights: ► In this paper, we define lifespan of mobile phones and estimate their average total lifespan. ► The estimation of lifespan distribution is based on large sample of EoL mobile phones. ► Total lifespan of Czech mobile phones is surprisingly long, exactly 7.99 years. ► In the years 2010–20, about 26.3 million pieces of EoL mobile phones will be generated in the Czech Republic. - Abstract: The volume of waste electrical and electronic equipment (WEEE) has been rapidly growing in recent years. In the European Union (EU), legislation promoting the collection and recycling of WEEE has been in force since the year 2003. Yet, both current and recently suggested collection targets for WEEE are completely ineffective when it comes to collection and recycling of small WEEE (s-WEEE), with mobile phones as a typical example. Mobile phones are the most sold EEE and at the same time one of appliances with the lowest collection rate. To improve this situation, it is necessary to assess the amount of generated end of life (EoL) mobile phones as precisely as possible. This paper presents a method of assessment of EoL mobile phones generation based on delay model. Within the scope of this paper, the method has been applied on the Czech Republic data. However, this method can be applied also to other EoL appliances in or outside the Czech Republic. Our results show that the average total lifespan of Czech mobile phones is surprisingly long, exactly 7.99 years. We impute long lifespan particularly to a storage time of EoL mobile phones at households, estimated to be 4.35 years. In the years 1990–2000, only 45 thousands of EoL mobile phones were generated in the Czech Republic, while in the years 2000–2010 the number grew to 6.5 million pieces and it is estimated that in the years 2010–2020 about 26.3 million pieces will be generated. Current European legislation sets targets on collection and recycling of WEEE in general, but no specific collection target

Improving Computational Efficiency of Prediction in Model-Based Prognostics Using the Unscented Transform

Science.gov (United States)

Daigle, Matthew John; Goebel, Kai Frank

2010-01-01

Model-based prognostics captures system knowledge in the form of physics-based models of components, and how they fail, in order to obtain accurate predictions of end of life (EOL). EOL is predicted based on the estimated current state distribution of a component and expected profiles of future usage. In general, this requires simulations of the component using the underlying models. In this paper, we develop a simulation-based prediction methodology that achieves computational efficiency by performing only the minimal number of simulations needed in order to accurately approximate the mean and variance of the complete EOL distribution. This is performed through the use of the unscented transform, which predicts the means and covariances of a distribution passed through a nonlinear transformation. In this case, the EOL simulation acts as that nonlinear transformation. In this paper, we review the unscented transform, and describe how this concept is applied to efficient EOL prediction. As a case study, we develop a physics-based model of a solenoid valve, and perform simulation experiments to demonstrate improved computational efficiency without sacrificing prediction accuracy.

Discussion Strategies for the Inclusion of ALL Students

Science.gov (United States)

Weih, Timothy G.

2015-01-01

Student-centered discussion strategies are described in this article in pursuance of insuring that ALL student voices have a chance to be heard in the classroom. Discussion strategies that are presented include the following: The 10 Second Rule, Think-Pair-Share, Quick Writes, Recorder-Reporter, and K-W-L.

Product Family Approach in E-Waste Management: A Conceptual Framework for Circular Economy

Directory of Open Access Journals (Sweden)

Keshav Parajuly

2017-05-01

Full Text Available As the need for a more circular model is being increasingly pronounced, a fundamental change in the end-of-life (EoL management of electrical and electronic products (e-products is required in order to prevent the resource losses and to promote the reuse of products and components with remaining functionality. However, the diversity of product types, design features, and material compositions pose serious challenges for the EoL managers and legislators alike. In order to address these challenges, we propose a framework that is based on the ‘product family’ philosophy, which has been used in the manufacturing sector for a long time. For this, the product families can be built based on intrinsic and extrinsic attributes of e-products as well as of the EoL management system. Such an approach has the potential to improve the current EoL practices and to support designers in making EoL thinking operational during the product design stage. If supported by a better EoL collection, presorting and testing platform, and a family-centric approach for material recovery, such a framework carries the potential to avoid the losses occurring in today’s e-waste management system. This, in turn, could facilitate a smooth transition towards a circular model for the electrical and electronic industry.

Problems and Opportunities of an International Financial Reporting Standard for Small and Medium-sized Entities. The EAA FRSC's Comment on the IASB's Discussion Paper

DEFF Research Database (Denmark)

Thinggaard, Frank; Evans, Lisa; Gebhardt, Günther

2005-01-01

and questions arising from this. This paper briefly introduces the background to the publication of the Discussion Paper. This is followed by a review of prior litterature on SME financial reporting implications, prepared by the European Accountin Association's Financial Reporting Standards Committee...

Homeless Individuals Approaching the End of Life: Symptoms and Attitudes.

Science.gov (United States)

Tobey, Matthew; Manasson, Julia; Decarlo, Kristen; Ciraldo-Maryniuk, Katrina; Gaeta, Jessie M; Wilson, Erica

2017-04-01

Over a million individuals in the United States experience homelessness annually and homeless individuals die at a higher rate than domiciled peers. Homeless individuals often have unique experiences at the end of life (EOL). This study examined the symptoms experienced by homeless individuals nearing the EOL and explored social background, attitudes, and experiences. Investigators conducted surveys of homeless individuals approaching the EOL at a medical respite home. Eligibility required a serious medical condition and for the patient's medical provider to answer "no" to the question "Would you be surprised if this patient were not alive in one year?" Interviews explored symptoms using the Memorial Symptom Assessment Survey. Symptoms were compared with those of relevant comparator groups in other studies. Participants (n = 20) were young to face the EOL (median age = 58) and suffered high rates of substance use disorders (n = 18; 90%) and psychiatric diagnoses (n = 16; 80%). Symptom frequency was high, especially as regarded pain and psychological symptoms. Previous experience with death among family and peers was universal (n = 20; 100%). Mistrust of others' decisions about the EOL was common, as was concern about receiving too little (n = 11; 55%) or too much (n = 8; 40%) care at the EOL. The frequency of symptoms was higher than in three comparator studies and those studies' subgroups (P Homeless individuals may experience a high frequency of pain and other symptoms as they approach the EOL. Care for such individuals may require a tailored approach. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Factors influencing the provision of End of Life care for adolescents and young adults with advanced cancer: a scoping review protocol

OpenAIRE

Edwards, Deborah Jayne; Carrier, Judith Angela Kathryn; Gillen, Elizabeth; Hawker, Clare; Sutton, Joanne; Kelly, Daniel M.

2013-01-01

The objective of this review is to locate and describe literature relating to EoL care provision to adolescents and young adults with cancer. The specific areas of investigation will include:\\ud - Care service provision in adolescents and young adults with cancer during the EoL phase of care\\ud - Experiences and perceptions of adolescents and young adults with cancer during the EoL phase of care\\ud - Experience and perceptions of the health professionals and family members involved in their c...

A Definitive Interoperability Test Methodology for the Malicious Activity Simulation Tool (MAST)

Science.gov (United States)

2013-03-01

Information Assurance Range DON Department of the Navy DON CIO Department of the Navy Chief Information Officer DoS Denial of Service EOL End-of...came “as part of PMW 160’s solution to the risk posed by Windows™ NT End-of-Life 43 ( EOL ).” Second, “[it] marked the beginning of a steady and...sometimes outdated, systems and programs. [34]. Table 1 shows the basic implementation and EOL timeline, the OS version for both server and

NCAR Earth Observing Laboratory - An End-to-End Observational Science Enterprise

Science.gov (United States)

Rockwell, A.; Baeuerle, B.; Grubišić, V.; Hock, T. F.; Lee, W. C.; Ranson, J.; Stith, J. L.; Stossmeister, G.

2017-12-01

Researchers who want to understand and describe the Earth System require high-quality observations of the atmosphere, ocean, and biosphere. Making these observations not only requires capable research platforms and state-of-the-art instrumentation but also benefits from comprehensive in-field project management and data services. NCAR's Earth Observing Laboratory (EOL) is an end-to-end observational science enterprise that provides leadership in observational research to scientists from universities, U.S. government agencies, and NCAR. Deployment: EOL manages the majority of the NSF Lower Atmosphere Observing Facilities, which includes research aircraft, radars, lidars, profilers, and surface and sounding systems. This suite is designed to address a wide range of Earth system science - from microscale to climate process studies and from the planet's surface into the Upper Troposphere/Lower Stratosphere. EOL offers scientific, technical, operational, and logistics support to small and large field campaigns across the globe. Development: By working closely with the scientific community, EOL's engineering and scientific staff actively develop the next generation of observing facilities, staying abreast of emerging trends, technologies, and applications in order to improve our measurement capabilities. Through our Design and Fabrication Services, we also offer high-level engineering and technical expertise, mechanical design, and fabrication to the atmospheric research community. Data Services: EOL's platforms and instruments collect unique datasets that must be validated, archived, and made available to the research community. EOL's Data Management and Services deliver high-quality datasets and metadata in ways that are transparent, secure, and easily accessible. We are committed to the highest standard of data stewardship from collection to validation to archival. Discovery: EOL promotes curiosity about Earth science, and fosters advanced understanding of the

Assessing Online Discussions: A Holistic Approach

Science.gov (United States)

Wang, Yu-mei; Chen, Der-Thanq

2017-01-01

This article reports a holistic approach to assessing online discussions. This holistic approach integrates three assessment methods: assessment of learning, assessment for learning, and assessment as learning. Assessment of learning directly examines students' learning products to decide whether they have achieved the expected learning through…

Challenges to code status discussions for pediatric patients.

Directory of Open Access Journals (Sweden)

Katherine E Kruse

Full Text Available In the context of serious or life-limiting illness, pediatric patients and their families are faced with difficult decisions surrounding appropriate resuscitation efforts in the event of a cardiopulmonary arrest. Code status orders are one way to inform end-of-life medical decision making. The objectives of this study are to evaluate the extent to which pediatric providers have knowledge of code status options and explore the association of provider role with (1 knowledge of code status options, (2 perception of timing of code status discussions, (3 perception of family receptivity to code status discussions, and (4 comfort carrying out code status discussions.Nurses, trainees (residents and fellows, and attending physicians from pediatric units where code status discussions typically occur completed a short survey questionnaire regarding their knowledge of code status options and perceptions surrounding code status discussions.Single center, quaternary care children's hospital.203 nurses, 31 trainees, and 29 attending physicians in 4 high-acuity pediatric units responded to the survey (N = 263, 90% response rate. Based on an objective knowledge measure, providers demonstrate poor understanding of available code status options, with only 22% of providers able to enumerate more than two of four available code status options. In contrast, provider groups self-report high levels of familiarity with available code status options, with attending physicians reporting significantly higher levels than nurses and trainees (p = 0.0125. Nurses and attending physicians show significantly different perception of code status discussion timing, with majority of nurses (63.4% perceiving discussions as occurring "too late" or "much too late" and majority of attending physicians (55.6% perceiving the timing as "about right" (p<0.0001. Attending physicians report significantly higher comfort having code status discussions with families than do nurses or trainees

Palliative Care in Critical Care Settings: A Systematic Review of Communication-Based Competencies Essential for Patient and Family Satisfaction.

Science.gov (United States)

Schram, Andrew W; Hougham, Gavin W; Meltzer, David O; Ruhnke, Gregory W

2017-11-01

There is an emerging literature on the physician competencies most meaningful to patients and their families. However, there has been no systematic review on physician competency domains outside direct clinical care most important for patient- and family-centered outcomes in critical care settings at the end of life (EOL). Physician competencies are an essential component of palliative care (PC) provided at the EOL, but the literature on those competencies relevant for patient and family satisfaction is limited. A systematic review of this important topic can inform future research and assist in curricular development. Review of qualitative and quantitative empirical studies of the impact of physician competencies on patient- and family-reported outcomes conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines for systematic reviews. The data sources used were PubMed, MEDLINE, Web of Science, and Google Scholar. Fifteen studies (5 qualitative and 10 quantitative) meeting inclusion and exclusion criteria were identified. The competencies identified as critical for the delivery of high-quality PC in critical care settings are prognostication, conflict mediation, empathic communication, and family-centered aspects of care, the latter being the competency most frequently acknowledged in the literature identified. Prognostication, conflict mediation, empathic communication, and family-centered aspects of care are the most important identified competencies for patient- and family-centered PC in critical care settings. Incorporation of education on these competencies is likely to improve patient and family satisfaction with EOL care.

An Efficient Deterministic Approach to Model-based Prediction Uncertainty

Data.gov (United States)

National Aeronautics and Space Administration — Prognostics deals with the prediction of the end of life (EOL) of a system. EOL is a random variable, due to the presence of process noise and uncertainty in the...

An Integrated Framework for Model-Based Distributed Diagnosis and Prognosis

Science.gov (United States)

2012-09-01

0 : t) denotes all measurements observed up to time t. The goal of prognosis is to determine the end of (use- ful) life ( EOL ) of a system, and/or its...remaining useful life (RUL). For a given fault, f , using the fault estimate, p(xf (t),θf (t)|y(0 : t)), a probability distribution of EOL , p(EOLf (tP...is stochas- tic, EOL /RUL are random variables and we represent them by probability distributions. The acceptable behavior of the system is expressed

Research, Commercialization, & Workforce Development in the Polymer/Electronics Recycling Industry

Energy Technology Data Exchange (ETDEWEB)

Carl Irwin; Rakesh Gupta; Richard Turton; GangaRao Hota; Cyril Logar; Tom Ponzurick; Buddy Graham; Walter Alcorn; Jeff Tucker

2006-02-01

The Mid-Atlantic Recycling Center for End-of-Life Electronics (MARCEE) was set up in 1999 in response to a call from Congressman Alan Mollohan, who had a strong interest in this subject. A consortium was put together which included the Polymer Alliance Zone (PAZ) of West Virginia, West Virginia University (WVU), DN American and Ecolibrium. The consortium developed a set of objectives and task plans, which included both the research issues of setting up facilities to demanufacture End-of-Life Electronics (EoLE), the economics of the demanufacturing process, and the infrastructure development necessary for a sustainable recycling industry to be established in West Virginia. This report discusses the work of the MARCEE Project Consortium from November 1999 through March 2005. While the body of the report is distributed in hard-copy form the Appendices are being distributed on CD's.

Pulmonary Nodules with Cutaneous Manifestations: A Case Report and Discussion

Directory of Open Access Journals (Sweden)

Ardiles T

2012-04-01

Full Text Available The differential diagnosis of multiple pulmonary nodules is large and includes congenital and inherited disorders, malignancy, infectious etiologies, noninfectious granulomatous and inflammatory conditions,among many others. Diagnostic evaluation is aided by attention to extrapulmonary symptoms and features. We herein describe an unusual case of multiple pulmonary nodules attributed to cysticercosis and present a discussion of pathophysiologic changes related to medications and highlight the diagnostic value of extrapulmonary cutaneous features.

Building the Encyclopedia of Life

Science.gov (United States)

Mangiafico, P. A.; Patterson, D. J.

2010-04-01

The Encyclopedia of Life (EOL) is a collaborative project that indexes information about species, and makes it freely accessible to anyone. In order to accomplish this, EOL is building collaborative tools and infrastructure to unify the information.

Development and Validation of a Scale for the End of Life Caregiving Appraisal

Directory of Open Access Journals (Sweden)

JuHee Lee, PhD, RN

2010-03-01

Conclusion: Nurses and other healthcare professionals could use the EOLCAS to assess the experiences of EOL caregivers to understand their experience in the EOL and enhance their quality of life although psychometrics of EOLCAS shows limited findings.

Focusing on SSI's risk and radiation protection criteria. A report based on discussions in focus groups in Oesthammar and Oskarshamn municipalities

International Nuclear Information System (INIS)

Drottz-Sjoeberg, Britt-Marie

2003-11-01

The project was a result of the authority's continued work on the 1998 regulations on protection of human health and the environment in final disposal of spent nuclear fuel and nuclear waste. The idea behind the project, to involve persons from the municipalities participating in SKB's site selection investigation in focus group discussions, was that the questions and points of views that emerged in the discussions could serve as a basis for the authority's work of producing general guidelines associated with the regulations. The finished report would then be handed over to an expert group at the authority which answered or commented on the issues raised, and made a report on this to the participating municipalities Oskarshamn and Oesthammar. The result of discussions in two focus groups in Oskarshamn municipality and two in Oesthammar municipality in October 2002 is presented here, together with a presentation of the project's purpose and organisation. The results are presented in three main sections. The first concentrates on radiation and radioactivity since the task in the discussion groups was to attempt to clarify the issues and problems observed in this area in order to contribute to the authority's work of developing the general guidelines. The second section, on understanding of concepts, measurement, risk and safety, illustrates that the frequently asked and 'simple' knowledge related questions are only the tip of the iceberg where many of the participants have also thought about the more complex contexts and the fundamental problems in the risk and safety analysis, its validity and use. The third section of the report focuses primarily on content and information aspects. It provides a number of ideas about how information on current problems and important issues can be improved, how knowledge can be deepened in the site selection municipalities and how working methods in the process can be developed. The report mainly consists of a presentation of the

Estimation of end of life mobile phones generation: the case study of the Czech Republic.

Science.gov (United States)

Polák, Miloš; Drápalová, Lenka

2012-08-01

The volume of waste electrical and electronic equipment (WEEE) has been rapidly growing in recent years. In the European Union (EU), legislation promoting the collection and recycling of WEEE has been in force since the year 2003. Yet, both current and recently suggested collection targets for WEEE are completely ineffective when it comes to collection and recycling of small WEEE (s-WEEE), with mobile phones as a typical example. Mobile phones are the most sold EEE and at the same time one of appliances with the lowest collection rate. To improve this situation, it is necessary to assess the amount of generated end of life (EoL) mobile phones as precisely as possible. This paper presents a method of assessment of EoL mobile phones generation based on delay model. Within the scope of this paper, the method has been applied on the Czech Republic data. However, this method can be applied also to other EoL appliances in or outside the Czech Republic. Our results show that the average total lifespan of Czech mobile phones is surprisingly long, exactly 7.99 years. We impute long lifespan particularly to a storage time of EoL mobile phones at households, estimated to be 4.35 years. In the years 1990-2000, only 45 thousands of EoL mobile phones were generated in the Czech Republic, while in the years 2000-2010 the number grew to 6.5 million pieces and it is estimated that in the years 2010-2020 about 26.3 million pieces will be generated. Current European legislation sets targets on collection and recycling of WEEE in general, but no specific collection target for EoL mobile phone exists. In the year 2010 only about 3-6% of Czech EoL mobile phones were collected for recovery and recycling. If we make similar estimation using an estimated average EU value, then within the next 10 years about 1.3 billion of EoL mobile phones would be available for recycling in the EU. This amount contains about 31 tonnes of gold and 325 tonnes of silver. Since Europe is dependent on import

Discussing study limitations in reports of biomedical studies-the need for more transparency

NARCIS (Netherlands)

Puhan, Milo A.; Akl, Elie A.; Bryant, Dianne; Xie, Feng; Apolone, Giovanni; ter Riet, Gerben

2012-01-01

Unbiased and frank discussion of study limitations by authors represents a crucial part of the scientific discourse and progress. In today's culture of publishing many authors or scientific teams probably balance 'utter honesty' when discussing limitations of their research with the risk of being

End-of-life care for advanced dementia patients in residential care home-a Hong Kong perspective.

Science.gov (United States)

Luk, James K H; Chan, Felix H W

2017-08-28

Dementia will become more common as the population ages. Advanced dementia should be considered as a terminal illnesses and end-of-life (EOL) care is very much needed for this disease group. Currently, the EOL services provided to this vulnerable group in Hong Kong, especially those living in residential care homes, is limited. The usual practice of residential care homes is to send older residents with advanced dementia to acute hospitals when they are sick, irrespective of their wish, premorbid status, diagnoses and prognosis. This may not accord with what the patients perceive to be a "good death". There are many barriers for older people to die in place, both at home and at the residential care home. In the community, to enhance EOL care to residential care home for the elderly (RCHE) residents, pilot EOL program had been carried out by some Community Geriatric Assessment Teams. Since 2015, the Hospital Authority funded program "Enhance Community Geriatric Assessment Team Support to End-of-life Patients in Residential Care Homes for the Elderly" has been started. In the program, advance care planning (ACP), Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) (non-hospitalized) order will be established and the program will be expected to cover all clusters in Hong Kong by 2018/2019. In hospital setting, EOL clinical plan and EOL ward in geriatric step-down hospitals may be able to improve the quality of death of older patients. In Sep 2015, the Hospital Authority Guidelines on Life-Sustaining Treatment in the Terminally Ill was updated. Amongst other key EOL issues, careful (comfort) hand feeding was mentioned in the guideline. Other new developments include the possible establishment of enduring power of attorney for health care decision and enhancement of careful hand feeding amongst advanced dementia patients in RCHEs.

End-of-Life Care in Nunavik, Quebec: Inuit Experiences, Current Realities, and Ways Forward.

Science.gov (United States)

Hordyk, Shawn Renee; Macdonald, Mary Ellen; Brassard, Paul

2017-06-01

Increasing longevity for Inuit living in Nunavik, northern Quebec, has resulted in heightened rates of cancers and chronic diseases necessitating complex treatments. Consequently, end-of-life (EOL) care, once the domain of Inuit families and communities, has come to include professionalized healthcare providers with varying degrees of awareness of factors to consider in providing care to Inuit populations. To better understand the factors shaping EOL care in Nunavik to support the development of a sustainable model of care. Using focused ethnography, we conducted participant observations and informal and semistructured interviews with 103 participants (community members, healthcare practitioners, and administrators) across Nunavik and in Montreal, the affiliated tertiary care center. Data domains included the following: care trajectories; patient and family experiences receiving and providing EOL care; local and urban resources and challenges; and ways forward. Sociocultural, historical, and geographic factors shape EOL care in Nunavik, presenting a complex set of challenges for Inuit patients, families, and healthcare providers. A sustainable model of EOL care requires building on shared initiatives, capitalizing on the existing strengths in communities, and attending to the multiple bereavement needs in the region. Building a sustainable model of EOL care requires respectful collaboration among governing structures, healthcare institutions, and community members. It must centrally value local knowledge and initiatives. To ensure Inuit families and patients are supported throughout the dying process, future initiatives must centrally include local stakeholders in both the design and evaluation of any changes to the current healthcare system.

Family Communication about End-of-Life Decisions and the Enactment of the Decision-Maker Role

Directory of Open Access Journals (Sweden)

April R. Trees

2017-06-01

Full Text Available End-of-life (EOL decisions in families are complex and emotional sites of family interaction necessitating family members coordinate roles in the EOL decision-making process. How family members in the United States enact the decision-maker role in EOL decision situations was examined through in-depth interviews with 22 individuals who participated in EOL decision-making for a family member. A number of themes emerged from the data with regard to the enactment of the decision-maker role. Families varied in how decision makers enacted the role in relation to collective family input, with consulting, informing and collaborating as different patterns of behavior. Formal family roles along with gender- and age-based roles shaped who took on the decision-maker role. Additionally, both family members and medical professionals facilitated or undermined the decision-maker’s role enactment. Understanding the structure and enactment of the decision-maker role in family interaction provides insight into how individuals and/or family members perform the decision-making role within a cultural context that values autonomy and self-determination in combination with collective family action in EOL decision-making.

Thematic report on the conference and panel discussion

International Nuclear Information System (INIS)

Amold, N.; Brodowski, R.; Gepp, C.; Giersch, M.; Gufler, K.; Lahodynsky, R.; Hellermschmidt-Alber, J.

2010-01-01

The Viennese Environmental Prosecutor's Office as nuclear protection commissioner of the city of Vienna is engaged with all aspects of nuclear energy and its hazards. Nuclear energy is in a minority of states used for energy production and in even less cases, it contributes to a short-term share of the energy supply. These conditions - in addition to the acute consideration of operational safety - are the Request of Questioning the use of nuclear energy in principle. In the light of the general raw materials debate - a conference on uranium was organized. Just over two percent of the global energy demand is covered by nuclear energy and nevertheless, a fuel debate similar to that of fossil fuels - which cover more than 80 percent of the energy demand - arose. Therefore some questions arise: It can be seen that in a hypothetical - still very low - nuclear energy's share of five percent, the range of nuclear fuel would sink on about the half. Due to the small amount that nuclear energy contributes to Energy supply and due to CO2 emissions throughout the process of at least about 30 g / kWh (also set by nuclear energy supporters), the Climate protection argument for nuclear energy is in a very questionable light. The event and the present report show that the issue of uranium availability is also a important issue for the nuclear industry. Not least for this reason, despite little progress since the 1960s, alternatives to existing reactor concepts and fuels are being researched. The purpose of this report is to provide insight into commodity forecasting and availability. It also takes a quick look at the enormous problems posed by uranium mining to the environment and the people involved. In addition, it will be shown where the border between the wishful thinking of the various actors and valid data runs. (roessner)

Examining the Doctoral Thesis: A Discussion

Science.gov (United States)

Carter, Susan

2008-01-01

The examination of doctoral theses controls an important academic threshold, yet practices are often private, codes non-specific, and individuals isolated. This article adds to recent investigation of the examination culture by reporting informal panel discussion amongst a total of 23 University of Auckland (New Zealand) faculty members as to…

Recycling solid residues recovered from glass fibre-reinforced composites – A review applied to wind turbine blade materials

DEFF Research Database (Denmark)

Beauson, Justine; Lilholt, Hans; Brøndsted, Povl

2014-01-01

For the sustainable development of modern societies, optimized life cycle management of any technologies must be considered, from their development and implementation to their end of life (EoL). This is of main concern for the wind energy sector. Rapidly growing, this industrial sector will have...... to face large amount of future wind turbine (WT) blades coming to EoL. Among the EoL solutions available for WT blades, i.e. reuse, remanufacturing, recycling, incineration or disposal, this literature review focuses on recycling and particularly the recycling of shredded composite (SC) materials...

Procedures of grasp92 code to calculate accurate Dirac-Coulomb energy for the ground sate of helium atom

International Nuclear Information System (INIS)

Utsumi, Takayuki; Sasaki, Akira

2000-02-01

The procedures of grasp92 code to calculate accurate (relative error nearly equal 10 -7 ) eigenvalue for the ground sate of helium atom of the Dirac-Coulomb Hamiltonian are presented. The grasp92 code, based on the multi-configuration Dirac-Fock method, is widely used to calculate the atomic properties. However, the main part of the accurate calculations, extended optimal level calculation (EOL), suffer frequently numerical instabilities due to the lack of the confident procedures. The purpose of this report is to illustrate the guideline for stable EOL calculations by calculating the most fundamental atomic system, i.e. the ground sate of helium atom ls 2 1 S 2 . This procedure could be extended for the high-precise eigenfunction calculation of more complex atomic systems, for example highly ionized atoms and high-Z atoms. (author)

An interprofessional workshop for students to improve communication and collaboration skills in end-of-life care.

Science.gov (United States)

Erickson, Jeanne M; Blackhall, Leslie; Brashers, Valentina; Varhegyi, Nikole

2015-12-01

Interprofessional care is critical for patients at the end of life (EOL), but programs to teach communication skills to medical and nursing students are rare. The aims of this study were to determine whether an interprofessional workshop improves (1) student attitudes toward teamwork and (2) self-efficacy for communicating in difficult situations. Nursing and medical students attended a workshop with collaborative role play of an EOL conversation. Before the workshop, students showed different attitudes toward teamwork and collaboration and varying levels of confidence about communication skills. After the workshop, both groups reported more positive attitudes toward teamwork but a mixed picture of confidence in communication. Experiential interprofessional education workshops enhance perceptions about the benefits of teamwork, but further teaching and evaluation methods are needed to maximize the effectiveness. © The Author(s) 2014.

Appraisal of literature reviews on end-of-life care for minority ethnic groups in the UK and a critical comparison with policy recommendations from the UK end-of-life care strategy

Directory of Open Access Journals (Sweden)

Pool Robert

2011-06-01

Full Text Available Abstract Background Evidence of low end-of-life (EoL care service use by minority ethnic groups in the UK has given rise to a body of research and a number of reviews of the literature. This article aims to review and evaluate literature reviews on minority ethnic groups and EoL care in the UK and assess their suitability as an evidence base for policy. Methods Systematic review. Searches were carried out in thirteen electronic databases, eight journals, reference lists, and grey literature. Reviews were included if they concerned minority ethnic groups and EoL care in the UK. Reviews were graded for quality and key themes identified. Results Thirteen reviews (2001-2009 met inclusion criteria. Seven took a systematic approach, of which four scored highly for methodological quality (a mean score of six, median seven. The majority of systematic reviews were therefore of a reasonable methodological quality. Most reviews were restricted by ethnic group, aspect of EoL care, or were broader reviews which reported relevant findings. Six key themes were identified. Conclusions A number of reviews were systematic and scored highly for methodological quality. These reviews provide a good reflection of the primary evidence and could be used to inform policy. The complexity and inter-relatedness of factors leading to low service use was recognised and reflected in reviews' recommendations for service improvement. Recommendations made in the UK End-of-Life Care Strategy were limited in comparison, and the Strategy's evidence base concerning minority ethnic groups was found to be narrow. Future policy should be embedded strongly in the evidence base to reflect the current literature and minimise bias.

Appraisal of literature reviews on end-of-life care for minority ethnic groups in the UK and a critical comparison with policy recommendations from the UK end-of-life care strategy.

Science.gov (United States)

Evans, Natalie; Meñaca, Arantza; Andrew, Erin Vw; Koffman, Jonathan; Harding, Richard; Higginson, Irene J; Pool, Robert; Gysels, Marjolein

2011-06-02

Evidence of low end-of-life (EoL) care service use by minority ethnic groups in the UK has given rise to a body of research and a number of reviews of the literature. This article aims to review and evaluate literature reviews on minority ethnic groups and EoL care in the UK and assess their suitability as an evidence base for policy. Systematic review. Searches were carried out in thirteen electronic databases, eight journals, reference lists, and grey literature. Reviews were included if they concerned minority ethnic groups and EoL care in the UK. Reviews were graded for quality and key themes identified. Thirteen reviews (2001-2009) met inclusion criteria. Seven took a systematic approach, of which four scored highly for methodological quality (a mean score of six, median seven). The majority of systematic reviews were therefore of a reasonable methodological quality. Most reviews were restricted by ethnic group, aspect of EoL care, or were broader reviews which reported relevant findings. Six key themes were identified. A number of reviews were systematic and scored highly for methodological quality. These reviews provide a good reflection of the primary evidence and could be used to inform policy. The complexity and inter-relatedness of factors leading to low service use was recognised and reflected in reviews' recommendations for service improvement. Recommendations made in the UK End-of-Life Care Strategy were limited in comparison, and the Strategy's evidence base concerning minority ethnic groups was found to be narrow. Future policy should be embedded strongly in the evidence base to reflect the current literature and minimise bias.

2012 review of French research reactors

International Nuclear Information System (INIS)

Estrade, Jerome

2013-01-01

Proposed by the French Reactor Operators' Club (CER), the meeting and discussion forum for operators of French research reactors, this report first gives a brief presentation of these reactors and of their scope of application, and a summary of highlights in 2012 for each of them. Then, it proposes more detailed presentations and reviews of characteristics, activities, highlights, objectives and results for the different types of reactors: neutron beam reactors (Orphee, High flux reactor-Laue-Langevin Institute or HFR-ILL), technological irradiation reactors (Osiris and Phenix), training reactors (Isis and Azur), reactors for safety research purposes (Cabri and Phebus), reactors for neutronic studies (Caliban, Prospero, Eole, Minerve and Masurca), and new research reactors (the RES facility and the Jules Horowitz reactor or JHR)

Paediatric advance care planning survey: a cross-sectional examination of congruence and discordance between adolescents with HIV/AIDS and their families.

Science.gov (United States)

Lyon, Maureen E; Dallas, Ronald H; Garvie, Patricia A; Wilkins, Megan L; Garcia, Ana; Cheng, Yao Iris; Wang, Jichuan

2017-09-21

To identify patient-reported paediatric advance care planning (pACP) needs of adolescents living with HIV and to examine the congruence with their family's perception of their needs. A cross-sectional survey among six paediatric hospital-based outpatient HIV specialty clinics. Participants included 48 adolescent/family dyads (n=96 participants) within a larger study facilitating pACP. The main outcome measure was the Lyon Advance Care Planning Survey - Adolescent and Surrogate Versions-Revised. Adolescents' mean age was 18 years (range ≥14-congruence in pACP needs within adolescent/family dyads. There was substantial congruence in that being free from pain (PABAK=0.83), and understanding your treatment choices (PABAK=0.92) were very important or important. There was discordance about being off machines that extend life (PABAK=0.08) and when is the best time to bring up EOL decisions (PABAK=0.32). Areas of discordance were associated with life-sustaining choices and when to have the EOL conversation. Targeted, adolescent/family-centred, evidence-based pACP interventions are needed to improve family understanding of youth's EOL wishes. NCT01289444; Results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Emergency end of life operations for CNES remote sensing satellites—Management and operational process

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Bertrand, Régis; Alby, Fernand; Costes, Thierry; Dejoie, Joël; Delmas, Dominique-Roland; Delobette, Damien; Gibek, Isabelle; Gleyzes, Alain; Masson, Françoise; Meyer, Jean-Renaud; Moreau, Agathe; Perret, Lionel; Riclet, François; Ruiz, Hélène; Schiavon, Françoise; Spizzi, Pierre; Viallefont, Pierre; Villaret, Colette

2012-10-01

The French Space Agency (CNES) is currently operating thirteen satellites among which five remote sensing satellites. This fleet is composed of two civilian (SPOT) and three military (HELIOS) satellites and it has been recently completed by the first PLEIADES satellite which is devoted to both civil and military purposes. The CNES operation board decided to appoint a Working Group (WG) in order to anticipate and tackle issues related to the emergency End Of Life (EOL) operations due to unexpected on-board events affecting the satellite. This is of particular interest in the context of the French Law on Space Operations (LSO), entered in force on Dec. 2010, which states that any satellite operator must demonstrate its capability to control the space vehicle whatever the mission phase from the launch up to the EOL. Indeed, after several years in orbit the satellites may be affected by on-board anomalies which could damage the implementation of EOL operations, i.e. orbital manoeuvres or platform disposal. Even if automatic recovery actions ensure autonomous reconfigurations on redundant equipment, i.e. setting for instance the satellite into a safe mode, it is crucial to anticipate the consequences of failures of every equipment and functions necessary for the EOL operations. For this purpose, the WG has focused on each potential anomaly by analysing: its emergency level, as well as the EOL operations potentially inhibited by the failure and the needs of on-board software workarounds… The main contribution of the WG consisted in identifying a particular satellite configuration called "minimal Withdrawal From Service (WFS) configuration". This configuration corresponds to an operational status which involves a redundancy necessary for the EOL operations. Therefore as soon as a satellite reaches this state, a dedicated steering committee is activated and decides of the future of the satellite with respect to three options: a/. the satellite is considered safe and can

Transmutation research and fuel cycle (report on discussion at Research Reactor Institute, Kyoto University)

International Nuclear Information System (INIS)

Yamana, Hajimu

1999-01-01

A symposium was held on a topic of 'Transmutation Research' on Dec. 21 and 22, 1999 at Research Reactor Institute, Kyoto University. This meeting was held as a joint-meeting of KUR's specialist meeting and Tokyo University's activity supported by the Grant-in-Aid for Scientific Research of Ministry of Education, Sport and Culture of Japan. This paper describes the overview of the discussions of this joint-meeting, and interprets their significance. Major themes discussed are, needed discussions on the transmutation research, policy and concepts of the organizations doing transmutation researches, a view from university side, transmutation researches in the oversea countries, opinions from various standpoints of the nuclear fuel cycle, conclusive discussions. 'the meanings of the transmutation research should be discussed together with the geological disposal and fast reactor system', 'transmutation may be a cooperative option for the disposal, thus, they should not be in a independent relation', and Balance evaluation will be needed' are the examples of the conclusive remarks of this meeting. (author)

Examining how discussing underrepresentation may mediate female engagement in physics

Science.gov (United States)

Lock, Robynne M.; Tompkins, Reganne; Hazari, Zahra

2013-04-01

Despite the large number of female students taking high school physics, only about a fifth of physics bachelor's degrees are awarded to women. In a previous study, we tested five factors commonly proposed to positively impact female students' choice of a physical science career using multivariate matching methods on national survey data. Four of these factors (having a single-sex class, having female scientist guest speakers, having a female physics teacher, and discussing the work of female scientists) were found to have no effect. The only factor found to have a positive effect was the explicit discussion of the underrepresentation of women in physics. In order to explore this further, a case study of the classes of one teacher reported to discuss the underrepresentation of women was conducted. Two classroom underrepresentation discussions were recorded, students and teacher were interviewed, and relevant student work was collected. Analyzing the case study data, we report on how discussing underrepresentation may mediate female engagement in physics.

Searching for Intertextual Connections in Small Group Text Discussion

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Chi, Feng-ming

2012-01-01

This paper reports the sources for and intentions of intertextuality made by 10 groups of Taiwanese university students in the process of discussing two American stories. Two types of data, small group text discussions and oral interviews, were gathered. The results indicated that participants used diverse sources of intertextual links, and with…

Oncologists' communication about end of life: the relationship among secondary traumatic stress, compassion satisfaction, and approach and avoidance communication.

Science.gov (United States)

Granek, Leeat; Nakash, Ora; Cohen, Michal; Ben-David, Merav; Ariad, Samuel

2017-11-01

Oncologists must communicate effectively with patients and their families about end of life (EOL). Despite the importance of communicating on this topic, many oncologists avoid these conversations. The objective of this study was to examine the associations between secondary traumatic stress and compassion satisfaction and approach and avoidant communication about EOL with cancer patients. A convenience sample of 79 oncologists (n = 27 men, n = 52 women) participated in the study. Oncologists completed a survey that included a sociodemographic and clinical information questionnaire, the Professional Quality of Life Scale, and Communication about End of Life Survey. To examine the effect of secondary traumatic stress and compassion satisfaction on approach and avoidant communication, while controlling for gender and age, 2 hierarchical linear regression analyses were computed. Oncologists reported high levels of secondary traumatic stress and high compassion satisfaction. Scores on the approach and avoidant communication scales were in the mid-range of the scale. Lower reports of secondary traumatic stress and higher compassion satisfaction were associated with higher approach communication strategies: however, only higher secondary traumatic stress was associated with higher avoidant communication strategies. Our findings indicate that there is an association between emotional factors and approach communication. The findings have clinical implications in designing effective communication skills training. Further research and training should take secondary traumatic stress and compassion satisfaction into consideration to be able to ensure that terminal patients and their families receive the best quality EOL care. Copyright © 2016 John Wiley & Sons, Ltd.

PSYCHOPATHOLOGICAL DYNAMICS OF A DISASTER VICTIM, REJECTING MENTAL HEALTH CARE – A CASE REPORT AND DISCUSSION

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Ivan Aleksandrov

2017-05-01

Full Text Available Background: Seeking and receiving psychological help after a stressful life event is associated with certain prejudice attitudes, especially present in minority ethnic groups. Case description: This case report describes the specific reactions and psychopathological dynamics of a female patient, the age of 43, who survived the terrible accident on December the 10th 2016, in Hitrino village. Discussion: Due to stigmatising beliefs, patient reluctantly had only a few meeting with a clinical psychologist, refused proper psychiatric treatment, and developed an acute stress reaction in the first few days after the accident, followed by post-traumatic stress disorder the next few weeks, as described chronologically in the ICD-10. Conclusion: Stigmatising beliefs are further amplified by ethnic minorities’ prejudice of seeking mental health and having a mental illness, which affects professionals’ ability to provide comprehensive medical care.

Metal Recovery from Industrial Solid Waste — Contribution to Resource Sustainability

Science.gov (United States)

Yang, Yongxiang

Increased demand of metals has driven the accelerated mining and metallurgical production in recent years, causing fast depletion of primary metals resources. On the contrary, the mining and metallurgical industry generates large amount of solid residues and waste such as tailings, slags, flue dust and leach residues, with relative low valuable metal contents. On the other hand, end-of-life (EoL) consumer products form another significant resources. The current technology and processes for primary metals production are not readily applicable for direct metals extraction from these waste materials, and special adaptation and tailor-made processes are required. In the present paper, various solid waste resources are reviewed, and current technologies and R&D trends are discussed. The recent research at author's group is illustrated for providing potential solutions to future resource problems, including metal recovery from MSW incinerator bottom ashes, zinc recovery from industrial ashes and residues, and rare earth metals recovery from EoL permanent magnets.

Conceptualizing Surrogate Decision-Making at End of Life in the Intensive Care Unit using Cognitive Task Analysis

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Dionne-Odom, J. Nicholas; Willis, Danny G.; Bakitas, Marie; Crandall, Beth; Grace, Pamela J.

2014-01-01

Background Surrogate decision-makers (SDMs) face difficult decisions at end of life (EOL) for decisionally incapacitated intensive care unit (ICU) patients. Purpose Identify and describe the underlying psychological processes of surrogate decision-making for adults at EOL in the ICU. Method Qualitative case study design using a cognitive task analysis (CTA) interviewing approach. Participants were recruited from October 2012 to June 2013 from an academic tertiary medical center’s ICU located in the rural Northeastern United States. Nineteen SDMs for patients who had died in the ICU completed in-depth semi-structured CTA interviews. Discussion The conceptual framework formulated from data analysis reveals that three underlying, iterative, psychological dimensions: gist impressions, distressing emotions, and moral intuitions impact a SDM’s judgment about the acceptability of either the patient’s medical treatments or his or her condition. Conclusion The framework offers initial insights about the underlying psychological processes of surrogate decision-making and may facilitate enhanced decision support for SDMs. PMID:25982772

Synthesis report of a reactor-physics programme devoted to the qualification of the project calculation methods applied to the mixed (U-Pu) fuelled reloadings

International Nuclear Information System (INIS)

Golinelli, C.

1982-01-01

The Commission of the European Communities has sponsored three sets of experiments with a contract in the framework of the LWR plutonium recycling programme. The aim of this experimental programme was to supplement the qualification of the computer codes used in connection with control and safety studies relating to plutonium recycling in LWR power stations. The experiments are performed at the Cadarache centre by CEA and EdF in the MINERVE and EOLE facilities. The power distributions in various kinds of assemblies with some heterogeneities (water holes, absorbers, UO 2 /UO 2 -PuO 2 interfaces) are studied in MINERVE as well as the DOPPLER effect. This second programme consisted in oscillating the UO 2 and UO 2 -PuO 2 samples which were heated between 20 0 C and 800 0 C. The CREOLE experiments in EOLE dealt with the moderator temperature effect from 20 0 C to 300 0 C. All the results show that the calculation schema for the hot point values must be sophisticated and that it is possible to reduce the uncertainties concerning the feedback factors

Social-cultural factors in end-of-life care in Belgium: A scoping of the research literature

NARCIS (Netherlands)

Andrew, E.V.; Cohen, J.; Evans, N.C.; Menaca, A.; Harding, R.; Higginson, I.; Pool, R.; Gysels, M.

2013-01-01

Background: As end-of-life (EoL) care expands across Europe and the world, service developments are increasingly studied. The sociocultural context in which such changes take place, however, is often neglected in research. Aim: To explore sociocultural factors in EoL care in Belgium as represented

Culture and end of life care: a scoping exercise in seven European countries

NARCIS (Netherlands)

Gysels, M.; Evans, N.; Meñaca, A.; Andrew, E.; Toscani, F.; Finetti, S.; Pasman, H.R.; Higginson, I.; Harding, R.; Pool, R.

2012-01-01

Aim: Culture is becoming increasingly important in relation to end of life (EoL) care in a context of globalization, migration and European integration. We explore and compare socio-cultural issues that shape EoL care in seven European countries and critically appraise the existing research evidence

Culture and End of Life Care: A Scoping Exercise in Seven European Countries

NARCIS (Netherlands)

Gysels, M.; Evans, N.C.; Menaca, A.; Andrew, E.; Toscani, F.; Finetti, S.; Pasman, H.R.W.; Higginson, I.; Harding, R.; Pool, R.

2012-01-01

Aim: Culture is becoming increasingly important in relation to end of life (EoL) care in a context of globalization, migration and European integration. We explore and compare socio-cultural issues that shape EoL care in seven European countries and critically appraise the existing research evidence

Automated Maneuver Design and Checkout for the Lunar Reconnaissance Orbiter

Science.gov (United States)

2014-12-01

cosmic ray telescope for the effects of radiation DCM direction cosine matrix DLRE diviner lunar radiometer experiment EOL end of life ISS...estimate of the LRO at EOL . The reaction wheel capacities listed are at their operational limits, and represent a value 25 percent lower than design

Reconceptualising Moderation in Asynchronous Online Discussions Using Grounded Theory

Science.gov (United States)

Vlachopoulos, Panos; Cowan, John

2010-01-01

This article reports a grounded theory study of the moderation of asynchronous online discussions, to explore the processes by which tutors in higher education decide when and how to moderate. It aims to construct a theory of e-moderation based on some key factors which appear to influence e-moderation. It discusses previous research on the…

Hardships of end-of-life care with court-appointed guardians.

Science.gov (United States)

Hastings, Kylie B

2014-02-01

In the United States, the court-appointed guardians do not have the ability to make decisions regarding end-of-life (EOL) care for their clients. Additionally, the process of initiating EOL care measures can be slow and cumbersome, despite an existing process of getting approval for such care. This process has the potential to prolong suffering and delay imperative decisions. This article reviews the hardships that patients, court-appointed guardians, and health care staff endure while moving through the oppressive process of obtaining EOL care orders through the court. This article also proposes ways of tuning up the laws, regulations, and communications to make it easier and faster to obtain orders regarding EOL care to preserve the dignity of our patients and loved ones. "A guardianship is a legal relationship created when a person or institution named in a will or assigned by the court to take care of minor children or incompetent adults."

Panel discussion: Nuclear cardiology

International Nuclear Information System (INIS)

Schwaiger, M.

1991-01-01

The panel discussion opened with a question concerning whether true quantification of myocardial sympathetic presynaptic function or receptor density can be obtained with currently available radiopharmaceuticals. What are the relative advantages of the two general approaches that have been proposed for quantification: (1) The assessment of tracer distribution volume in tissue following bolus injection and (2) quantification based on tracer displacement kinetics following administration of excess unlabeled tracer. It was pointed out that tracer kinetics for the delineation of presynaptic and postsynaptic binding sites by radiopharmaceuticals or radiolabeled receptor antagonists are rather complex, reflecting several physiologic processes that are difficult to separate. Several approaches were examined. The possibility of regional definition of receptor density by PET was questioned and it was noted that regions of interest can be applied to calculate regional receptor kinetics. However, due to the limited spatial resolution of PET, only average transmural values can be determined. The discussion then turned to the discrepancy between the known sparse parasympathetic innervation of the heart and the high density of muscarinic receptors observed with PET. Experiences with MIBG imaging were reported, including uptake in the transplanted heart and interaction of drugs with MIBG uptake

Export, metal recovery and the mobile phone end-of-life ecosystem

NARCIS (Netherlands)

Bollinger, L.A.; Blass, V.

2012-01-01

Against a background of rapidly growing mobile phone consumption in developing and emerging economies, falling use times and looming metal scarcity, finding better ways to deal with end-of-life (EoL) phones is imperative. The current dynamic in which large numbers of EoL phones are exported from

End of life care in sub-Saharan Africa: a systematic review of the qualitative literature

NARCIS (Netherlands)

Gysels, M.H.; Pell, C.; Straus, L.; Pool, R.

2011-01-01

Background End of life (EoL) care in sub-Saharan Africa still lacks the sound evidence-base needed for the development of effective, appropriate service provision. It is essential to make evidence from all types of research available alongside clinical and health service data, to ensure that EoL

End-of-life care across Southern Europe: a critical review of cultural similarities and differences between Italy, Spain and Portugal

NARCIS (Netherlands)

Meñaca, A.; Evans, N.; Andrew, E.V.W.; Toscani, F.; Finetti, S.; Gómez-Batiste, X.; Higginson, I.J.; Harding, R.; Pool, R.; Gysels, M.H.

2012-01-01

Evidence from a range of sources demonstrates that end-of-life (EoL) care practices and preferences vary across countries; culture is consistently one of the main explanations given for this. In order to understand how cultural factors are used to explain similarities and differences in EoL care

Living with a crucial decision: a qualitative study of parental narratives three years after the loss of their newborn in the NICU.

Directory of Open Access Journals (Sweden)

Laurence Caeymaex

Full Text Available BACKGROUND: The importance of involving parents in the end-of-life decision-making-process (EOL DMP for their child in the neonatal intensive care unit (NICU is recognised by ethical guidelines in numerous countries. However, studies exploring parents' opinions on the type of involvement report conflicting results. This study sought to explore parents' experience of the EOL DMP for their child in the NICU. METHODS: The study used a retrospective longitudinal design with a qualitative analysis of parental experience 3 years after the death of their child in four NICUs in France. 53 face-to-face interviews and 80 telephone interviews were conducted with 164 individuals. Semi-structured interviews were conducted to explore how parents perceived their role in the decision process, what they valued about physicians' attitudes in this situation and whether their long-term emotional well being varied according to their perceived role in the EOL DMP. FINDINGS: Qualitative analysis identified four types of perceived role in the DMP: shared, medical, informed parental decision, and no decision. Shared DM was the most appreciated by parents. Medical DM was experienced as positive only when it was associated with communication. Informed parental DM was associated with feelings of anxiousness and abandonment. The physicians' attitudes that were perceived as helpful in the long term were explicit sharing of responsibility, clear expression of staff preferences, and respectful care and language toward the child. INTERPRETATION: Parents find it valuable to express their opinion in the EOL DMP of their child. Nonetheless, they do need continuous emotional support and an explicit share of the responsibility for the decision. As involvement preferences and associated feelings can vary, parents should be able to decide what role they want to play. However, our study suggests that fully autonomous decisions should be misadvised in these types of tragic choices.

QL-09TRAJECTORY OF QUALITY OF LIFE AT END OF LIFE IN MALIGNANT GLIOMA: SUPPORT FOR THE TERMINAL DROP THEORY

Science.gov (United States)

Farace, Elana; Sheehan, Jonas

2014-01-01

Very little is known about quality of life (QOL) at end-of-life (EOL) in malignant brain tumor patients, which limits clinicians ability to best to help patients at this stage. The QOL trajectory at EOL has commonly been hypothesized to be "terminal decline," a linear relationship to time before death with a relatively gradual decline. Alternately, QOL at EOL could be hypothesized to be analogous to the "terminal drop" theory of cognitive aging, wherein the patient QOL has a curvilinear relationship to time before death; a relatively flat curve with a rapid decline a short time before death. 89 patients with malignant glioma were enrolled in this NCI funded study of QOL and neurocognition. Patients completed the EORTC-QLQ-C30 at three month intervals until death. Mean length of follow-up was 224 days (median 155 days). Mean age of patients was 52 years (range 18-80). The gender ratio was 49% men and 51% women. One patient was Latino (so 97% Non-Hispanic), 69 participants were Caucasian, one was African American, and one was Native American. The mean educational level was 13 years (range 8-20). Twenty-eight patients had glioblastoma (grade IV), nine had a grade III oligodendroglioma, and six had a grade III oligoastrocytoma. Data were plotted over time to determine if the shape of the curve resembles terminal decline or terminal drop. Interestingly, as can be seen from the graph, Global QOL slightly improved over time. Growth Curve Analysis confirms this finding. Results of this study may supporting the terminal drop theory but may also illustrate response shift, a conundrum for QOL researchers in which patients' perspective changes and thus they report improved QOL. Longer follow-up is necessary to delineate this pattern. A better understanding of QOL at EOL will improve medical and psychosocial palliative care.

Safety goals for nuclear power plants: a discussion paper

International Nuclear Information System (INIS)

1982-02-01

This report includes a proposed policy statement on safety goals for nuclear power plants published by the Commission for public comment and a supporting discussion paper. Proposed qualitative goals and associated numerical guidelines for nuclear power-plant accident risks are presented. The significance of the goals and guidelines, their bases and rationale, and their proposed mode of implementation are discussed

Family factors affect clinician attitudes in pediatric end-of-life decision making: a randomized vignette study.

Science.gov (United States)

Ruppe, Michael D; Feudtner, Chris; Hexem, Kari R; Morrison, Wynne E

2013-05-01

Conflicts between families and clinicians in pediatric end-of-life (EOL) care cause distress for providers, dissatisfaction for patients' families, and potential suffering for terminally ill children. We hypothesized that family factors might influence clinician decision making in these circumstances. We presented vignettes concerning difficult EOL decision making, randomized for religious objection to therapy withdrawal and perceived level of family involvement, to clinicians working in three Children's Hospital intensive care units. Additionally, attitudes about EOL care were assessed. Three hundred sixty-four respondents completed the questionnaire, for an overall response rate of 54%. Respondents receiving the "involved family" vignette were more likely to agree to continue medical care indefinitely (Pfamilies had nonreligious objections to withdrawal (P=0.05). Respondents who thought that a fear of being sued affected decisions were less likely to pursue unilateral withdrawal (odds ratio 0.8, 95% CI=0.6-0.9). Those who felt personal distress as a result of difficult EOL decision making, thought they often provided "futile" care, or those who felt EOL care was effectively addressed at the institution were less likely to want to defer to the parents' wishes (range of odds ratios 0.7-1). In this randomized vignette study, we have shown that family factors, particularly how involved a family seems to be in a child's life, affect what clinicians think is ethically appropriate in challenging EOL cases. Knowledge of how a family's degree of involvement may affect clinicians should be helpful to the clinical ethics consultants and offer some degree of insight to the clinicians themselves. Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Inuit interpreters engaged in end-of-life care in Nunavik, Northern Quebec.

Science.gov (United States)

Hordyk, Shawn Renee; Macdonald, Mary Ellen; Brassard, Paul

2017-01-01

Inuit interpreters are key players in end-of-life (EOL) care for Nunavik patients and families. This emotionally intensive work requires expertise in French, English and Inuit dialects to negotiate linguistic and cultural challenges. Cultural differences among medical institutions and Inuit communities can lead to value conflicts and moral dilemmas as interpreters navigate how best to transmit messages of care at EOL. Our goal was to understand the experience of Inuit interpreters in the context of EOL care in Nunavik in order to identify training needs. In the context of a larger ethnographic project on EOL care in Nunavik, we met with 24 current and former interpreters from local health centres and Montreal tertiary care contexts. Data included informal and formal interviews focusing on linguistic resources, experiences concerning EOL care, and suggestions for the development of interpretation training. Inuit working as interpreters in Nunavik are hired to provide multiple services of which interpretation plays only a part. Many have no formal training and have few resources (e.g. visual aids, dictionaries) to draw upon during medical consultations. Given the small size of communities, many interpreters personally know their clients and often feel overwhelmed by moral dilemmas when translating EOL information for patients and families. The concept of moral distress is a helpful lens to make sense of their experience, including personal and professional repercussions. Inuit interpreters in Nunavik are working with little training yet in context with multiple linguistic and cultural challenges. Linguistic and cultural resources and focused training on moral dilemmas unique to circumpolar contexts could contribute to improved work conditions and ultimately to patient care.​​​​.

Advance Care Planning in Glioblastoma Patients

Directory of Open Access Journals (Sweden)

Lara Fritz

2016-11-01

Full Text Available Despite multimodal treatment with surgery, radiotherapy and chemotherapy, glioblastoma is an incurable disease with a poor prognosis. During the disease course, glioblastoma patients may experience progressive neurological deficits, symptoms of increased intracranial pressure such as drowsiness and headache, incontinence, seizures and progressive cognitive dysfunction. These patients not only have cancer, but also a progressive brain disease. This may seriously interfere with their ability to make their own decisions regarding treatment. It is therefore warranted to involve glioblastoma patients early in the disease trajectory in treatment decision-making on their future care, including the end of life (EOL care, which can be achieved with Advance Care Planning (ACP. Although ACP, by definition, aims at timely involvement of patients and proxies in decision-making on future care, the optimal moment to initiate ACP discussions in the disease trajectory of glioblastoma patients remains controversial. Moreover, the disease-specific content of these ACP discussions needs to be established. In this article, we will first describe the history of patient participation in treatment decision-making, including the shift towards ACP. Secondly, we will describe the possible role of ACP for glioblastoma patients, with the specific aim of treatment of disease-specific symptoms such as somnolence and dysphagia, epileptic seizures, headache, and personality changes, agitation and delirium in the EOL phase, and the importance of timing of ACP discussions in this patient population.

When parents face the death of their child: a nationwide cross-sectional survey of parental perspectives on their child's end-of life care.

Science.gov (United States)

Zimmermann, Karin; Bergstraesser, Eva; Engberg, Sandra; Ramelet, Anne-Sylvie; Marfurt-Russenberger, Katrin; Von der Weid, Nicolas; Grandjean, Chantal; Fahrni-Nater, Patricia; Cignacco, Eva

2016-03-09

Parents facing the death of their child have a strong need for compassionate professional support. Care services should be based on empirical evidence, be sensitive to the needs of the families concerned, take into account the heterogeneity within the medical field of paediatrics, and fit into the local health care system. We need to better understand the perspectives of parents facing the death of their child in order to guide further development and evaluation of specialised paediatric palliative and end-of-life (EOL) care services. Questionnaire survey to assess the EOL care perspectives of a Swiss population-based sample of bereaved parents who had lost a child due to a cardiac, neurological or oncological condition, or during the neonatal period in the years 2011 or 2012. The parental perspective was assessed with a newly developed and tested instrument that was structured according to six evidence-based quality domains. Responses regarding parental experiences and perceived satisfaction are described. Differences between the four diagnostic groups are analysed using a generalized estimation equation to account for the dyadic data structure. Of 307 eligible families, 267 could be contacted and 135 (51%) consented to participate in this questionnaire survey. Our findings show positive parental experiences of their child's EOL care and high perceived satisfaction with the care their child received. Parents of a child with cancer rated their experiences highest in most of the six quality domains and reported the highest satisfaction with care. The lowest scores were mainly reported by parents from the neurology group, with the exception of the shared decision making domain, where parents of neonates reported significantly less positive experiences. Although positive in general, our study results suggest some areas for improvement. The integration of specialised paediatric palliative care has the potential to minimise lost opportunities to support and assist

Discussion on ``Teaching the Second Law''

Science.gov (United States)

Silbey, Robert; Beretta, Gian Paolo; Cengel, Yunus; Foley, Andrew; Gyftopoulos, Elias P.; Hatsopoulos, George N.; Keck, James C.; Lewins, Jeffery; Lior, Noam; Nieuwenhuizen, Theodorus M.; Steinfeld, Jeffrey; von Spakovsky, Michael R.; Wang, Lin-Shu; Zanchini, Enzo

2008-08-01

This article reports an open discussion that took place during the Keenan Symposium "Meeting the Entropy Challenge" (held in Cambridge, Massachusetts, on October 5, 2007) following the short presentations—each reported as a separate article in the present volume—by Joseph Smith Jr., Howard Butler, Andrew Foley, Kimberly Hamad-Schifferli, Bernhardt Trout, Jeffery Lewins, Enzo Zanchini, and Michael von Spakovsky. All panelists and the audience were asked to address the following questions • Why is the second law taught in so many different ways? Why so many textbooks on thermodynamics? Why so many schools of thought? • Some say that thermodynamics is limited to equilibrium, others that it extends to nonequilibrium. How is entropy defined for nonequilibrium states?

capital. A discussion paper

Directory of Open Access Journals (Sweden)

Ewa Chojnacka

2015-04-01

Full Text Available The purpose of this study is to confront certain propositions presented in Lesław Niemczyk’s publication Rachunkowość finansowa aktywów kompetencyjnych i kapitału intelektualnego. Nowy dział rachunkowości(Accounting for Competence Assets and Intellectual Capital. A New Area in Accounting with ideas published in other studies. The authors discuss issues concerning firm value, selected definitions of intellectual capital, as well as certain methods of intellectual capital measurement and valuation. Other problems analysed include accounting for and reporting of intellectual capital and similarities and differences between the way those issues are presented in Polish and in international studies as well as in existing legal regulations and standards.

Information Needs of Family Carers of People with Diabetes at the End of Life: A Literature Review

NARCIS (Netherlands)

Dikkers, M.F.; Dunning, T.; Savage, S.

2013-01-01

Background: Recent research identified the issue that family carers of people with diabetes at the end of life (EOL) did not receive sufficient information to enable them to help their relative manage their diabetes at the EOL. Aim: The aim of the current study was to identify by conducting a

Thermodynamic and Kinematic Flow Characteristics of Some Developing and Non-Developing Disturbances in Predict

Science.gov (United States)

2014-12-01

PROCESSING FROM THE DROPSONDES The dropsonde data used in this thesis is in an EOL format, which is an ascii text format containing a header and...Depression investigation of cloud-systems in the Tropics (PREDICT) 2010 Quality Controlled Dropsonde Data Set’ under the ‘ EOL file format’ section found at

Review and Analysis of Algorithmic Approaches Developed for Prognostics on CMAPSS Dataset

Science.gov (United States)

2014-12-23

training datasets that have complete (run-to-failure) tra- jectories. Using data with complete trajectories gives access to the true End-of-Life ( EOL ) to...2010) as the actual EOL is known apriori. This allows testing the critical time aspect of a prediction in addi- tion to accuracy and precision

Symptoms and medication management in the end of life phase of high-grade glioma patients

NARCIS (Netherlands)

Koekkoek, J.A.F.; Dirven, L.; Sizoo, E.M.; Pasman, H.R.W.; Heimans, J.J.; Postma, T.J.; Deliens, L.; Grant, R.; McNamara, S.; Stockhammer, G.; Medicus, E.; Taphoorn, M.J.B.; Reijneveld, J.C.

2014-01-01

During the end of life (EOL) phase of high-grade glioma (HGG) patients, care is primarily aimed at reducing symptom burden while maintaining quality of life as long as possible. In this study, we evaluated the prevalence of symptoms and medication management in HGG patients during the EOL phase. We

Saturday 4 November 2006: Eole and/or E.ON fault?; Samedi 4 novembre 2006: la faute a Eole ou/et E.ON?

Energy Technology Data Exchange (ETDEWEB)

Poizat, F

2006-12-15

According to the UCTE (Union for the Coordination of Transmission of Electricity) Interim Report, it appears that the wind generators all over Europe suffered from the over-frequencies or under-frequencies resulting from the splitting of the European electricity transmission grid: besides 15 million customers being cut off from the electric supply, more than 10,000 MW, i.e. 60 % of the wind generation became un-operational. This made the production deficiency in Western Europe even worse, constraining the grid controllers to proceed with further load shedding in order to recover the situation. Moreover, as the classic production units were being stopped to reduce the excessive frequency, the wind generators in the Eastern zone began to reconnect automatically as the over-frequency was progressively being damped, complicating the task of the Central European dispatchers, at the risk of a complete collapse. Adding to the anarchic behavior of the wind generators is the suspicion that they contributed to the set of circumstances (human and organizational errors in particular) from which the black-out originated. This hypothesis rests on the poor accuracy of the production projections of a wind energy fleet as large as that of Germany (a power capacity reaching almost 20,000 MW)

Mechanisms for the proliferation of eosinophilic leukemia cells by FIP1L1-PDGFRα

International Nuclear Information System (INIS)

Ishihara, Kenji; Kitamura, Hajime; Hiraizumi, Kenji; Kaneko, Motoko; Takahashi, Aki; Zee, OkPyo; Seyama, Toshio; Hong, JangJa; Ohuchi, Kazuo; Hirasawa, Noriyasu

2008-01-01

The constitutively activated tyrosine kinase Fip1-like 1 (FIP1L1)-platelet-derived growth factor receptor α (PDGFRα) causes eosinophilic leukemia EoL-1 cells to proliferate. Recently, we demonstrated that histone deacetylase inhibitors suppressed this proliferation and induced the differentiation of EoL-1 cells into eosinophils in parallel with a decrease in the level of FIP1L1-PDGFRα. In this study, we analyzed the mechanism by which FIP1L1-PDGFRα induces the proliferation and whether the suppression of cell proliferation triggers the differentiation into eosinophils. The FIP1L1-PDGFRα inhibitor imatinib inhibited the proliferation of EoL-1 cells and decreased the level of the oncoprotein c-Myc as well as the phosphorylation of extracellular signal-regulated kinase and c-Jun N-terminal kinase (JNK). The proliferation of EoL-1 cells and expression of c-Myc were also inhibited by the MEK inhibitor U0126 and JNK inhibitor SP600125. The expression of the eosinophilic differentiation marker CCR3 was not induced by imatinib. These findings suggest that FIP1L1-PDGFRα induces the proliferation of EoL-1 cells through the induction of c-Myc expression via ERK and JNK signaling pathways, but is not involved in the inhibition of differentiation toward mature eosinophils

Students' Learning in Asynchronous Discussion Forums: A Meta-Analysis

Science.gov (United States)

Martono, Fkipuntan; Salam, Urai

2017-01-01

Asynchronous discussion forums are among the most preferred tools chosen to foster learning opportunities and knowledge construction. To reveal the cognitive engagement evidenced in the transcripts of the discussion forums, this study presents 51 papers. 17 papers reported research on students' attitude toward the use of ICT for learning, 16…

Physicians' self-reported practice behaviour regarding fertility-related discussions in paediatric oncology in Sweden.

Science.gov (United States)

Armuand, G M; Nilsson, J; Rodriguez-Wallberg, K A; Malmros, J; Arvidson, J; Lampic, C; Wettergren, L

2017-10-01

The aim of this study was to investigate practice behaviours of Swedish physicians with regard to discussing the impact of cancer treatment on fertility with paediatric oncology patients and their parents, and to identify factors associated with such discussions. A cross-sectional survey study was conducted targeting all physicians in Sweden working in paediatric oncology care settings. Participants responded to a questionnaire measuring practice behaviour, attitudes, barriers, and confidence in knowledge. Multivariable logistic regression was used to determine factors associated with seldom discussing fertility. More than half of the physicians routinely talked with their patients/parents about the treatment's potential impact on fertility (male patients: 62%; female patients: 57%; P = 0.570). Factors associated with less frequently discussing fertility with patients/parents were working at a non-university hospital (male patients: OR 11.49, CI 1.98-66.67; female patients: OR 33.18, CI 4.06-271.07), concerns that the topic would cause worry (male patients: OR 8.23, CI 1.48-45.89; female patients: OR 12.38, CI 1.90-80.70), and perceiving the parents as anxious (male patients: OR 7.18, CI 1.20-42.85; female patients: OR 11.65, CI 1.32-103.17). Based on our findings, we recommend structured training in how to communicate about fertility issues in stressful situations, which in turn might increase fertility-related discussions in paediatric oncology. © 2017 The Authors. Psycho-Oncology published by John Wiley & Sons Ltd.

Pre-screening Discussions and Prostate-Specific Antigen Testing for Prostate Cancer Screening.

Science.gov (United States)

Li, Jun; Zhao, Guixiang; Hall, Ingrid J

2015-08-01

For many men, the net benefit of prostate cancer screening with prostate-specific antigen (PSA) tests may be small. Many major medical organizations have issued recommendations for prostate cancer screening, stressing the need for shared decision making before ordering a test. The purpose of this study is to better understand associations between discussions about benefits and harms of PSA testing and uptake of the test among men aged ≥40 years. Associations between pre-screening discussions and PSA testing were examined using self-reported data from the 2012 Behavioral Risk Factor Surveillance System. Unadjusted prevalence of PSA testing was estimated and AORs were calculated using logistic regression in 2014. The multivariate analysis showed that men who had ever discussed advantages of PSA testing only or discussed both advantages and disadvantages were more likely, respectively, to report having had a test within the past year than men who had no discussions (ptesting with their healthcare providers were more likely (AOR=2.75, 95% CI=2.00, 3.79) to report getting tested than men who had no discussions. Discussions of the benefits or harms of PSA testing are positively associated with increased uptake of the test. Given the conflicting recommendations for prostate cancer screening and increasing importance of shared decision making, this study points to the need for understanding how pre-screening discussions are being conducted in clinical practice and the role played by patients' values and preferences in decisions about PSA testing. Published by Elsevier Inc.

A New Observational Strategy for Monitoring the Tropical Cyclone Outflow Layer and its Relationship to Intensity and Structure Change

Science.gov (United States)

2013-09-30

vertical structure of outflow layer jets for Hurricanes Leslie and Nadine in 2012 and Invest 97L in 2013 has been conducted using NCAR- EOL /Vaisala mini...generation of dropsonde, the Yankee, Inc HDSS and XDD sonde was intercompared during CIRPAS Twin Otter test flights on 24-25 June, 2011 with NCAR- EOL

The Encyclopedia of Life v2: Providing Global Access to Knowledge About Life on Earth

Directory of Open Access Journals (Sweden)

Cynthia S. Parr

2014-04-01

We have shown that it is possible to successfully integrate large amounts of descriptive biodiversity data from diverse sources into a robust, standards-based, dynamic, and scalable infrastructure. Increasing global participation and the emergence of EOL-powered applications demonstrate that EOL is becoming a significant resource for anyone interested in biological diversity.

Physician-patient discussions of controversial cancer screening tests.

Science.gov (United States)

Dunn, A S; Shridharani, K V; Lou, W; Bernstein, J; Horowitz, C R

2001-02-01

Screening mammography for younger women and prostate-specific antigen (PSA) measurement have controversial benefits and known potential adverse consequences. While providing informed consent and eliciting patient preference have been advocated for these tests, little is known about how often these discussions take place or about barriers to these discussions. We administered a survey to medical house staff and attending physicians practicing primary care. The survey examined physicians' likelihood of discussing screening mammography and PSA testing, and factors influencing the frequency and quality of these discussions. For the three scenarios, 16% to 34% of physicians stated that they do not discuss the screening tests. The likelihood of having a discussion was significantly associated with house staff physicians' belief that PSA screening is advantageous; house staff and attending physicians' intention to order a PSA test, and attending physicians' intention to order a mammogram; and a controversial indication for screening. The most commonly identified barriers to discussions were lack of time, the complexity of the topic, and a language barrier. Physicians report they often do not discuss cancer screening tests with their patients. Our finding that physicians' beliefs and intention to order the tests, and extraneous factors such as time constraints and a language barrier, are associated with discussions indicates that some patients may be inappropriately denied the opportunity to choose whether to screen for breast and prostate cancer.

Remarks presented (questions/answers discussed) at public regional meetings to discuss regulations (10 CFR Part 21) for reporting of defects and noncompliance, July 12--26, 1977

International Nuclear Information System (INIS)

1977-09-01

In enacting the Energy Reorganization Act of 1974, Congress included Section 206 which requires the reporting of defects and noncompliances directly to the Nuclear Regulatory Commission (NRC). This congressional action required that the NRC promulgate rules and regulations, as necessary, to assure appropriate implementation of Section 206. In response to this mandate, the NRC drafted a new regulation. Following a period of public comment and revision, the regulation identified as 10 CFR Part 21, Reporting Defects and Noncompliance, was published in a Federal Register Notice on June 6, 1977. To assist NRC licensees and other firms and organizations covered by the new Part 21 regulation, public regional meetings were conducted by staff representatives to explain the rule. At these meetings the staff presented prepared remarks and answered questions on the meaning and application of the rule. Staff remarks contained in the original publication of this document were also provided to those in attendance. At each meeting the staff received a request for the questions and answers discussed by the staff to be made available for use as guidance by the nuclear industry covered by the rule. It was announced that a consolidation of the staff position question/answer guidance would be made available to each organization or firm attending these meetings and for others where a request is made in accordance with the directions printed insidethe front cover of the document. The staff will be guided in its implementation and enforcement of Part 21 by the positions set forth in the document. The revision of NUREG-0302 includes the following three parts relating to 10 CFR Part 21: (1) remarks presented by staff representatives; (2) Federal Register Notice material; and (3) a consolidation of questions and answers from the public regional meetings

Evaluating Critical Thinking in Computer Mediated Communication Discussions

Directory of Open Access Journals (Sweden)

Faizah Mohamad

2008-06-01

Full Text Available This paper presents an investigation of whether computer mediated communication (CMC can develop critical thinking in language classrooms. The research was conducted at a university branch campus in Malaysia over a period of 12 weeks. It involved three groups of learners in which each group was exposed to different discussion modes. The first group was exposed to a CMC discussion mode, the second group was exposed to a mixed mode of CMC and face-to-face (F2F discussions and the third group had only the face-to-face mode of discussion. The critical thinking development in these three conditions was evaluated based on the content analysis method used by Newman, Johnson, Cochrane and Webb (1995. This research reports the findings which hopefully will give some insight to other teaching practitioners who are interested in incorporating IT in their classrooms

Uncertainty Representation and Interpretation in Model-based Prognostics Algorithms based on Kalman Filter Estimation

Science.gov (United States)

2012-09-01

interpreting the state vector as the health indicator and a threshold is used on this variable in order to compute EOL (end-of-life) and RUL. Here, we...End-of-life ( EOL ) would match the true spread and would not change from one experiment to another. This is, however, in practice impossible to achieve

Rural-Urban Differences in End-of-Life Nursing Home Care: Facility and Environmental Factors

Science.gov (United States)

Temkin-Greener, Helena; Zheng, Nan Tracy; Mukamel, Dana B.

2012-01-01

Purpose of the study: This study examines urban-rural differences in end-of-life (EOL) quality of care provided to nursing home (NH) residents. Data and Methods: We constructed 3 risk-adjusted EOL quality measures (QMs) for long-term decedent residents: in-hospital death, hospice referral before death, and presence of severe pain. We used…

[Depersonalization syndrome after acquired brain damage. Overview based on 3 case reports and the literature and discussion of etiological models].

Science.gov (United States)

Paulig, M; Böttger, S; Sommer, M; Prosiegel, M

1998-12-01

Depersonalization after brain damage is still only rarely reported and poorly understood. We describe three patients between the ages of 21 and 25 who experienced depersonalization and derealization for periods of 6 weeks to 4 months, two after traumatic brain injury, the third after surgical and radiation treatment of a pineocytoma. Each one believed to be living in a nightmare and thought about committing suicide in order to wake up. One patient developed symptoms as described in Cotard delusion. Aspects of neuroanatomy, psychodynamics, and anthropology are discussed with reference to the literature. Frontal and temporal lesions seem only to play a facilitating role but not to be a necessary condition. There is evidence for additional influence of psychological and premorbid personality factors. Summarizing the current state of information we consider depersonalization with the experience of being in a dream or being dead as a heuristic reaction to brain damage. Similar models have already been discussed in neuropsychological disorders as for instance reduplicative paramnesias, neglect, and anosognosia.

Impact of End-of-Life manoeuvres on the collision risk in protected regions

Science.gov (United States)

Frey, Stefan; Lemmens, Stijn; Bastida Virgili, Benjamin; Flohrer, Tim; Gass, Volker

2017-09-01

The Inter-Agency Space Debris Coordination Committee (IADC) Space Debris Mitigation Guidelines, issued in 2002 and revised in 2007, address the post mission disposal of objects in orbit. After their mission, objects crossing the Low Earth Orbit (LEO) should have a remaining lifetime in orbit not exceeding 25 years. Objects near the Geostationary Orbit (GEO) region should be placed in an orbit that remains outside of the GEO protected region. In this paper, the impact of satellites and rocket bodies performing End-of-Life (EOL) orbital manoeuvres on the collision risk in the LEO and GEO protected regions is investigated. The cases of full or partial compliance with the IADC post mission disposal guideline are studied. ESA's Meteoroid and Space Debris Terrestrial Environment Reference (MASTER) model is used to compare the space debris flux rate of the object during the remaining lifetime estimated for the pre-EOL-manoeuvre and for the post-EOL-manoeuvre orbit. The study shows that, on average, the probability of collision can be significantly decreased by performing an EOL-manoeuver.

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

2017-01-01

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...

The Allocation of Tasks and Competencies in Dutch Water Management : Discussions, developments and present state

NARCIS (Netherlands)

Mostert, E.

1997-01-01

This report discusses subsidiarity in Dutch water management and forms the Dutch contribution to the Water 21 Phase II report on subsidiarity. Rather than discussing the Dutch interpretations of the concept (the concept is used almost exclusively in relation to the European Union), this report

Providing grief resolution as an oncology nurse retention strategy: a literature review.

Science.gov (United States)

Hildebrandt, Lori

2012-12-01

Oncology nurses play a pivotal role in optimizing care provided to patients at the end of life (EOL). Although oncology nurses commonly provide EOL care and witness deaths of patients that they have maintained long-standing relationships with, they are frequently excluded from grief resolution endeavors. With a worldwide shortage of oncology nurses, retention is paramount to ensuring that the care patients with cancer receive is not jeopardized. Various strategies were identified to resolve grief and increase nurse retention, including creating supportive work environments, debriefing with colleagues, providing EOL and grief education, and altering patient care assignments. Future research on emerging technologies and their effects on oncology nurse coping and retention strategies also was suggested.

Intermediate report. Base for the Broad Public Discussion on Energy Policy in the Netherlands. Het tussenrapport. Basis voor de Brede Maatschappelijke Discussie

Energy Technology Data Exchange (ETDEWEB)

1983-01-01

The Broad Public Djiscussion on Energy Policy (BMD) in the Netherlands is subdivided in an informative and a discussion stage. This intermediate report gives a summary of the first stage. In Ch. 2 the concept of energy and the utilized unities are discussed. Ch. 3 gives information about the actual energy consumption in the world and in the Netherlands and about the varying estimations for the future energy consumption. In Ch. 4 various possibilities for economization of energy in the Netherlands are discussed. Ch. 5 to 7 give the necessary information about the various energy sources. By source respectively the storages, applications, costs, effects on men and environment and public consequences are under discussion. Ch. 8 presents a comparative summary of the advantages and the drawbacks of various energy sources, the estimations for the future use and possibilities for energy economization. Also some attention is paid to the question on which grounds a choice from the policy possibilities may be based. Ch. 9 and 10 deal with the actual energy policy: how it is realized and what it holds. In Ch. 11 the results are discussed of four scenario-studies: how does the future energy consumption look like under different economical circumstances. What could be the effects of this on the environment at different applications of coal, natural gas, nuclear energy etc.. Furthermore the alternatives, which anounce themselves on the ground of the scenario studies, for the future energy policy are discussed. Finally the discussion questions are presented which following the coordination group will be the centre of interest in the second stage of the BMD. 427 refs.; figs.; tabs.

Friedreich's ataxia cardiomyopathy: case based discussion and management issues.

LENUS (Irish Health Repository)

Hanley, A

2010-04-01

Cardiac involvement is common in Friedreich\\'s Ataxia and is a common cause of premature death. Evidence regarding treatment of congestive heart failure in patients with Friedreich\\'s Ataxia is lacking. The case of a 31-year-old male with advanced Friedreich\\'s Ataxia who presented with an acute diarrhoeal illness and features of acute heart failure is discussed. We then review the reported cardiac manifestations of Friedreich\\'s Ataxia and discuss management options.

Energy summit discussions with Federal Chancellor Merkel - potential legislative consequences

International Nuclear Information System (INIS)

Heller, W.

2006-01-01

The energy summit discussions held by Federal Chancellor Merkel are to converge in a consistent energy policy concept by late 2007. The second summit held on October 9, 2006 was prepared by three working groups. Working Group 1 was to handle 'International Aspects', Working Group 2, the 'National Aspects of Energy Supply', and Working Group 3, finally, 'Research and Energy Efficiency'. The reports dealing with international aspects and with research and energy efficiency were in the focus of discussions at the summit. The report about national aspects had not yet reached the level of maturity required for discussion. None of the reports contained anything under the headings of 'Setting aside the Gorleben Moratorium' and 'Continued Exploration of the Salt Dome for a Repository' and 'Extension of the Plant Life of Our Nuclear Power Plants'. This sounds very easy and is urgently required, but it is neither announced nor seriously debated in politics. If these legislative measures were taken and the rhetoric about the broad energy mix turned into energy policy reality, many problems in climate protection, in energy supply continuity, and in competitive electricity supply could be solved more easily. (orig.)

Focusing on SSI's risk and radiation protection criteria. A report based on discussions in focus groups in Oesthammar and Oskarshamn municipalities

Energy Technology Data Exchange (ETDEWEB)

Drottz-Sjoeberg, Britt-Marie [BMD Research (Sweden)

2003-11-01

The project was a result of the authority's continued work on the 1998 regulations on protection of human health and the environment in final disposal of spent nuclear fuel and nuclear waste. The idea behind the project, to involve persons from the municipalities participating in SKB's site selection investigation in focus group discussions, was that the questions and points of views that emerged in the discussions could serve as a basis for the authority's work of producing general guidelines associated with the regulations. The finished report would then be handed over to an expert group at the authority which answered or commented on the issues raised, and made a report on this to the participating municipalities Oskarshamn and Oesthammar. The result of discussions in two focus groups in Oskarshamn municipality and two in Oesthammar municipality in October 2002 is presented here, together with a presentation of the project's purpose and organisation. The results are presented in three main sections. The first concentrates on radiation and radioactivity since the task in the discussion groups was to attempt to clarify the issues and problems observed in this area in order to contribute to the authority's work of developing the general guidelines. The second section, on understanding of concepts, measurement, risk and safety, illustrates that the frequently asked and 'simple' knowledge related questions are only the tip of the iceberg where many of the participants have also thought about the more complex contexts and the fundamental problems in the risk and safety analysis, its validity and use. The third section of the report focuses primarily on content and information aspects. It provides a number of ideas about how information on current problems and important issues can be improved, how knowledge can be deepened in the site selection municipalities and how working methods in the process can be developed. The report mainly

Physician–Patient Discussions of Controversial Cancer Screening Tests

Science.gov (United States)

Dunn, Andrew S.; Shridharani, Kanan V.; Lou, Wendy; Bernstein, Jeffrey; Horowitz, Carol R.

2016-01-01

Background Screening mammography for younger women and prostate-specific antigen (PSA) measurement have controversial benefits and known potential adverse consequences. While providing informed consent and eliciting patient preference have been advocated for these tests, little is known about how often these discussions take place or about barriers to these discussions. Methods We administered a survey to medical house staff and attending physicians practicing primary care. The survey examined physicians’ likelihood of discussing screening mammography and PSA testing, and factors influencing the frequency and quality of these discussions. Results For the three scenarios, 16% to 34% of physicians stated that they do not discuss the screening tests. The likelihood of having a discussion was significantly associated with house staff physicians’ belief that PSA screening is advantageous; house staff and attending physicians’ intention to order a PSA test, and attending physicians’ intention to order a mammogram; and a controversial indication for screening. The most commonly identified barriers to discussions were lack of time, the complexity of the topic, and a language barrier. Conclusions Physicians report they often do not discuss cancer screening tests with their patients. Our finding that physicians’ beliefs and intention to order the tests, and extraneous factors such as time constraints and a language barrier, are associated with discussions indicates that some patients may be inappropriately denied the opportunity to choose whether to screen for breast and prostate cancer. PMID:11165455

Interpreting patient-reported outcomes from clinical trials in COPD: a discussion

Directory of Open Access Journals (Sweden)

Jones PW

2016-12-01

Full Text Available Paul W Jones,1,2 Stephen Rennard,3,4 Maggie Tabberer,5 John H Riley,2 Mitra Vahdati-Bolouri,2 Neil C Barnes2,6 1Institute for Infection and Immunity, University of London, London, 2Global Respiratory Franchise, GlaxoSmithKline, Uxbridge, UK; 3Division of Pulmonary, Critical Care, Sleep and Allergy, Nebraska Medical Center, Omaha, NE, USA; 4Clinical Discovery Unit, AstraZeneca, Cambridge, 5Global R&D, GlaxoSmithKline, Uxbridge, 6William Harvey Institute, Bart’s and the London School of Medicine and Dentistry, London, UK Abstract: One of the challenges faced by the practising physician is the interpretation of patient-reported outcomes (PROs in clinical trials and the relevance of such data to their patients. This is especially true when caring for patients with progressive diseases such as COPD. In an attempt to incorporate the patient perspective, many clinical trials now include assessments of PROs. These are formalized methods of capturing patient-centered information. Given the importance of PROs in evaluating the potential utility of an intervention for a patient with COPD, it is important that physicians are able to critically interpret (and critique the results derived from them. Therefore, in this paper, a series of questions is posed for the practising physician to consider when reviewing the treatment effectiveness as assessed by PROs. The focus is on the St George’s Respiratory Questionnaire for worked examples, but the principles apply equally to other symptom-based questionnaires. A number of different ways of presenting PRO data are discussed, including the concept of the minimum clinically important difference, whether there is a ceiling effect to PRO results, and the strengths and weaknesses of responder analyses. Using a worked example, the value of including a placebo arm in a study is illustrated, and the influence of the study on PRO results is considered, in terms of the design, patient withdrawal, and the selection of

Discussing dementia-related behaviors during medical visits for people with Alzheimer's disease.

Science.gov (United States)

Hunsaker, Amanda E; Schmidt, Karen; Lingler, Jennifer H

2010-05-01

Research suggests that caregivers appreciate support from primary care physicians (PCPs) regarding dementia care; however, there remains a need for studies examining the role that PCPs play in behavior management. The purpose of this study was to quantitatively characterize the discussion on dementia-related behaviors (DRBs) during PCP visits and compare findings to an independently administered assessment of DRBs exhibited within a period of 4 weeks prior to the PCP visit. Twenty-five PCP visits of persons with dementia, in which caregivers coattended the visit, were audio-recorded and analyzed for occurrence of DRB discussion. Disruptive behaviors were reported by 80% of caregivers via independent assessment, yet discussed in 23% of medical visits. Dementia-related behavior discussion occurred in visits where caregivers independently reported significantly higher behavior frequency and behavior-related burden. Implications of findings for ways PCPs can assist the caregiver in behavior management are discussed.

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

Science.gov (United States)

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

2018-06-01

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

LGBT Roundtable Discussion: Meet-up and Mentoring Discussion

Science.gov (United States)

2014-03-01

The LGBT+ Physicists group welcomes those who identify as gender sexual minorities, as LGBTQQIAAP+, or as allies to participate in a round-table discussion on mentoring physicists. The session will provide an opportunity to learn and discuss successful mentoring strategies at different career stages for physicists in all environments, including academia, industry, etc. Attendees are encouraged to attend a social event to follow the panel to continue to network. Allies are especially welcome at this event to learn how to support and mentor LGBT+ physicists.

Detained and Dying: Ethical Issues Surrounding End-of-Life Care in Prison.

Science.gov (United States)

Stensland, Meredith; Sanders, Sara

2016-01-01

Prisons are increasingly being called upon to provide end-of-life (EOL) care within the restrictive correctional environment. Several relatively recent phenomena have brought medical ethics to the forefront of prison EOL care-including aging behind bars, a paradigm shift in prison culture, the increasing rate of in-prison deaths, and the corresponding prison hospice movement. This article examines prominent ethical issues that emerge for prison personnel who are tasked with providing care to terminally ill offenders by presenting three offender composite characters that exemplify dying offenders and emergent ethical issues surrounding their care. Identification and critical analysis of these ethical issues demonstrate the need for strong commitment to ethical practice and highlights specific issues for prisons to examine in their own EOL care practice.

IRIS Toxicological Review of Trichloroethylene (Interagency Science Discussion Draft)

Science.gov (United States)

EPA is releasing the draft report, Toxicological Review of Trichloroethylene, that was distributed to Federal agencies and White House Offices for comment during the Science Discussion step of the IRIS Assessment Development Process. Comments received from other Federal agencies ...

Discussing Animal Rights and Animal Research in the Classroom.

Science.gov (United States)

Herzog, Harold A.

1990-01-01

Reviews two prominent philosophical justifications for animal liberation and describes a simulation that facilitates class discussion of animal research issues. Students reported that the exercise increased their awareness of the issues and of the complexity of making ethical decisions. (DB)

Quality management of the nuclear regulatory body. Peer discussions on regulatory practices

International Nuclear Information System (INIS)

2001-09-01

This report is the outcome of the ninth series of peer discussions on regulatory practices entitled Nuclear Regulatory Body Quality Management, held in March and May 2001, and which involved the participation of senior nuclear regulators from 23 IAEA Member States. This report conveys the essence of two peer group discussions and highlights some good practices identified by the participating senior regulators. The objective of the discussions was to share experiences of regulatory bodies in implementing QM systems in their own work so as to ensure that the regulatory control over the licensees is effective and efficient and is commensurate with the mandate assigned by their governments. The shared experiences and good practices presented in the report, however, do not necessarily reflect the views of and good practices endorsed by the governments of the nominating Member States, the organizations to which the regulators belong, or the IAEA. The report sets down the peer group's experience in developing, implementing and evaluating QM within their regulatory bodies and identifies points to bear in mind when introducing such a system. This report is structured so that it covers the subject matter under the main headings of: application of quality management to regulatory work; development and implementation of quality management; assessment and improvement of performance; and good practices

Discussions of the uranium geology working groups IGC, Sydney

International Nuclear Information System (INIS)

1978-01-01

The report is divided into six working group discussions on the following subjects: 1) Chemical and physical mechanisms in the formation of uranium mineralization, geochronology, isotope geology and mineralogy; 2) Sedimentary basins and sandstone-type uranium deposits; 3) Uranium in quartz-pebble conglomerates; 4) Vein and similar type deposits (pitchblende); 5) Other uranium deposits; 6) Relation of metallogenic, tectonic and zoning factors to the origin of uranium deposits. Each working group paper contains a short introductory part followed by a discussion by the working group members

A discussion of the several types of two-stroke-cycle engines

Science.gov (United States)

Venediger, Herbert J

1935-01-01

This report discusses different types of two-stroke engines as well as the three most important design factors: volume of scavenge and charge delivery, scavenging process (scavenging result), and result of charge. Some of the types of engines discussed include: single cylinder with crank-chamber scavenge pump and auxiliary suction piston linked to working connecting rod; and two cylinder engines with a rotary scavenge pump arrangement. Three and four cylinder engines are also discussed in various designs.

Screening for Intimacy Concerns in a Palliative Care Population: Findings from a Pilot Study.

Science.gov (United States)

Kelemen, Anne; Cagle, John; Groninger, Hunter

2016-10-01

Intimacy is an important component of the palliative care (PC) assessment. Evaluation of patient concerns related to intimacy should be included in a comprehensive PC consultation. The concerns are rarely assessed for hospitalized PC patients, yet there is evidence to support that patients want to talk about intimacy. We wanted to understand (1) if intimacy was an important issue for hospitalized PC patients; (2) how intimacy was impacted by illness; and, (3) if intimacy concerns were present, what those concerns involved. We designed a brief screening tool to administer to adult patients receiving PC consultation at two hospitals. The tool included demographic information, relevant medical diagnoses, two questions to help identify intimacy issues, and PC team communication to the referring medical team. Mean screening tool administration time was eight minutes. Although the vast majority (96%) of patients reported that they had not been asked about intimacy concerns before the PC consult, a slight majority (56.2%) reported that illness had either significantly or moderately impacted intimacy. Most (96%) found the intimacy discussion helpful and wanted to discuss these issues with medical providers. Those at end of life (EOL) (died intimacy, and all reported the conversation was helpful and wanted to discuss the issue with providers. Pilot data from this quality improvement (QI) project suggest a clear need for intimacy assessment in PC consultation. Intimacy is impacted by serious illness and patients/partners want to discuss issues with clinicians. PC clinicians can incorporate intimacy discussions as part of a routine assessment without adding significant amount of time.

Discussion

International Nuclear Information System (INIS)

Sutcliffe, W.G.

1991-01-01

This is an edited transcript of the recorded discussions that followed the presentation of each paper and on the general comments at the conclusion of the session. No attempt was made to identity those who offered comments or asked questions

Development of an end-of-life vehicle recovery model using system dynamics and future research needs

Science.gov (United States)

Mohamad-Ali, N.; Ghazilla, R. A. R.; Abdul-Rashid, S. H.; Sakundarini, N.; Ahmad-Yazid, A.; Stephenie, L.

2017-06-01

The implementation of end-of-life vehicle (ELV) recovery policy in Malaysia has led vehicle manufacturers to look at different ways to improve design and development of vehicles. Nowadays, it is crucial to incorporate end-of-life (EOL) design strategies into the vehicle design in order to enhance the effectiveness of the ELV recovery network. Although recent studies have shown that product design has a significant effect on the product recovery rate, there is a lack of studies on how EOL design strategies affects the effectiveness of ELV recovery, particularly when there are dynamic changes in the behaviour of the product recovery network. Thus, in this study, we developed a preliminary model based on the system dynamics approach in order to predict the effectiveness of ELV recovery in response to dynamic changes of various factors (including EOL design strategies) in the business environment. We developed this model based on preliminary data that we had gathered from unstructured interviews with the key stakeholders of ELV management in Malaysia. We believe that our model will greatly benefit product designers in incorporating the appropriate EOL design strategies in order to boost ELV recovery effectiveness in Malaysia.

Implementation of the Welfare Quality broiler assessment protocol – final report : overview of outcome-based measurement of broiler welfare and a general discussion on the Welfare Quality broiler assessment protocol

NARCIS (Netherlands)

Jong, de I.C.; Gunnink, H.; Hindle, V.A.

2015-01-01

In the current report, two topics related to our study on the implementation of the Welfare Quality® broiler assessment protocol are discussed. First, animal-based measures for broiler welfare, currently included in the Welfare Quality® broiler assessment protocol, are discussed with respect to

The Effects of Largest Claim and Excess of Loss Reinsurance on a Company’s Ruin Time and Valuation

Directory of Open Access Journals (Sweden)

Yuguang Fan

2017-01-01

Full Text Available We compare two types of reinsurance: excess of loss (EOL and largest claim reinsurance (LCR, each of which transfers the payment of part, or all, of one or more large claims from the primary insurance company (the cedant to a reinsurer. The primary insurer’s point of view is documented in terms of assessment of risk and payment of reinsurance premium. A utility indifference rationale based on the expected future dividend stream is used to value the company with and without reinsurance. Assuming the classical compound Poisson risk model with choices of claim size distributions (classified as heavy, medium and light-tailed cases, simulations are used to illustrate the impact of the EOL and LCR treaties on the company’s ruin probability, ruin time and value as determined by the dividend discounting model. We find that LCR is at least as effective as EOL in averting ruin in comparable finite time horizon settings. In instances where the ruin probability for LCR is smaller than for EOL, the dividend discount model shows that the cedant is able to pay a larger portion of the dividend for LCR reinsurance than for EOL while still maintaining company value. Both methods reduce risk considerably as compared with no reinsurance, in a variety of situations, as measured by the standard deviation of the company value. A further interesting finding is that heaviness of tails alone is not necessarily the decisive factor in the possible ruin of a company; small and moderate sized claims can also play a significant role in this.

Discussing Dementia-Related Behaviors During Medical Visits for People With Alzheimer’s Disease

Science.gov (United States)

Hunsaker, Amanda E.; Schmidt, Karen; Lingler, Jennifer H.

2011-01-01

Research suggests that caregivers appreciate support from primary care physicians (PCPs) regarding dementia care; however, there remains a need for studies examining the role that PCPs play in behavior management. The purpose of this study was to quantitatively characterize the discussion on dementia-related behaviors (DRBs) during PCP visits and compare findings to an independently administered assessment of DRBs exhibited within a period of 4 weeks prior to the PCP visit. Twenty-five PCP visits of persons with dementia, in which caregivers coattended the visit, were audio-recorded and analyzed for occurrence of DRB discussion. Disruptive behaviors were reported by 80% of caregivers via independent assessment, yet discussed in 23% of medical visits. Dementia-related behavior discussion occurred in visits where caregivers independently reported significantly higher behavior frequency and behavior-related burden. Implications of findings for ways PCPs can assist the caregiver in behavior management are discussed. PMID:20147601

Discussion in Postsecondary Classrooms

Directory of Open Access Journals (Sweden)

Curt Dudley-Marling

2013-11-01

Full Text Available Spoken language is, arguably, the primary means by which teachers teach and students learn. Much of the literature on language in classrooms has focused on discussion that is seen as both a method of instruction and a curricular outcome. While much of the research on discussion has focused on K-12 classrooms, there is also a body of research examining the efficacy of discussion in postsecondary settings. This article provides a review of this literature in order to consider the effect of discussion on student learning in college and university classrooms, the prevalence of discussion in postsecondary settings, and the quality of discussion in these settings. In general, the results of research on the efficacy of discussion in postsecondary settings are mixed. More seriously, researchers have not been explicit about the meaning of discussion and much of what is called discussion in this body of research is merely recitation with minimal levels of student participation. Although the research on discussion in college and university classrooms is inconclusive, some implications can be drawn from this review of the research including the need for future researchers to clearly define what they mean by “discussion.”

Resident reflections on end-of-life education: a mixed-methods study of the 3 Wishes Project.

Science.gov (United States)

Centofanti, J; Swinton, M; Dionne, J; Barefah, A; Boyle, A; Woods, A; Shears, M; Heels-Ansdell, D; Cook, D

2016-03-31

The objectives of this study were to describe residents' experiences with end-of-life (EOL) education during a rotation in the intensive care unit (ICU), and to understand the possible influence of the 3 Wishes Project. We enrolled dying patients, their families and 1-3 of their clinicians in the 3 Wishes Project, eliciting and honouring a set of 3 wishes to bring peace to the final days of a critically ill patient's life, and ease the grieving process for families. We conducted semistructured interviews with 33 residents who had cared for 50 dying patients to understand their experiences with the project. Interviews were recorded, transcribed verbatim, then analysed using a qualitative descriptive approach. 21-bed medical surgical ICU in a tertiary care, university-affiliated hospital. 33 residents participated from internal medicine (24, 72.7%), anaesthesia (8, 24.2%) and laboratory medicine (1, 3.0%) programmes in postgraduate years 1-3. 3 categories and associated themes emerged. (1) EOL care is a challenging component of training in that (a) death in the ICU can invoke helplessness, (b) EOL education is inadequate, (c) personal connections with dying patients is difficult in the ICU and (d) EOL skills are valued by residents. (2) The project reframes the dying process for residents by (a) humanising this aspect of practice, (b) identifying that family engagement is central to the dying process, (c) increasing emotional responsiveness and (d) showing that care shifts, not stops. (3) The project offers experiential education by (a) intentional role modelling, (b) facilitating EOL dialogue, (c) empowering residents to care in a tangible way and (d) encouraging reflection. For residents, the 3 Wishes Project integrated many forms of active learning for residents. Practice-based rather than classroom-based programmes may engage trainees to develop EOL skills transferable to other settings. Published by the BMJ Publishing Group Limited. For permission to use (where

Canada's Compassionate Care Benefit: is it an adequate public health response to addressing the issue of caregiver burden in end-of-life care?

Science.gov (United States)

Williams, Allison M; Eby, Jeanette A; Crooks, Valorie A; Stajduhar, Kelli; Giesbrecht, Melissa; Vuksan, Mirjana; Cohen, S Robin; Brazil, Kevin; Allan, Diane

2011-05-18

An increasingly significant public health issue in Canada, and elsewhere throughout the developed world, pertains to the provision of adequate palliative/end-of-life (P/EOL) care. Informal caregivers who take on the responsibility of providing P/EOL care often experience negative physical, mental, emotional, social and economic consequences. In this article, we specifically examine how Canada's Compassionate Care Benefit (CCB)--a contributory benefits social program aimed at informal P/EOL caregivers--operates as a public health response in sustaining informal caregivers providing P/EOL care, and whether or not it adequately addresses known aspects of caregiver burden that are addressed within the population health promotion (PHP) model. As part of a national evaluation of Canada's Compassionate Care Benefit, 57 telephone interviews were conducted with Canadian informal P/EOL caregivers in 5 different provinces, pertaining to the strengths and weaknesses of the CCB and the general caregiving experience. Interview data was coded with Nvivo software and emerging themes were identified by the research team, with such findings published elsewhere. The purpose of the present analysis was identified after comparing the findings to the literature specific to caregiver burden and public health, after which data was analyzed using the PHP model as a guiding framework. Informal caregivers spoke to several of the determinants of health outlined in the PHP model that are implicated in their burden experience: gender, income and social status, working conditions, health and social services, social support network, and personal health practises and coping strategies. They recognized the need for improving the CCB to better address these determinants. This study, from the perspective of family caregivers, demonstrates that the CCB is not living up to its full potential in sustaining informal P/EOL caregivers. Effort is required to transform the CCB so that it may fulfill the

Summary of presentations and discussions

International Nuclear Information System (INIS)

Takeuchi, Mitsuo

2008-01-01

In December 2007, the Forum on Stakeholder Confidence discussed its theme entitled 'Link between research, development and demonstration (RD and D) and stakeholder confidence'. It was remarked that regulators need a technical demonstration to aid in evaluating the safety case. Local stakeholders appreciate the opportunity to visualise technological arrangements. In both cases, demonstration adds to confidence in the feasibility of solutions. Some believe there is an important role for analogues in communication with stakeholders, if handled with integrity. To explore and benchmark current practices, it was decided to hold a topical session at the 9. regular meeting of the FSC on 4 June 2008 regarding the use of analogues for confidence building. The session opened with an introductory presentation by the session rapporteur. This incorporated input provided for the purpose by FSC members in cooperation with their country's representative to the NEA RWMC 'Integration Group on the Safety Case'. Three speakers then presented the various uses of analogues by implementers, regulators and scientists to build their own confidence; a fourth speaker dealt with the experience of using natural analogues in public information. The presentations addressed the use of analogues in the field of geological disposal of high-level waste (HLW) and long-lived intermediate level (ILW-LL) radioactive waste. Then the FSC participants split into two working groups for discussion. The outcome of these discussions was reported in plenary on 6 June 2008 and it was agreed to publish proceedings of the session. The present summary, prepared by the session rapporteur with input from the NEA Secretariat, captures the main points heard in the course of the event. It combines data from the formal presentations and remarks made in discussion. The latter represent viewpoints expressed by a group whose primary focus is not natural analogues but rather stakeholder interests. The summary and viewpoints

Pleasing but also unfair - The first year of cost-covering remuneration

International Nuclear Information System (INIS)

Niederhaeusern, A.

2009-01-01

In this interview with Reto Rigassi from Suisse Eole, the Swiss Wind Energy Association, the situation in Switzerland with regard to the cost-covering remuneration (KEV) for renewable energy fed into the public electricity mains is discussed. The economic viability of feeding-in power generated by wind energy installations is discussed in the light of reduced remuneration rates. The financial situation is compared with that prevailing before the introduction of the KEV. The resulting effects on the wind energy business are commented on. The number of installations in service is noted as is alternative financing via 'renewable power stock-exchanges'. Reductions in prices to be expected and the global wind energy situation are also discussed

Discussion of the dizziness handicap inventory.

Science.gov (United States)

Mutlu, Basak; Serbetcioglu, Bulent

2013-01-01

A review of the Dizziness Handicap Inventory (DHI). NUMBER OF STUDIES: Seventy-four studies. Articles published between January 1990 and May 2012 were identified by searches in PubMed electronic database. Of the 227 articles meeting the inclusion criteria 74 were reviewed. These articles are discussed under nine topics; Reliability, validity and internal consistency of the original version of DHI, relationship between vestibular/balance tests and DHI, association between DHI and the other scales related to balance impairments, exploratory factor analysis of the DHI, screening version of DHI, translations of DHI into other languages, the role of DHI to assess the success of the treatment of balance disorder, DHI results in various vestibular disorders, general characteristics of DHI in patients with balance impairment. Self reported measures represent unique pieces of the information important for the management of dizzy patients. DHI is the most widely used self reported measurement of patients with dizziness. It has been translated into fourteen languages, so it is widely accepted.

IRIS Toxicological Review of Tetrahydrofuran (THF) (Interagency Science Discussion Draft)

Science.gov (United States)

EPA is releasing the draft report, Toxicological Review of Tetrahydrofuran, that was distributed to Federal agencies and White House Offices for comment during the Science Discussion step of the iris/process.htm">IRIS Assessment Development Proc...

End-of-Life Care Interventions: An Economic Analysis.

Science.gov (United States)

Pham, B; Krahn, M

2014-01-01

The annual cost of providing care for patients in their last year of life is estimated to account for approximately 9% of the Ontario health care budget. Access to integrated, comprehensive support and pain/symptom management appears to be inadequate and inequitable. To evaluate the cost-effectiveness of end-of-life (EoL) care interventions included in the EoL care mega-analysis. Multiple sources were used, including systematic reviews, linked health administration databases, survey data, planning documents, expert input, and additional literature searches. We conducted a literature review of cost-effectiveness studies to inform the primary economic analysis. We conducted the primary economic analysis and budget impact analysis for an Ontario cohort of decedents and their families and included interventions pertaining to team-based models of care, patient care planning discussions, educational interventions for patients and caregivers, and supportive interventions for informal caregivers. The time horizon was the last year of life. Costs were in 2013 Canadian dollars. Effectiveness measures included days at home, percentage dying at home, and quality-adjusted life-days. We developed a Markov model; model inputs were obtained from a cohort of Ontario decedents assembled from Institute for Clinical Evaluative Sciences databases and published literature. In-home palliative team care was cost-effective; it increased the chance of dying at home by 10%, increased the average number of days at home (6 days) and quality-adjusted life-days (0.5 days), and it reduced costs by approximately $4,400 per patient. Expanding in-home palliative team care to those currently not receiving such services (approximately 45,000 per year, at an annual cost of $76-108 million) is likely to improve quality of life, reduce the use of acute care resources, and save $191-$385 million in health care costs. Results for the other interventions were uncertain. The cost-effectiveness analysis was

Familial Multiple Myeloma: Report on Two Families and Discussion of Screening Options

Directory of Open Access Journals (Sweden)

Gerkes Erica H

2007-06-01

Full Text Available Abstract Multiple myeloma (MM is a relatively rare haematological malignancy seen in older persons. It has an unknown aetiology and usually occurs incidentally within a family. However, several families have been reported with multiple cases of MM, so that the existence of hereditary MM has been postulated although no causative germline mutations have been detected so far. First-degree relatives of MM patients have been reported to have a relative risk between two and four times higher than normal of developing MM and we presume the risks are higher for relatives in the case of familial MM. Here we report on two families with MM who requested presymptomatic screening of healthy relatives. Although risk estimates for asymptomatic relatives in these types of families are not available, a clinically significant risk of developing MM cannot be excluded. We suggest that, in a research setting, screening for MM could be offered to individuals with more than one first-degree affected relative, or to those with one first-degree and at least one second-degree relative with MM. We propose a screening programme of annual protein electrophoresis of blood and urine, starting at age 40 (or earlier if a family member presented with MM at a younger age.

Promoting Discussion in Peer Instruction: Discussion Partner Assignment and Accountability Scoring Mechanisms

Science.gov (United States)

Chou, Chih-Yueh; Lin, Pin-Hsun

2015-01-01

Peer instruction (PI) involves students answering questions and peer discussion learning activities. PI can enhance student performance and engagement in classroom instruction. However, some students do not engage in the discussions. This study proposes two mechanisms, discussion partner assignment and accountability scoring mechanisms, to form…

What do we know about metal recycling rates?

Science.gov (United States)

Graedel, T.E.; Allwood, J.; Birat, J.-P.; Buchert, M.; Hageluken, C.; Reck, B.K.; Sibley, S.F.; Sonnemann, G.

2011-01-01

The recycling of metals is widely viewed as a fruitful sustainability strategy, but little information is available on the degree to which recycling is actually taking place. This article provides an overview on the current knowledge of recycling rates for 60 metals. We propose various recycling metrics, discuss relevant aspects of recycling processes, and present current estimates on global end-of-life recycling rates (EOL-RR; i.e., the percentage of a metal in discards that is actually recycled), recycled content (RC), and old scrap ratios (OSRs; i.e., the share of old scrap in the total scrap flow). Because of increases in metal use over time and long metal in-use lifetimes, many RC values are low and will remain so for the foreseeable future. Because of relatively low efficiencies in the collection and processing of most discarded products, inherent limitations in recycling processes, and the fact that primary material is often relatively abundant and low-cost (which thereby keeps down the price of scrap), many EOL-RRs are very low: Only for 18 metals (silver, aluminum, gold, cobalt, chromium, copper, iron, manganese, niobium, nickel, lead, palladium, platinum, rhenium, rhodium, tin, titanium, and zinc) is the EOL-RR above 50% at present. Only for niobium, lead, and ruthenium is the RC above 50%, although 16 metals are in the 25% to 50% range. Thirteen metals have an OSR greater than 50%. These estimates may be used in considerations of whether recycling efficiencies can be improved; which metric could best encourage improved effectiveness in recycling; and an improved understanding of the dependence of recycling on economics, technology, and other factors. ?? 2011 by Yale University.

Discussion of management review in nuclear power plants

International Nuclear Information System (INIS)

Duan Hongwei; Li Juan; Wang Jing; Zhang Hui; Wang Yanqi; Tian Feng

2015-01-01

According to the nuclear safety regulations and guidelines in China, the information of the IAEA and the NRC, this paper discusses the origin, purpose, method and report of the management review, the basic concepts and requirements. In order to identify the difference between the management review and the internal quality assurance audit, the paper also compares their purpose, nature, the pursuant documents, and etc. (authors)

Administrators' perspectives on end-of-life care for cancer patients in Japanese long-term care facilities.

Science.gov (United States)

Fukahori, Hiroki; Miyashita, Mitsunori; Morita, Tatsuya; Ichikawa, Takayuki; Akizuki, Nobuya; Akiyama, Miki; Shirahige, Yutaka; Eguchi, Kenji

2009-10-01

The purpose of this study was to clarify administrators' perspectives on availability of recommended strategies for end-of-life (EOL) care for cancer patients at long-term care (LTC) facilities in Japan. A cross-sectional survey was conducted with administrators at Japanese LTC facilities. Participants were surveyed about their facilities, reasons for hospitalization of cancer patients, and their perspectives on availability of and strategies for EOL care. The 97 responses were divided into medical facility (n = 24) and non-medical facility (n = 73) groups according to physician availability. The most frequent reasons for hospitalization were a sudden change in patient's condition (49.4%), lack of around-the-clock care (43.0%), and inability to palliate symptoms (41.0%). About 50% of administrators believed their facilities could provide EOL care if supported by palliative care experts. There was no significant difference between facility types (P = 0.635). Most administrators (81.2%) regarded unstable cancer patients as difficult to care for. However, many (68.4%) regarded opioids given orally as easy to administer, but regarded continuous subcutaneous infusion/central venous nutrition as difficult. Almost all administrators believed the most useful strategy was transferring patients to hospitals at the request of patients or family members (96.9%), followed by consultation with palliative care experts (88.5%). Although LTC facilities in Japan currently do not provide adequate EOL care for cancer patients, improvement might be possible with support by palliative care teams. Appropriate models are necessary for achieving a good death for cancer patients. Interventions based on these models are necessary for EOL care for cancer patients in LTC facilities.

Round table discussion during session 1

International Nuclear Information System (INIS)

Aebersold, M.

2004-01-01

The round table discussions of the first session of the Belgium Workshop addressed the following questions: - Accepting or refusing a person, an institution or a grouping as a legitimate Stakeholder who makes the decision and how? - How are the local partnerships built and organised? - How to obtain community support for the partnership's legitimate decisions/findings? - Experience teaches that no decision is reached solely by formal and legal processes. What role do informal processes play? - How can the informal procedures be accepted? Do they need to be made explicit? Discussion took place after the plenary presentations, at tables grouping Belgian stakeholders and FSC delegates. After the discussion, each table's findings were reported to the plenary. Most of the discussion concerned the local partnerships. Important findings were that the statutes for the partnerships were developed by the partnerships themselves and there were no legally binding rules handed down by the federal level. The partnerships are part of an informal process. A legally binding participation (i.e. within the EIA) will be initiated at a later stage. As the partnerships function outside of the formal legal procedure, they can function in a more flexible way. It was noted that the partnerships make recommendations, but it is not clear what the government will do with these recommendations. It was also argued that the process may cause conflicts between neighboring communities. As in other contexts visited by the FSC, the importance of the right of veto of the community was stressed, although this may cause a conflict between technical suitability and social acceptance. Access of the community to the local partnership is necessary. Finally it was accepted that time is needed to explain the recommendations to the broader community before any decisions are taken. (author)

Advances and bottlenecks in modelling the greenhouse climate: summary of a group discussion

NARCIS (Netherlands)

Seginer, I.; Bakker, J.C.

1998-01-01

This report is a summary of a group discussion at the symposium 'Models in protected cultivation' held in Wageningen, August 1997. The discussion focused on the reasons for the relatively limited acceptance and application of greenhouse climate models, especially in commercial practice. The

Application of GRA for Sustainable Material Selection and Evaluation Using LCA

Science.gov (United States)

Jayakrishna, Kandasamy; Vinodh, Sekar; Sakthi Sanghvi, Vijayaselvan; Deepika, Chinadurai

2016-07-01

Material selection is identified as a successful key parameter in establishing any product to be sustainable, considering its end of life (EoL) characteristics. An accurate understanding of expected service conditions and environmental considerations are crucial in the selection of material plays a vital role with overwhelming customer expectations and stringent laws. Therefore, this article presents an integrated approach for sustainable material selection using grey relational analysis (GRA) considering the EoL disposal strategies with respect to an automotive product. GRA, an impact evaluation model measures the degree of similarity between the comparability (choice of material) sequence and reference (EoL strategies) sequence based on the relational grade. The ranking result shows that the outranking relationships in the order, ABS-REC > PP-INC > AL-REM > PP-LND > ABS-LND > ABS-INC > PU-LND > AL-REC > AL-LND > PU-INC > AL-INC. The best sustainable material selected was ABS and recycling was selected as the best EoL strategy with the grey relational value of 2.43856. The best material selected by this approach, ABS was evaluated for its viability using life cycle assessment and the estimated impacts also proved the practicability of the selected material highlighting the focus on dehumidification step in the manufacturing of the case product using this developed multi-criteria approach.

Saturday 4 November 2006: Eole and/or E.ON fault?

International Nuclear Information System (INIS)

Poizat, F.

2006-12-01

According to the UCTE (Union for the Coordination of Transmission of Electricity) Interim Report, it appears that the wind generators all over Europe suffered from the over-frequencies or under-frequencies resulting from the splitting of the European electricity transmission grid: besides 15 million customers being cut off from the electric supply, more than 10,000 MW, i.e. 60 % of the wind generation became un-operational. This made the production deficiency in Western Europe even worse, constraining the grid controllers to proceed with further load shedding in order to recover the situation. Moreover, as the classic production units were being stopped to reduce the excessive frequency, the wind generators in the Eastern zone began to reconnect automatically as the over-frequency was progressively being damped, complicating the task of the Central European dispatchers, at the risk of a complete collapse. Adding to the anarchic behavior of the wind generators is the suspicion that they contributed to the set of circumstances (human and organizational errors in particular) from which the black-out originated. This hypothesis rests on the poor accuracy of the production projections of a wind energy fleet as large as that of Germany (a power capacity reaching almost 20,000 MW)

International Space Station End-of-Life Probabilistic Risk Assessment

Science.gov (United States)

Duncan, Gary W.

2014-01-01

The International Space Station (ISS) end-of-life (EOL) cycle is currently scheduled for 2020, although there are ongoing efforts to extend ISS life cycle through 2028. The EOL for the ISS will require deorbiting the ISS. This will be the largest manmade object ever to be de-orbited therefore safely deorbiting the station will be a very complex problem. This process is being planned by NASA and its international partners. Numerous factors will need to be considered to accomplish this such as target corridors, orbits, altitude, drag, maneuvering capabilities etc. The ISS EOL Probabilistic Risk Assessment (PRA) will play a part in this process by estimating the reliability of the hardware supplying the maneuvering capabilities. The PRA will model the probability of failure of the systems supplying and controlling the thrust needed to aid in the de-orbit maneuvering.

Accuracy and congruence of patient and physician weight-related discussions: from Project CHAT (Communicating Health: Analyzing Talk)

Science.gov (United States)

Bodner, Michael E.; Dolor, Rowena J.; Óstbye, Truls; Lyna, Pauline; Alexander, Stewart C.; Tulsky, James A.; Pollak, Kathryn I.

2014-01-01

Objective Primary care providers should counsel overweight patients to lose weight. Rates of self-reported weight-related counseling vary, perhaps due to self-report bias. We assessed accuracy and congruence of weight-related discussions among patients, physicians, and audio-recorded encounters. Methods We audio recorded encounters between physicians (n=40) and their overweight/obese patients (n=461) at five community-based practices. We coded weight-related content and surveyed patients and physicians immediately after the visit. Generalized linear mixed models assessed factors associated with accuracy. Results Overall, accuracy was moderate: patient (67%), physician (70%), and congruence (62%). When encounters contained weight-related content were analyzed, patients (98%) and physicians (97%) were highly accurate and congruent (95%) but when weight was not discussed patients and physicians were more inaccurate and incongruent (patient 36%; physician 44%; 28% congruence). Physicians less comfortable discussing weight were more likely to misreport that weight was discussed [OR = 4.5 (95% CI=1.88–10.75, p<0.001)]. White physicians with African-American patients were more likely to report accurately no discussion about weight than White physicians with White patients OR=0.30 (95% CI=0.13–0.69, p<0.01). Conclusion Physician and patient self-report of weight-related discussions were highly accurate and congruent when audio-recordings indicated weight was discussed, but not when recordings indicated no weight discussions. Physician overestimation of weight discussions when weight is not discussed constitutes missed opportunities for health interventions. PMID:24390888

Protection of the environment from the effects of ionizing radiation. A report for discussion

International Nuclear Information System (INIS)

1999-07-01

The acceptability of practices which involve the release of radionuclides into the environment, and of situations where residual radionuclides from accidents or improperly controlled practices exist in the environment, are generally assessed on the basis of implied radiation doses to humans. This approach is consistent with the recommendations of the International Commission on Radiological Protection (ICRP), which include the statement that 'the standard of environmental control needed to protect man to the degree currently thought desirable will ensure that other species are not put at risk'. The general applicability of this statement has been explored in previous IAEA and other publications. These concluded that the statement is generally valid but that reliance upon human based radiological protection criteria may not be adequate for all possible space or time scales. In recent years awareness of the vulnerability of the environment has increased and the need to protect it against the effects of industrial pollutants has been recognized. This trend is reflected in new and developing international policies for environmental protection. In the context of protection of the environment against ionizing radiation, the existing international approach is being challenged in some IAEA Member States and proposals are being made for strategies which provide for explicit protection of the environment. The present publication represents a first step towards establishing an internationally accepted philosophy and associated methodology for protecting the environment against ionizing radiations. The report reviews the various related issues and examines possible approaches to establishing criteria. It is intended for use in stimulating discussion on the subject in Member States. For its part, the IAEA intends to continue a programme of work in this area with the long term objective of providing specific recommendations on primary protection criteria and methods for

Use of Simulation in End-of-Life Care Education.

Science.gov (United States)

Grabow, Debra

Death and dying encompasses the period when individuals present with a limited prognosis and are near death or have recently died. Using simulation to educate nurses on end-of-life (EOL) care helps focus more on the needs of the learner rather than the patient, and allows the learner to process feelings in preparation for a real experience. Incorporating simulation with a spiritual perspective is essential and needed in EOL nursing care.

Parental perceptions of forgoing artificial nutrition and hydration during end-of-life care.

Science.gov (United States)

Rapoport, Adam; Shaheed, Jenny; Newman, Christine; Rugg, Maria; Steele, Rose

2013-05-01

Forgoing artificial nutrition and hydration (FANH) in children at the end of life (EOL) is a medically, legally, and ethically acceptable practice under specific circumstances. However, most of the evidence on FANH involves dying adults. There is a paucity of pediatric evidence to guide health care providers' and parents' decision-making around this practice. Objectives were (1) to explore the experiences of bereaved parents when a decision had been made to FANH during EOL care for their child and (2) to describe the perceived quality of death in these children, as reported by their parents. This was a qualitative study using in-depth interviews with parents whose children died after a decision to FANH. Parental perceptions about the experience and their child's quality of death were explored. Interviews were audiotaped and transcribed, then data were analyzed by using interpretive description methodology. All parents were satisfied with their decision to FANH and believed that their child's death was generally peaceful and comfortable. The child's perceived poor quality of life was central to the decision to FANH, with feeding intolerance often contributing to this perception. Despite overall satisfaction, all parents had doubts and questions about the decision and benefited from ongoing assurances from the clinical team. FANH in children at the EOL is an acceptable form of palliation for some parents and may contribute to a death that is perceived to be peaceful and comfortable. In situations in which FANH may be a reasonable possibility, physicians should be prepared to introduce the option.

Discussion forum for researchers in nuclear geology. Programme and abstracts

International Nuclear Information System (INIS)

Brynard, H.J.

1986-11-01

The Atomic Energy Corporation of SA Ltd (AEC) sponsors research in nuclear geology at several South African universities with a view to delineating target areas for uranium prospecting by mining companies. In order to ensure the efficient co-ordination of this research an annual meeting is held where sponsored researchers and other organizations report on their progress during the year. This ensures valuable cross-pollination of ideas, and an input from the mining industry is gained as to which direction future research should take. The results of the researchers reported on at these meetings is not necessarily complete and the abstracts in this volume should therefore not be regarded as conclusive. In this discussion forum uranium in granites and uranium in sedimentory deposits are covered. The geochemical anomalies of uranium as well as the geohydrology and its application in defining uranium are also discussed

Learning through Discussions

Science.gov (United States)

Ellis, Robert A.; Calvo, Rafael; Levy, David; Tan, Kelvin

2004-01-01

Students studying a third-year e-commerce subject experienced face-to-face and online discussions as an important part of their learning experience. The quality of the students' experiences of learning through those discussions is investigated in this study. This study uses qualitative approaches to investigate the variation in the students'…

Closing the loop of EOL concrete

NARCIS (Netherlands)

Lotfi, Somayeh; Rem, P.C.; Di Maio, F.; Teklay, Abraham; Hu, M.; van Roekel, E; van der Stelt, H; Di Maio, F.; Lotfi, S.; Bakker, M.; Hu, M.; Vahidi, A.

2017-01-01

Production of waste materials, via industrial and human activities, creates big environmental and economic problems but also opportunities to recover valuable resources. EU28 currently generates 461 million tons per year of ever more complex Construction and Demolition Waste (CDW) with average

Public Spaces For The Discussion Of Peru.

Directory of Open Access Journals (Sweden)

Cynthia E. Milton.

2007-12-01

Full Text Available In theaftermath of civil conflict and a truth commission into twenty years of violence (19802000, Peru is presently engaged in the difficult task of establishing overarching narratives that provide frameworks for organizing personal and collective memories in the few public spaces available for the discussion of this recent past. This article looks at two public spaces, a series of performative events in Ayacucho duringthe submission of the truth commission's Final Report, and Lima's memorysite, The Eye that Cries. One contentious memory is over who are appropriate victims and heroes to remember.

LITHIUM TOXICITY IN ELDERLY-A CASE REPORT AND DISCUSSION

Directory of Open Access Journals (Sweden)

Mariana D. Arnaoudova

2014-07-01

Full Text Available Background: The therapeutic effect of Lithium as a mono therapy or as an augmenting agent in a variety of medical and psychiatric disorders is under doubt. However, lithium is associated with a number of adverse effects. Method and objective: A review of the literature on lithium use in older adults and a case report presentation. Summary of results: The literature, concerning current uses of Lithium in older patients, especially for patients with neurologic or cognitive impairments is limited due to the lack of well-designed, large clinical trials. Elderly patients are at higher risk to develop neurotoxicity in the course of lithium therapy. We present a case of 66 years old female patient, suffering bipolar disorder, who developed lithium toxicity and was admitted at the gerontopsychiatric department due to a confusional state, tremor and gait abnormality. Lithium toxicity was suspected when sufficient information about previous medical history of lithium therapy has been obtained. Lithium level found to be 1.69mmol/L. The patient has developed intoxication during maintenance therapy with a lithium dosage which had been unchanged for months. Conclusion: Elderly patients require lower doses of Lithium to achieve similar serum concentrations as those in younger adults. Neurotoxicity could be suspected at serum lithium levels which are considered therapeutic in younger adults. When prescribing lithium agents in elderly we should consider age-related changes in pharmacokinetics. The best way to prevent lithium toxicity is to control the serum concentration regularly during therapy.

Time-series product and substance flow analyses of end-of-life electrical and electronic equipment in China

International Nuclear Information System (INIS)

Habuer,; Nakatani, Jun; Moriguchi, Yuichi

2014-01-01

Highlights: • We estimate the possession and obsolescence of household appliances (HAs) in China. • Over 4.8–5.1 billion units of major HAs will be discarded in the next 20 years. • We calculate the amounts of substances contained in end-of-life (EoL) TV sets. • Less common metals will tend to decrease in content in generation of EoL TV sets. • Precious metals will tend to increase in content in EoL TV sets in 2015–2030. - Abstract: Given the amounts of end-of-life electrical and electronic equipment (EoL-EEE) being generated and their contents of both harmful and valuable materials, the EoL-EEE issue should be regarded not only as an emerging environmental problem but also as a resource management strategy in China. At present, in order to provide the basis for managing EoL-EEE at both product and substance levels in China, it is necessary to carry out a quantitative analysis on EoL-EEE and to determine how much of it will be generated and how much materials and substances it contains. In this study, the possession and obsolescence amounts of five types of household appliance (HA) including television (TV) sets and the amounts of substances contained in EoL TV sets were estimated using time-series product flow analysis (PFA) and substance flow analysis (SFA). The results of PFA indicated that the total possession amounts of those five types of HAs will exceed 3.1 billion units in 2030, which will be two times higher than those in 2010. In addition, it was estimated that cumulatively over 4.8–5.1 billion units of these five types of EoL HA would be obsoleted between 2010–2030. The results of SFA on TV sets indicated that the generated amounts of most of the less common metals and a part of common metals such as copper (Cu) would tend to decrease, whereas those of other common metals such as iron (Fe) as well as precious metals would tend to increase in EoL TV sets in 2015–2030. The results of this study provide a quantitative basis for helping

Time-series product and substance flow analyses of end-of-life electrical and electronic equipment in China

Energy Technology Data Exchange (ETDEWEB)

Habuer,, E-mail: habuer@env.t.u-tokyo.ac.jp; Nakatani, Jun; Moriguchi, Yuichi

2014-02-15

Highlights: • We estimate the possession and obsolescence of household appliances (HAs) in China. • Over 4.8–5.1 billion units of major HAs will be discarded in the next 20 years. • We calculate the amounts of substances contained in end-of-life (EoL) TV sets. • Less common metals will tend to decrease in content in generation of EoL TV sets. • Precious metals will tend to increase in content in EoL TV sets in 2015–2030. - Abstract: Given the amounts of end-of-life electrical and electronic equipment (EoL-EEE) being generated and their contents of both harmful and valuable materials, the EoL-EEE issue should be regarded not only as an emerging environmental problem but also as a resource management strategy in China. At present, in order to provide the basis for managing EoL-EEE at both product and substance levels in China, it is necessary to carry out a quantitative analysis on EoL-EEE and to determine how much of it will be generated and how much materials and substances it contains. In this study, the possession and obsolescence amounts of five types of household appliance (HA) including television (TV) sets and the amounts of substances contained in EoL TV sets were estimated using time-series product flow analysis (PFA) and substance flow analysis (SFA). The results of PFA indicated that the total possession amounts of those five types of HAs will exceed 3.1 billion units in 2030, which will be two times higher than those in 2010. In addition, it was estimated that cumulatively over 4.8–5.1 billion units of these five types of EoL HA would be obsoleted between 2010–2030. The results of SFA on TV sets indicated that the generated amounts of most of the less common metals and a part of common metals such as copper (Cu) would tend to decrease, whereas those of other common metals such as iron (Fe) as well as precious metals would tend to increase in EoL TV sets in 2015–2030. The results of this study provide a quantitative basis for helping

INFORMATION SCIENCE--OUTLINE, ASSESSMENT, INTERDISCIPLINARY DISCUSSION. REPORT FOR JUNE, 1965-JUNE, 1966.

Science.gov (United States)

IBERALL, A.S.

THIS REPORT PROVIDES AN ASSESSMENT AND INTRODUCTION TO THE INTERDISCIPLINARY LITERATURE OF THREE APSECTS OF INFORMATION SCIENCE, IN ANNOTATED BIBLIOGRAPHY FORM. THESE ARE--COMMUNICATION NETWORKS, HUMAN INFORMATION PROCESSES (PRINCIPALLY LANGUAGE AND INFORMATION RETRIEVAL), AND THE LARGE CYBERNETIC SYSTEMS SUCH AS THE HUMAN BRAIN AND CENTRAL…

IRIS Toxicological Review of Trichloroacetic Acid (TCA) (Interagency Science Discussion Draft)

Science.gov (United States)

EPA is releasing the draft report, Toxicological Review of Trichloroacetic Acid (TCA), that was distributed to Federal agencies and White House Offices for comment during the Science Discussion step of the IRIS Assessment Development ...

E-Cigarette Liquid Nicotine Ingestion in a Child: Case Report and Discussion.

Science.gov (United States)

Gill, Natasha; Sangha, Gurinder; Poonai, Naveen; Lim, Rodrick

2015-11-01

Nicotine poisoning is well described in the pediatric population, and even small oral doses may result in toxic effects. The source of nicotine is usually tobacco products and nicotine replacement products such as gum and patches. With the more frequent use of novel products such as e-cigarettes, concern has arisen regarding liquid nicotine. As there are no regulations regarding childproof bottling and packaging, there may be increased potential for unintentional ingestion of these colorfully and appealingly packaged products by children. We present and discuss a case of this nature, as we feel emergency physicians should be aware of this new mode of poisoning, and public health efforts should be made to minimize such exposures.

Measuring, Reporting and Verifying Nationally Appropriate Mitigation Actions. Reflecting experiences under the Mitigation Momentum Project. Discussion paper

Energy Technology Data Exchange (ETDEWEB)

De Vit, C.; Roeser, F.; Fekete, H.; Hoehne, N.; Wartmann, S.; Van Tilburg, X.; Larkin, J.; Escalante, D.; Haensel, G.; Veum, K.; Cameron, L.; Halcomb, J.

2013-06-15

The Mitigation Momentum project aims to support the development of Nationally Appropriate Mitigation Actions (NAMAs). It contributes to the concrete design of NAMA proposals in five countries (Peru, Chile, Indonesia, Tunisia and Kenya). A further aim is to foster cooperation and knowledge exchange within the NAMA community while advancing the international climate policy debate on mitigation and related issues, including approaches for the Measurement, Reporting and Verification (MRV) of NAMAs. MRV enables the assessment of the effectiveness of both internationally supported NAMAs (supported NAMAs) and domestically supported NAMAs (unilateral NAMAs) by tracking NAMA impacts including greenhouse gas (GHG) emission reductions and non-GHG related impacts such as sustainable development benefits. MRV also supports improved policy design and decision making through systematic progress reporting and is a key tool to ensure accountability of NAMA stakeholders. Both host countries and funders share the common interest of having strong, implementable MRV systems in place. From both perspectives, this raises a number of questions, as well as potential challenges, on how to adapt the MRV approach to the specific circumstances of each NAMA. The objective of this paper is to identify open issues for the MRV of impacts of NAMAs, understood here as implementable actions, i.e. a project, a policy, a programme or a strategy. It pays particular attention to NAMAs with a supported component and reflects relevant initial experiences with developing NAMA proposals in the five Mitigation Momentum countries (i.e. using country examples where appropriate). As MRV systems for these NAMAs are still under development or at their preliminary stage, we hope to share further lessons learned in a subsequent discussion paper. Key challenges analysed in this paper include: How to design a MRV system that satisfies both the host country's and funder's expectations while complying with

End-of-life resource recovery from emerging electronic products

DEFF Research Database (Denmark)

Parajuly, Keshav; Habib, Komal; Cimpan, Ciprian

2016-01-01

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

Social Work Practice with LGBT Elders at End of Life: Developing Practice Evaluation and Clinical Skills Through a Cultural Perspective.

Science.gov (United States)

Arthur, Darren P

2015-01-01

This article focuses on culturally sensitive clinical issues related to best practices with lesbian, gay, bisexual, transgender (LGBT) elder patients at end-of-life (EOL) at key points in the therapeutic relationship. Vital concepts, including practice evaluation and clinical skills, are presented through a cultural and oncology lens. There is a paucity of LGBT research and literature as well as a shortfall of MSW graduate school education specific to social work palliative and end-of-life care (PELC) practice with LGBT elders. The content of this article is designed to be adapted and used as an educational tool for institutions, agencies, graduate programs, medical professions, social work, and students. Learning the unique elements of LGBT cultural history and their implications on EOL care can improve social work practice. This article provides an examination from assessment and engagement basics to advance care planning incorporating specific LGBT EOL issues.

Session 1 - discussion

International Nuclear Information System (INIS)

Wells, C.; Richards, K.M.; McKerrow, J.F.

1991-01-01

This discussion session of the Landfill Gas-Energy and Environment 90 Conference covered the landfill gas potential, the setting up of the Non-Fossil Fuel Obligation; anticipated developments in the post 1998 period, the problem of smell for those who live near a landfill, and the length of time a landfill site is productive in terms of gas evolution. Relevant regulations in California are briefly discussed. (author)

Background discussion document on energy in New Brunswick, 1990-2000

Energy Technology Data Exchange (ETDEWEB)

1990-01-01

Outline of the role of governments and the private sector in energy development and detailed discussion of energy supply and demand, including indigenous and imported energy supplies and projections of electrical energy demand to 2000. Energy efficiency and conservation is presented as a cornerstone and major initiative to help meet the expected energy needs of the future. A number of major projects being considered in the electrical energy development area are outlined for the 1990s. Details are given on environmental effects and the need for sustainable development. The report concludes with a discussion of transportion and the need for R D. This document is the initial step in the development of a provincial energy policy and is intended to serve as a background discussion paper for the public consultation process.

Assessment of regulatory effectiveness. Peer discussions on regulatory practices

International Nuclear Information System (INIS)

1999-09-01

This report arises from the seventh series of peer discussions on regulatory practices entitled 'Assessment of Regulatory Effectiveness'. The term 'regulatory effectiveness' covers the quality of the work and level of performance of a regulatory body. In this sense, regulatory effectiveness applies to regulatory body activities aimed at preventing safety degradation and ensuring that an acceptable level of safety is being maintained by the regulated operating organizations. In addition, regulatory effectiveness encompasses the promotion of safety improvements, the timely and cost effective performance of regulatory functions in a manner which ensures the confidence of the operating organizations, the general public and the government, and striving for continuous improvements to performance. Senior regulators from 22 Member States participated in two peer group discussions during March and May 1999. The discussions were focused on the elements of an effective regulatory body, possible indicators of regulatory effectiveness and its assessment. This report presents the outcome of these meetings and recommendations of good practices identified by senior regulators, which do not necessarily reflect those of the governments of the nominating Member States, the organizations they belong to, or the International Atomic Energy Agency. In order to protect people and the environment from hazards associated with nuclear facilities, the main objective of a nuclear regulatory body is to ensure that a high level of safety in the nuclear activities under its jurisdiction is achieved, maintained and within the control of operating organizations. Even if it is possible to directly judge objective safety levels at nuclear facilities, such safety levels would not provide an exclusive indicator of regulatory effectiveness. The way the regulatory body ensures the safety of workers and the public and the way it discharges its responsibilities also determine its effectiveness. Hence the

Summary discussions

International Nuclear Information System (INIS)

Ritchie, R.H.

1982-01-01

Remarks intended to highlight topics of importance for future research were made by three of the participants at the conclusion of the Seminar. A brief listing is given of topics discussed by each of these rapporteurs

Cascade Model for Online Discussion Boards in an E-Learning Environment

Directory of Open Access Journals (Sweden)

Vibha Kumar

2010-03-01

Full Text Available This report is an outcome of five years of teaching and managing groups of students in an online learning environment. Some course management software allow the user to create groups and add different links within each group. Distinct platforms, with various sections, can be formed within those links for any given project. Students, as well as instructors, can manage the project for 6 to 8 weeks, cascading one discussion board into one or multiple platforms. This provides better understanding of the project material due to the step by step layout of the given exercise, leading to increased group management and greater communication among the student group members. This report provides the step-by-step procedure for cascading one discussion board into platforms, to manage online projects and provide a more controlled online environment for students in higher education.

Staff perceptions of end-of-life care in the acute care setting: a New Zealand perspective.

Science.gov (United States)

Sheward, Karen; Clark, Jean; Marshall, Bridget; Allan, Simon

2011-05-01

Understanding current end of life (EOL) care delivery in acute care is an important prerequisite to positively influencing practice, and published New Zealand (NZ) and international data are limited. Therefore, staff perceptions of EOL care in the hospital setting were investigated via survey. This article presents key findings. A total of 610 staff members in a 194-bed regional hospital were surveyed regarding their perceptions of EOL care, which yielded a response rate of 29% with 179 surveys returned. Respondents were from medical, nursing, and allied health staff working in medical, surgical, elder health, and a regional cancer treatment service. Responses to Likert scale statements regarding the Care of the dying, Communication, Teamwork, Documentation, Attitudes to death and dying in the workplace, and Barriers to the care of patients, their whānau (a NZ Māori word that refers to extended family or family group), and families frequently contrasted with additional and explanatory comments. The thematic analysis of written text identified five themes: The reality of care, The team dynamic, The direction of care, Knowledge and education, and Environmental and organizational factors. The quality and timeliness of EOL care was significantly influenced by the elements informing the themes and the pervasive nature and importance of communication. Meeting the needs of dying patients in acute care was complex but a significant priority for staff.

Focus group discussions

CERN Document Server

Hennink, Monique M

2014-01-01

The Understanding Research series focuses on the process of writing up social research. The series is broken down into three categories: Understanding Statistics, Understanding Measurement, and Understanding Qualitative Research. The books provide researchers with guides to understanding, writing, and evaluating social research. Each volume demonstrates how research should be represented, including how to write up the methodology as well as the research findings. Each volume also reviews how to appropriately evaluate published research. Focus Group Discussions addresses the challenges associated with conducting and writing focus group research. It provides detailed guidance on the practical and theoretical considerations in conducting focus group discussions including: designing the discussion guide, recruiting participants, training a field team, moderating techniques and ethical considerations. Monique Hennink describes how a methodology section is read and evaluated by others, such as journal reviewers or ...

Discussion on ``Frontiers of the Second Law''

Science.gov (United States)

Lloyd, Seth; Bejan, Adrian; Bennett, Charles; Beretta, Gian Paolo; Butler, Howard; Gordon, Lyndsay; Grmela, Miroslav; Gyftopoulos, Elias P.; Hatsopoulos, George N.; Jou, David; Kjelstrup, Signe; Lior, Noam; Miller, Sam; Rubi, Miguel; Schneider, Eric D.; Sekulic, Dusan P.; Zhang, Zhuomin

2008-08-01

This article reports an open discussion that took place during the Keenan Symposium "Meeting the Entropy Challenge" (held in Cambridge, Massachusetts, on October 4, 2007) following the short presentations—each reported as a separate article in the present volume—by Adrian Bejan, Bjarne Andresen, Miguel Rubi, Signe Kjelstrup, David Jou, Miroslav Grmela, Lyndsay Gordon, and Eric Schneider. All panelists and the audience were asked to address the following questions • Is the second law relevant when we trap single ions, prepare, manipulate and measure single photons, excite single atoms, induce spin echoes, measure quantum entanglement? Is it possible or impossible to build Maxwell demons that beat the second law by exploiting fluctuations? • Is the maximum entropy generation principle capable of unifying nonequilibrium molecular dynamics, chemical kinetics, nonlocal and nonequilibrium rheology, biological systems, natural structures, and cosmological evolution? • Research in quantum computation and quantum information has raised many fundamental questions about the foundations of quantum theory. Are any of these questions related to the second law?

Case-based discussion supporting learning and practice in optometry.

Science.gov (United States)

Bullock, Alison; Barnes, Emma; Ryan, Barbara; Sheen, Nik

2014-09-01

To enhance continuing professional development and address the risk that professional isolation poses, the UK General Optical Council introduced a requirement for all optometrists to engage in at least one case-based discussion per 3 year cycle of continuing education. In this paper, we explore participants' impression of the acceptability, effectiveness and long-term impact-on-practice of case-based discussion as a mode of continuing education. Case-based discussion participants attended an evening session comprising a lecture and a group discussion. They completed three questionnaires: prior to the session, immediately post-session and 3-4 months post-session. We coded the questionnaires to allow matching. Seventy-five case-based discussion groups were held with 379 participants; 377 completed both pre- and post-questionnaires and 331 (88%) returned a follow-up questionnaire. Case-based discussions were an acceptable method of learning, with many preferring it to distance-learning. Prior to the event, women, employees and part-time workers were more likely to have concerns about participating. In terms of learning, gaps in knowledge were more likely to be revealed in those who work in isolation. The respondents highlighted social aspects, reassurance of practice as well as new learning. Participants significantly improved self-confidence ratings in all key learning areas. At three months post-session, the majority (75%) self-reported that they had implemented their intended changes to practice. The evaluation showed that participants felt that case-based discussion developed their knowledge, notably for sole practitioners, and influenced later workplace practice. The peer interaction of this mode of continuing education can combat professional isolation. © 2014 The Authors Ophthalmic & Physiological Optics © 2014 The College of Optometrists.

A knowledge synthesis of culturally- and spiritually-sensitive end-of-life care: findings from a scoping review

OpenAIRE

Fang, Mei Lan; Sixsmith, Judith; Sinclair, Shane; Horst, Glen

2016-01-01

Background Multiple factors influence the end-of-life (EoL) care and experience of poor quality services by culturally- and spiritually-diverse groups. Access to EoL services e.g. health and social supports at home or in hospices is difficult for ethnic minorities compared to white European groups. A tool is required to empower patients and families to access culturally-safe care. This review was undertaken by the Canadian Virtual Hospice as a foundation for this tool. Methods To explore atti...

Review and meta-analysis of 82 studies on end-of-life management methods for source separated organics.

Science.gov (United States)

Morris, Jeffrey; Scott Matthews, H; Morawski, Clarissa

2013-03-01

This article reports on a literature review and meta-analysis of 82 studies, mostly life cycle assessments (LCAs), which quantified end-of-life (EOL) management options for organic waste. These studies were reviewed to determine the environmental preferability, or lack thereof, for a number of EOL management methods such as aerobic composting (AC), anaerobic digestion (AD), gasification, combustion, incineration with energy recovery (often denoted as waste-to-energy incineration), mechanical biological treatment, incineration without energy recovery (sometimes referenced by just the word "incineration"), and landfill disposal with and without energy recovery from generated methane. Given the vast differences in boundaries as well as uncertainty and variability in results, the LCAs among the 82 studies provided enough data and results to make conclusions regarding just four EOL management methods - aerobic composting, anaerobic digestion, mass burn waste-to-energy (WTE), and landfill gas-to-energy (LFGTE). For these four, the LCAs proved sufficient to determine that aerobic composting and anaerobic digestion are both environmentally preferable to either WTE or LFGTE in terms of climate change impacts. For climate change, LCA results were mixed for WTE versus LFGTE. Furthermore, there is a lack of empirically reliable estimates of the amount of organics input to AD that is converted to energy output versus remaining in the digestate. This digestate can be processed through aerobic composting into a compost product similar to the compost output from aerobic composting, assuming that the same type of organic materials are managed under AD as are managed via AC. The magnitude of any trade-off between generation of energy and production of compost in an AD system appears to be critical for ranking AC and AD for differing types of organics diversion streams. These results emphasize how little we generally know, and exemplify the fact that in the reviewed literature no

The Right Place at the Right Time: Medical Oncology Outpatients' Perceptions of Location of End-of-Life Care.

Science.gov (United States)

Waller, Amy; Sanson-Fisher, Rob; Zdenkowski, Nicholas; Douglas, Charles; Hall, Alix; Walsh, Justin

2018-01-01

Background: Helping people achieve their preferred location of care is an important indicator of quality end-of-life (EOL) care. Using a sample of Australian medical oncology outpatients, this study examined (1) their preferred location of EOL care; (2) their perceived benefits and worries of receiving care in that location; (3) the percentage who had discussed preferences with their doctor and/or support person; and (4) whether they wanted their doctor to ask them where they wanted to die. Methods: Adults with a confirmed diagnosis of cancer were approached between September 2015 and January 2016 in the waiting room of an Australian oncology outpatient clinic. Consenting participants completed a home-based pen-and-paper survey indicating preferred location of care, perceived benefits and worries of that location, whether they had discussed preferences with their doctors, and whether they were willing to be asked about their preferences. Results: A total of 203 patients returned the survey (47% of those eligible). Less than half preferred to be cared for at home (47%), 34% preferred a hospice/palliative care unit, and 19% preferred the hospital. Common benefits and worries associated with locations included perceived burden on others, familiarity of environment, availability of expert medical care, symptom management, and likelihood of having wishes respected. More patients had discussed preferences with their support persons (41%) than doctors (7%). Most wanted a doctor to ask them about preferred location of care (87%) and thought it was important to die in the location of their choice (93%). Conclusions: Patients were willing to have clinicians to ask them where they wanted to die, although few had discussed their preferences with doctors. Although home was the most preferred location for many patients, the overall variation suggests that clinicians should adopt a systematic approach to eliciting patient preferences. Copyright © 2018 by the National

End-of-life care across Southern Europe: a critical review of cultural similarities and differences between Italy, Spain and Portugal.

Science.gov (United States)

Meñaca, Arantza; Evans, Natalie; Andrew, Erin V W; Toscani, Franco; Finetti, Silvia; Gómez-Batiste, Xavier; Higginson, Irene J; Harding, Richard; Pool, Robert; Gysels, Marjolein

2012-06-01

Evidence from a range of sources demonstrates that end-of-life (EoL) care practices and preferences vary across countries; culture is consistently one of the main explanations given for this. In order to understand how cultural factors are used to explain similarities and differences in EoL care between Spain, Italy and Portugal, database and hand searches were performed and cross-cutting core themes identified. Similarities included higher proportions of people who wished to die at home than actually died at home, a persistent trend for partial disclosure in Italy and Spain, low use of advance directives, and low incidence of all medical EoL decisions (with the exception of terminal sedation) compared to northern European countries. The role of religion and the importance of family ties were the two main cultural factors used to explain the similarities. Further research is needed in order to interpret the important differences that were also found. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Engaging Patients With Advance Directives Using an Information Visualization Approach.

Science.gov (United States)

Woollen, Janet; Bakken, Suzanne

2016-01-01

Despite the benefits of advance directives (AD) to patients and care providers, they are often not completed due to lack of patient awareness. The purpose of the current article is to advocate for creation and use of an innovative information visualization (infovisual) as a health communication tool aimed at improving AD dissemination and engagement. The infovisual would promote AD awareness by encouraging patients to learn about their options and inspire contemplation and conversation regarding their end-of-life (EOL) journey. An infovisual may be able to communicate insights that are often communicated in words, but are much more powerfully communicated by example. Furthermore, an infovisual could facilitate vivid understanding of options and inspire the beginning of often difficult conversations among care providers, patients, and loved ones. It may also save clinicians time, as care providers may be able to spend less time explaining details of EOL care options. Use of an infovisual could assist in ensuring a well-planned EOL journey. Copyright 2016, SLACK Incorporated.

Theoretical and experimental discussion of Ixion, a possible thermonuclear device

Energy Technology Data Exchange (ETDEWEB)

Boyer, K; Hammel, J E; Longmire, C L; Nagle, D; Ribe, F L; Riesenfeld, W B [Los Alamos Scientific Laboratory, University of California, Los Alamos, NM (United States)

1958-07-01

Theoretical discussions of the diamagnetic effects and of the mirror enhancement brought about by the ion centrifugal force are presented and experiments are discussed. The successive operation of three models of Ixion are reported. The models differ primarily in the ranges of electric and magnetic fields which were used and in the series inductances of the electrical leads which in each case connected Ixion to energized capacitor banks. The first two models are with metallic center electrodes, while the latest version, Ixion III, has a 'plasma center electrode' It is believed that these experiments demonstrate the containment of a rotating plasma, although impurities are limiting the energy that can be contained.

Plutonium roundtable discussion

International Nuclear Information System (INIS)

Penneman, R.A.

1982-01-01

The roundtable discussion began with remarks by the chairman who pointed out the complicated nature of plutonium chemistry. Judging from the papers presented at this symposium, he noticed a pattern which indicated to him the result of diminished funding for investigation of basic plutonium chemistry and funding focused on certain problem areas. Dr. G.L. silver pointed to plutonium chemists' erroneous use of a simplified summary equation involving the disproportionation of Pu(EV) and their each of appreciation of alpha coefficients. To his appreciation of alpha coefficients. To his charges, Dr. J.T. Bell spoke in defense of the chemists. This discussion was followed by W.W. Schulz's comments on the need for experimental work to determine solubility data for plutonium in its various oxidation states under geologic repository conditions. Discussion then turned to plutonium pyrachemical process with Dana C. Christensen as the main speaker. This paper presents edited versions of participants' written version

Visual Linguistic Analysis of Political Discussions : Measuring Deliberative Quality

OpenAIRE

Gold, Valentin; El-Assady, Mennatallah; Hautli-Janisz, Annette; Bögel, Tina; Rohrdantz, Christian; Butt, Miriam; Holzinger, Katharina; Keim, Daniel

2017-01-01

This article reports on a Digital Humanities research project which is concerned with the automated linguistic and visual analysis of political discourses with a particular focus on the concept of deliberative communication. According to the theory of deliberative communication as discussed within political science, political debates should be inclusive and stakeholders participating in these debates are required to justify their positions rationally and respectfully and should eventually def...

Could ionospheric variations be precursors of a seismic event? A short discussion

Energy Technology Data Exchange (ETDEWEB)

Kouris, S.S. [Thessaloniki Univ., Thessaloniki (Greece). Dept. of Electrical and Computer Engineering; Spalla, P. [Consiglio Nazionale delle Ricerche, Istituto di Ricerca Onde Elettromagnetiche, Florence (Italy); Zolesi, B. [Istituto Nazionale di Geofisica e Vulcanologia, Rome (Italy)

2001-04-01

A short review of published papers on the perturbations in the ionosphere due to seismogenic effects is reported. The method to correlate different classes of phenomena as ionospheric variations and subsequent seismic events is discussed. Even if the theoretical attempts to understand or to explain the electromagnetic phenomena in the ionosphere, as precursors of earthquakes are not satisfactory, the reported results encourage further investigations.

To discuss illicit nuclear trafficking

Energy Technology Data Exchange (ETDEWEB)

Balatsky, Galya I [Los Alamos National Laboratory; Severe, William R [Los Alamos National Laboratory; Wallace, Richard K [Los Alamos National Laboratory

2010-01-01

The Illicit nuclear trafficking panel was conducted at the 4th Annual INMM workshop on Reducing the Risk from Radioactive and Nuclear Materials on February 2-3, 2010 in Washington DC. While the workshop occurred prior to the Nuclear Security Summit, April 12-13 2010 in Washington DC, some of the summit issues were raised during the workshop. The Communique of the Washington Nuclear Security Summit stated that 'Nuclear terrorism is one of the most challenging threats to international security, and strong nuclear security measures are the most effective means to prevent terrorists, criminals, or other unauthorized actors from acquiring nuclear materials.' The Illicit Trafficking panel is one means to strengthen nuclear security and cooperation at bilateral, regional and multilateral levels. Such a panel promotes nuclear security culture through technology development, human resources development, education and training. It is a tool which stresses the importance of international cooperation and coordination of assistance to improve efforts to prevent and respond to incidents of illicit nuclear trafficking. Illicit trafficking panel included representatives from US government, an international organization (IAEA), private industry and a non-governmental organization to discuss illicit nuclear trafficking issues. The focus of discussions was on best practices and challenges for addressing illicit nuclear trafficking. Terrorism connection. Workshop discussions pointed out the identification of terrorist connections with several trafficking incidents. Several trafficking cases involved real buyers (as opposed to undercover law enforcement agents) and there have been reports identifying individuals associated with terrorist organizations as prospective plutonium buyers. Some specific groups have been identified that consistently search for materials to buy on the black market, but no criminal groups were identified that specialize in nuclear materials or isotope

Literature Discussion as Positioning: Examining Positions in Dialogic Discussions in a Third-Grade Classroom

Science.gov (United States)

Wee, Jongsun

2010-01-01

The purpose of the study is to examine positions of students and a teacher in dialogic discussion. In this study, dialogic discussion was defined with Bakhtin's (1981) dialogism, Nystrand's (1997) explanation of dialogically organized instruction, and Mercer's (1995) explanation of Exploratory Talk. Studies about literature discussion in…

Monopoly control of the electric power network - a discussion of regime and the incentive structure

International Nuclear Information System (INIS)

Uthus, Baard Olav; Wangensteen, Ivar

1999-01-01

This report discusses the strong points and weak points of the income regulation imposed on local and regional network owners in Norway in 1997. This regulation is based on a formula containing the variables: initial income or initial cost, efficiency requirement, and increase of transported energy. These variables are important for the determination of the income and are discussed. The report discusses the problems that may arise from an individual income limit if socio-economically desirable measures are not commercially profitable. It is found that monopoly regulation based on income limits is a correct principle, but there are shortcomings in the current way of determining the income limit and improved methods should be worked out

Discussion method for the Wigner-Seitz model applied to plane problems; Methode de discussion du modele Wigner-Seitz appliquee a des problemes plans

Energy Technology Data Exchange (ETDEWEB)

Winter, J

1949-04-01

This report discusses the approximation which consists, for the study of a waves field, in replacing a square domain by a circular domain in a square orthogonal mesh network. For this purpose, it is proposed to introduce J{sub 4}(Kr)cos(4{theta}) and Y{sub 4}(Kr)cos(4{theta}) terms and to modify the outside limits of the mesh for the calculation of the coefficients of these terms.

Facilitators and barriers to discussing HIV prevention with adolescents: perspectives of HIV-infected parents.

Science.gov (United States)

Edwards, Laura L; Reis, Janet S; Weber, Kathleen M

2013-08-01

We examined HIV-infected parents' conversations about HIV prevention with their uninfected children, including what facilitated or hindered communication. Parents with HIV/AIDS (n = 90) who had children aged 10 to 18 years were recruited for a mixed method study from 2009 to 2010. Interviews assessed facilitators and barriers to discussing HIV prevention. A questionnaire identified the frequency and content of conversations, parental confidence level, and perceived importance of discussing preventive topics. Eighty-one percent of parents reported "sometimes" or "often" communicating about HIV prevention. A subset of parents found these conversations difficult; 44% indicated their desire for support. Facilitators to communication included utilizing support, focusing on the benefits of talking, and having a previous relationship with one's child. Barriers to discussions included fear of negative consequences, living in denial, and lacking a parental role model who discussed safer sex. Parents varied as to how they believed their HIV status affected communication. Those who did not disclose their HIV status to their children reported less frequent communication; self-efficacy partially mediated this relationship. Findings highlighted the need for communication skills training that support HIV-infected parents in their efforts to discuss HIV-related information with adolescents.

Development of an in-home standardized end-of-life treatment program for pediatric patients dying of brain tumors.

Science.gov (United States)

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

2013-04-01

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.

Human Cloning: Let's Discuss It.

Science.gov (United States)

Taras, Loretta; Stavroulakis, Anthea M.; Ortiz, Mary T.

1999-01-01

Describes experiences with holding discussions on cloning at a variety of levels in undergraduate biology courses. Discusses teaching methods used and student reactions to the discussions. Contains 12 references. (WRM)

Aerosol measurements and nuclear accidents: a reconsideration, report of the round table discussion

International Nuclear Information System (INIS)

Raes, F.

1988-01-01

Radioactivity Environmental Monitoring (REM) is commonly divided into routine and emergency monitoring. Routine REM must demonstrate the adequacy of controls on releases as well as the compliance with radiological standards. It should also be able to give an early warning in case of abnormal concentrations, so that emergency REM may be initiated promptly. It should be clear, however, that stack monitoring and other in-plant measurements are the primary information sources for abnormal conditions. Emergency REM should rapidly assess the extent of an accident and provide the information needed for taking countermeasures. The collection of in-depth information on environmental processes for model validation is usually considered as an additional benefit of both routine and emergency REM. In discussing techniques for measuring radioactive aerosols, in particular the need for new and more sophisticated techniques, one must consider the objectives of REM, define how much weight should be given to each of them, and investigate whether new techniques might help in meeting the objectives. The opinions of the experts are organized into three chapters: the first compiles experiences and opinions about radioactive aerosol monitoring and defines the experimental needs for such monitoring with respect to early warning and early assessment in case of nuclear accidents; the second chapter discusses radioactive aerosol monitoring from the point of view of the scientist who wants to increase or validate his knowledge about the behaviour of radionuclides in the atmosphere; the third chapter reviews recent developments in field of aerosol and nuclear metrology and their interest for nuclear safety. Each chapter ends with a number of conclusions and recommendations

Opportunity to discuss ethical issues during clinical learning experience.

Science.gov (United States)

Palese, Alvisa; Gonella, Silvia; Destrebecq, Anne; Mansutti, Irene; Terzoni, Stefano; Morsanutto, Michela; Altini, Pietro; Bevilacqua, Anita; Brugnolli, Anna; Canzan, Federica; Ponte, Adriana Dal; De Biasio, Laura; Fascì, Adriana; Grosso, Silvia; Mantovan, Franco; Marognolli, Oliva; Nicotera, Raffaela; Randon, Giulia; Tollini, Morena; Saiani, Luisa; Grassetti, Luca; Dimonte, Valerio

2018-01-01

Undergraduate nursing students have been documented to experience ethical distress during their clinical training and felt poorly supported in discussing the ethical issues they encountered. Research aims: This study was aimed at exploring nursing students' perceived opportunity to discuss ethical issues that emerged during their clinical learning experience and associated factors. An Italian national cross-sectional study design was performed in 2015-2016. Participants were invited to answer a questionnaire composed of four sections regarding: (1) socio-demographic data, (2) previous clinical learning experiences, (3) current clinical learning experience quality and outcomes, and (4) the opportunity to discuss ethical issues with nurses in the last clinical learning experience (from 0 - 'never' to 3 - 'very much'). Participants and research context: Participants were 9607 undergraduate nursing students who were attending 95 different three-year Italian baccalaureate nursing programmes, located at 27 universities in 15 Italian regions. Ethical considerations: This study was conducted in accordance with the Human Subject Research Ethics Committee guidelines after the research protocol was approved by an ethics committee. Overall, 4707 (49%) perceived to have discussed ethical issues 'much' or 'very much'; among the remaining, 3683 (38.3%) and 1217 (12.7%) students reported the perception of having discussed, respectively, 'enough' or 'never' ethical issues emerged in the clinical practice. At the multivariate logistic regression analysis explaining 38.1% of the overall variance, the factors promoting ethical discussion were mainly set at the clinical learning environment levels (i.e. increased learning opportunities, self-directed learning, safety and nursing care quality, quality of the tutorial strategies, competences learned and supervision by a clinical nurse). In contrast, being male was associated with a perception of less opportunity to discuss ethical issues

Medical students’ experiences of resuscitation and discussions surrounding resuscitation status

Directory of Open Access Journals (Sweden)

Aggarwal AR

2018-01-01

Full Text Available Asha R Aggarwal, Iqbal Khan Department of Medical Education, Northampton General Hospital, Northampton, UK Objectives: In the UK, cardiopulmonary resuscitation (CPR should be undertaken in the event of cardiac arrest unless a patient has a “Do Not Attempt CPR” document. Doctors have a legal duty to discuss CPR with patients or inform them that CPR would be futile. In this study, final-year medical students were interviewed about their experiences of resuscitation on the wards and of observing conversations about resuscitation status to explore whether they would be equipped to have an informed discussion about resuscitation in the future. Methods: Twenty final-year medical students from two medical schools were interviewed about their experiences on the wards. Interviews were transcribed verbatim, and thematic analysis was undertaken.Results: Students who had witnessed CPR on the wards found that aspects of it were distressing. A significant minority had never seen resuscitation status being discussed with a patient. No students reported seeing a difficult conversation. Half of the students interviewed reported being turned away from difficult conversations by clinicians. Only two of the twenty students would feel comfortable raising the issue of resuscitation with a patient. Conclusion: It is vital that doctors are comfortable talking to patients about resuscitation. Given the increasing importance of this aspect of communication, it should be considered for inclusion in the formal communication skills teaching during medical school. Keywords: undergraduate, communication, DNACPR, palliative care, end of life care

Supporting collaborative discussions on asynchronous time: a technological perspective

OpenAIRE

Caballé, Santi

2011-01-01

The aim of this paper is to report on an experience of using an innovative on-line learning tool to support real, collaborative learning through discussion in asynchronous time. While asynchronous interaction gives rise to unique opportunities that support active, collaborative learning, unique problems also arise, such as frustration, caused by waiting for other peoples' reactions and feedback and the consequent loss of motivation, which has a negative impact on learning outcomes. In order t...

Vicarious learning through capturing taskdirected discussions

Directory of Open Access Journals (Sweden)

F. Dineen

1999-12-01

Full Text Available The research programme on vicarious learning, part of which we report in this paper, has been aimed at exploring the idea that learning can be facilitated by providing learners with access to the experiences of other learners. We use Bandura's term vicarious learning to describe this (Bandura, 1986, and we believe it to be a paradigm that offers particular promise when seen as an innovative way of exploiting recent technical advances in multimedia and distance learning technologies. It offers the prospect of a real alternative to the building of intelligent tutors (which directly address the problem of allowing learners access to dialogue, but which have proved largely intractable in practice or to the direct support of live dialogues (which do not offer a solution to the problem of providing 'live' tutors - unless they are between peer learners. In the research reported here our main objectives were to develop techniques to facilitate learners' access to, especially, dialogues and discussions which have arisen when other learners were faced with similar issues or problems in understanding the material. This required us to investigate means of indexing and retrieving appropriate dialogues and build on these to create an advanced prototype system for use in educational settings.

Wind power - An impulse or just frustration for business?

International Nuclear Information System (INIS)

Wellstein, J.

2005-01-01

This article deals with the question raised as to whether the development of wind power can provide an impulse for industry. The answers provided by Markus Geissmann from the Swiss Federal Office of Energy (SFOE) and Robert Horbaty, head of 'Suisse Eole' - a Swiss society that supports the use of wind energy - are presented in the form of an interview. In particular, the fact that certain Swiss manufacturers have established themselves in the international wind energy market is discussed - in spite of the relatively low proportion of wind energy actually generated in Switzerland. The various factors influencing both on-shore and off-shore wind-power installations are discussed. The products and services offered are discussed and also the up-and-coming market for the replacement of older wind-power installations is looked at

To the Geoportal and Beyond! Preparing the Earth Observing Laboratory's Datasets for Inter-Repository Discovery

Science.gov (United States)

Gordon, S.; Dattore, E.; Williams, S.

2014-12-01

Even when a data center makes it's datasets accessible, they can still be hard to discover if the user is unaware of the laboratory or organization the data center supports. NCAR's Earth Observing Laboratory (EOL) is no exception. In response to this problem and as an inquiry into the feasibility of inter-connecting all of NCAR's repositories at a discovery layer, ESRI's Geoportal was researched. It was determined that an implementation of Geoportal would be a good choice to build a proof of concept model of inter-repository discovery around. This collaborative project between the University of Illinois and NCAR is coordinated through the Data Curation Education in Research Centers program. This program is funded by the Institute of Museum and Library Services.Geoportal is open source software. It serves as an aggregation point for metadata catalogs of earth science datasets, with a focus on geospatial information. EOL's metadata is in static THREDDS catalogs. Geoportal can only create records from a THREDDS Data Server. The first step was to make EOL metadata more accessible by utilizing the ISO 19115-2 standard. It was also decided to create DIF records so EOL datasets could be ingested in NASA's Global Change Master Directory (GCMD). To offer records for harvest, it was decided to develop an OAI-PMH server. To make a compliant server, the OAI_DC standard was also implemented. A server was written in Perl to serve a set of static records. We created a sample set of records in ISO 19115-2, FGDC, DIF, and OAI_DC. We utilized GCMD shared vocabularies to enhance discoverability and precision. The proof of concept was tested and verified by having another NCAR laboratory's Geoportal harvest our sample set. To prepare for production, templates for each standard were developed and mapped to the database. These templates will help the automated creation of records. Once the OAI-PMH server is re-written in a Grails framework a dynamic representation of EOL's metadata will

It's in the details: The role of selective discussion in forgetting of children's autobiographical memories.

Science.gov (United States)

Glynn, Ruth; Salmon, Karen; Low, Jason

2018-03-01

This experiment investigated whether retrieval-induced forgetting (RIF) would be found in children's self-generated autobiographical memory recall. An adapted version of the RIF paradigm for adults' autobiographical memories was administered to 8- and 9-year-old children (N = 65). We hypothesized that RIF would be found in terms of both number of memories recalled and amount of memory detail reported. The relationship between memory detail at the retrieval practice phase and RIF magnitude was also investigated. Consistent with hypotheses, RIF was found for both the number of memories recalled and the amount of memory detail reported. In addition, memory detail at retrieval practice was associated with increased RIF magnitude. Findings extend the current literature in three ways. First, they indicate that selective discussion of autobiographical events with children can cause forgetting of similar non-discussed events. Second, even when these non-discussed events are recalled, they contain sparser memory detail. Finally, when events are selectively discussed in greater detail, forgetting of similar non-discussed events occurs to a greater extent. Copyright © 2017 Elsevier Inc. All rights reserved.

The role of the principle of double effect in ethics education at US medical schools and its potential impact on pain management at the end of life.

Science.gov (United States)

Macauley, Robert

2012-03-01

Because opioids can suppress respiratory drive, the principle of double effect (PDE) has been used to justify their use for terminally ill patients. Recent studies, however, suggest that the risk of respiratory depression in typical end-of-life (EOL) situations may be overstated and that heightened concern for this rare occurrence can lead to inadequate treatment of pain. The purpose of this study is to examine the role of the PDE in medical school ethics education, with specific reference to its potential impact on pain management at EOL. After obtaining institutional review board approval, an electronic survey was sent to ethics educators at every allopathic medical school in the USA. One-third of ethics educators felt that opioids were 'likely' to cause significant respiratory depression that could hasten death. Educators' opinions of opioid effects did not influence their view of the relevance of the PDE, with approximately 70% deeming it relevant to EOL care. Only 15% of ethics educators believed that associating the PDE with opioid use might discourage clinicians from optimally treating pain, out of concern for respiratory depression. This study demonstrates that a significant minority of ethics educators believe, contrary to current evidence, that opioids are 'likely' to cause significant respiratory depression that could hasten death in terminally ill patients. Yet, many of those who do not feel this is likely still rely on the PDE to justify this possibility, potentially (and unknowingly) contributing to clinical misperceptions and underutilisation of opioids at EOL.

Factors Influencing Consumers’ Intention to Return the End of Life Electronic Products through Reverse Supply Chain Management for Reuse, Repair and Recycling

Directory of Open Access Journals (Sweden)

Kamyar Kianpour

2017-09-01

Full Text Available Resource depletion, population growth and environmental problems force companies to collect their end of life (EOL products for reuse, recycle and refurbishment through reverse supply chain management (RSCM. Success in collecting the EOL products through RSCM depends on the customers’ participation intention. The objectives of this study are: (1 To examine the important factors influencing customers’ attitude to participate in RSCM; (2 To examine the important factors influencing customers’ subjective norm to participate in RSCM; (3 To examine the main factors influencing customers’ perceived behavioral control to participate in RSCM; (4 To examine the influence of attitude, subjective norms and perceived behavioral control on customers’ participation intention in RSCM. The Decomposed Theory of Planned Behaviour (DTPB has been chosen as the underpinning theory for this research. The research conducted employed the quantitative approach. Non-probability (convenience sampling method was used to determine the sample and data was collected using questionnaires. Partial Least Squares-Structural Equation Modeling (PLS-SEM technique was employed. A total of 800 questionnaires were distributed among customers of electronic products in Malaysia. Finally, the questionnaire was distributed among the customers in electronic retailer companies based on convenience sampling method. The empirical results confirm that consumers perception about the risk associated with EOL electronic products, consumers’ ecological knowledge and relative advantages associated with reuse, repair and recycling can influence the attitude of consumers to return the EOL products for reuse, repair and recycling to producer.

Characterization of patients receiving palliative chemo- and radiotherapy during end of life at a regional cancer center in Norway.

Science.gov (United States)

Anshushaug, Malin; Gynnild, Mari Aas; Kaasa, Stein; Kvikstad, Anne; Grønberg, Bjørn H

2015-03-01

Many cancer patients receive chemotherapy and radiotherapy their last 30 days [end of life (EOL)]. The benefit is questionable and side effects are common. The aim of this study was to investigate what characterized the patients who received chemo- and radiotherapy during EOL, knowledge that might be used to improve practice. Patients dead from cancer in 2005 and 2009 were analyzed. Data were collected from hospital medical records. When performance status (PS) was not stated, PS was estimated from other information in the records. A Glasgow Prognostic Score (GPS) of 0, 1 or 2 was assessed from blood values (CRP and albumin). A higher score is associated with a shorter prognosis. In total 616 patients died in 2005; 599 in 2009. Among the 723 analyzed, median age was 71; 42% had metastases at diagnosis (synchronous metastases); 53% had PS 2 and 16% PS 3-4 at the start of last cancer therapy. GPS at the start of last cancer therapy was assessable in 70%; of these, 26% had GPS 1 and 35% GPS 2. Overall, 10% received chemotherapy and 8% radiotherapy during EOL. The proportions varied significantly between the different types of cancer. Multivariate analyses revealed that those at agelife. GPS 2 and synchronous metastases were most significantly associated with cancer therapy the last 30 days of life, indicating that in general, patients with the shortest survival time after diagnosis of cancer received more chemo- and radiotherapy during EOL than other patients.

Review and discussion: e-learning for academia and industry

OpenAIRE

Chang, Victor

2016-01-01

This paper presents a high level review and discussion about e-learning and proposes the use of interactive learning as a recommended method for staff training in industry and academia. Interactive learning is focused on the integrated e-learning and face-to-face learning to ensure that the process of learning can stimulate learners’ interests, report their progress and have tutors to provide their feedback and guide learners to the expected targets. Learning activities and varieties have bee...

Reducing the extraction of minerals

DEFF Research Database (Denmark)

Bouzon, Marina; Govindan, Kannan; Rodriguez, Carlos Manuel Taboada

2015-01-01

Mass consumption and shortening product lifecycles have increased worldwide production. Consequently, more raw materials such as minerals are used, and available landfills are filling up. Companies are urged to effectively incorporate sustainability issues such as End-of-life (EOL) management...... and Reverse Logistics (RL) practices to close the loop and diminish the amount of raw materials used in their production systems. However, implementing RL implies dealing with its barriers. The purpose of this article is to focus on the recovery of EOL products that use mostly raw materials from the mining...

On good ETOL forms

DEFF Research Database (Denmark)

Skyum, Sven

1978-01-01

This paper continues the study of ETOL forms and good EOL forms done by Maurer, Salomaa and Wood. It is proven that binary very complete ETOL forms exist, good synchronized ETOL forms exist and that no propagating or synchronized ETOL form can be very complete.......This paper continues the study of ETOL forms and good EOL forms done by Maurer, Salomaa and Wood. It is proven that binary very complete ETOL forms exist, good synchronized ETOL forms exist and that no propagating or synchronized ETOL form can be very complete....

GPs and end of life decisions : views and experiences

OpenAIRE

Abela, Jurgen

2015-01-01

The views and experiences of GPs with respect to end of life (EoL) care are seldom addressed. The aim of this article is to better understand this aspect of care. A cross-sectional survey of all doctors in the country was designed and set up. The overall response was 396 (39.7%), 160 of which were GPs. 28.7% of GPs received no formal training in palliative medicine. 89.8% of respondents declared that their religion was important in EoL care. 45.3% agreed with the right of a patient to decide ...

A Comparison of Preschool Children's Discussions with Parents during Picture Book and Chapter Book Reading

Science.gov (United States)

Leech, Kathryn A.; Rowe, Meredith L.

2014-01-01

Discussions that occur during book reading between parents and preschool children relate to children's language development, especially discussions during picture books that include extended discourse, a form of abstract language. While a recent report shows increased chapter book reading among families with preschool children, it is unknown…

Voices from School and Home: Arkansas Parents and Students Talk about Preparing for the World of Work and the Potential for Youth Apprenticeship. A Report on Focus Group Discussions.

Science.gov (United States)

Jobs for the Future, Inc., West Somerville, MA.

This report summarizes several group discussions with parents of high school students, high school students, and nursing students regarding the world of work and the advantages and disadvantages of a youth apprenticeship program. Section I is an executive summary that describes the methodology, summarizes key attitudes toward youth apprenticeships…

Practical examples and discussion in junior high school biological delivery classes

OpenAIRE

石井, 照久; ISHII, Teruhisa

2013-01-01

Practical examples of the delivery class in junior high school biological education were reported. In 2006-2012, author did 13 times of delivery class in 5 junior high schools in Akita Prefecture. The contents of the delivery classes were‘‘Observation of animals in river’’, ‘‘Marine ecology’’, ‘‘Ecological problems’’ and ‘‘cells and DNA’’. In this report, these contents were discussed in regard to new course of education in Japan. Also, better delivery class in junior high school biological e...

Facilitators and Barriers to Discussing HIV Prevention With Adolescents: Perspectives of HIV-Infected Parents

Science.gov (United States)

Reis, Janet S.; Weber, Kathleen M.

2013-01-01

Objectives. We examined HIV-infected parents’ conversations about HIV prevention with their uninfected children, including what facilitated or hindered communication. Methods. Parents with HIV/AIDS (n = 90) who had children aged 10 to 18 years were recruited for a mixed method study from 2009 to 2010. Interviews assessed facilitators and barriers to discussing HIV prevention. A questionnaire identified the frequency and content of conversations, parental confidence level, and perceived importance of discussing preventive topics. Results. Eighty-one percent of parents reported “sometimes” or “often” communicating about HIV prevention. A subset of parents found these conversations difficult; 44% indicated their desire for support. Facilitators to communication included utilizing support, focusing on the benefits of talking, and having a previous relationship with one’s child. Barriers to discussions included fear of negative consequences, living in denial, and lacking a parental role model who discussed safer sex. Parents varied as to how they believed their HIV status affected communication. Those who did not disclose their HIV status to their children reported less frequent communication; self-efficacy partially mediated this relationship. Conclusions. Findings highlighted the need for communication skills training that support HIV-infected parents in their efforts to discuss HIV-related information with adolescents. PMID:23763390

Report on ISFG SNP Panel Discussion

DEFF Research Database (Denmark)

Butler, John M.; Budowle, B.; Gill, P.

2008-01-01

Six scientists presented their views and experience with single nucleotide polymorphism (SNP) markers, multiplexes, and methods regarding their potential application in forensic identity and relationship testing. Benefits and limitations of SNPs were reviewed, as were different SNP marker...

Spectroscopy as a major programme in ASDEX - a discussion study

International Nuclear Information System (INIS)

Fussmann, G.

1986-03-01

This report deals with the objectives and possibilities of a spectroscopy programme in ASDEX and provides some basic information on the relevant processes of atomic physics in tokamaks. The spectroscopic analogies found in observation of astrophysical objects are also briefly treated. In addition, the possibilities for conducting investigations in alternative high-Z ion sources are discussed. A first proposal for an appropriate programme is then formulated. (orig.)

Education, Inequality and Life Chances: A Report on the Netherlands [and] Discussion Paper.

Science.gov (United States)

Tinbergen, Jan

Six chapters compose this report on the Netherlands: (1) some general characteristics of the Netherlands; (2) some notes on the history of income distribution and social security; (3) income distribution and social security around 1973; (4) opinions on income distribution, opportunities, and equality in Holland; (5) some forecasts on future income…

A contractor report to the Department of Energy on environmental management baseline programs and integration opportunities (discussion draft)

International Nuclear Information System (INIS)

1997-05-01

In July 1996, the US Department of Energy (DOE) Assistant Secretary for Environmental Management (EM) chartered a government contractor led effort to develop a suite of technically defensible, integrated alternatives which meet the EM mission. The contractor team was challenged to ''think outside-the-box'' for solutions that cross traditional site boundaries and enable the programs to get the job done at an earlier date and at a lower cost. This report documents baseline programs current plans for material disposition and presents the opportunities for additional acceleration of cleanup and cost savings. A graphical depiction of the disposition of EM-owned waste and material from current state to final disposition is shown as disposition maps in Attachments 1, 3, 5, 7, 9, and 11. These disposition maps detail the material disposition at eleven major DOE sites as planned in the current discussion draft plan, Accelerating Cleanup: Focus on 2006. Maps reflecting material disposition at additional sites will be added in the future. Opportunities to further accelerate the cleanup of DOE-EM sites and reduce the overall cost of cleanup are depicted in the alternative disposition maps shown in Attachments 2, 4, 6, 8, 10, and 12. These integration opportunities bring nation-wide resources to bear on common problems facing the DOE sites

Regulation of the life cycle of nuclear installations. Peer discussions on regulatory practices

International Nuclear Information System (INIS)

1999-06-01

This report arises from the sixth series of peer discussions on regulatory practices entitled 'Regulation of Life Cycle of Nuclear Installations'. Senior regulators from 18 Member States participated in three peer group discussions during 1997-1998. This report presents the outcome of these meetings and recommendations of good practices identified by senior regulators, which do not necessarily reflect those of the governments of the nominating Member States, the nominating organizations, or the IAEA. The purpose of this report is to disseminate the views which the senior regulators presented at the meetings relating to the policies, principles and requirements imposed by regulatory bodies for the safe management of the life cycle of a nuclear installation. The intention of doing this is to assist Member States in the formulation and enhancement of their regulatory control over PLCM by identifying commonly accepted good practices. This report is structured to cover the subject matter under the following main headings: Policies and Principles for the Life Cycle Management of Nuclear Installations; Responsibilities of the Regulatory Body and the Operating Organization; Requirements and Criteria Imposed by the Regulatory Body; Licensing and Regulatory Assessment for Plant Life Cycle Management; and Good Practices

Ethical issues in the use of in-depth interviews: literature review and discussion

OpenAIRE

Allmark, Peter; Boote, Jonathan; Chambers, E.; Clarke, Amanda; McDonnell, A.; Thompson, Andrew; Tod, Angela

2009-01-01

This paper reports a literature review on the topic of ethical issues in in-depth interviews. The review returned three types of article: general discussion, issues in particular studies, and studies of interview-based research ethics. Whilst many of the issues discussed in these articles are generic to research ethics, such as confidentiality, they often had particular manifestations in this type of research. For example, privacy was a significant problem as interviews sometimes probe unexpe...

Round Table Discussion on EASTWEST

Directory of Open Access Journals (Sweden)

Marina Tkacheva

2017-12-01

Full Text Available The discussion is focused on various aspects of interrelations between East and West. Its participants discuss the problems of the increasing tourist flows from China and the specific characteristics of Chinese tourists. The future development of tourism in the Baikal region is formulated, and the peculiarities of ethno tourism and its prospects are discussed.

Discussion on ``Foundations of the Second Law''

Science.gov (United States)

Silbey, Robert; Ao, Ping; Beretta, Gian Paolo; Cengel, Yunus; Foley, Andrew; Freedman, Steven; Graeff, Roderich; Keck, James C.; Lloyd, Seth; Maroney, Owen; Nieuwenhuizen, Theodorus M.; Weissman, Michael

2008-08-01

This article reports an open discussion that took place during the Keenan Symposium "Meeting the Entropy Challenge" (held in Cambridge, Massachusetts, on October 4, 2007) following the short presentations—each reported as a separate article in the present volume—by Seth Lloyd, Owen Maroney, Silviu Guiasu, Ping Ao, Jochen Gemmer, Bernard Guy, Gian Paolo Beretta, Speranta Gheorghiu-Svirschevski, and Dorion Sagan. All panelists and the audience were asked to address the following questions • Why is the second law true? Is it an inviolable law of nature? If not, is it possible to develop a perpetual motion machine of the second kind? • Are second law limitations objective or subjective, real or apparent, due to the nature of physical states or the representation and manipulation of information? Is entropy a physical property in the same sense as energy is universally understood to be an intrinsic property of matter? • Does the second law conflict with quantum mechanics? Are the differences between mechanical and thermodynamic descriptions of physical phenomena reconcilable? Does the reversible law of motion of hamiltonian mechanics and quantum mechanics conflict with the empirical observation of irreversible phenomena?

Discussion on ``The Second Law and Energy''

Science.gov (United States)

Lloyd, Seth; Banerjee, Debjyoti; Bejan, Adrian; Beretta, Gian Paolo; Geskin, Ernest; Ghoniem, Ahmed; Gutowski, Timothy G.; Gyftopoulos, Elias P.; Keck, James C.; Lior, Noam; Miller, Sam; Nieuwenhuizen, Theodorus M.; Peterson, Richard; Salamon, Peter; Williamson, Lihong

2008-08-01

This article reports an open discussion that took place during the Keenan Symposium "Meeting the Entropy Challenge" (held in Cambridge, Massachusetts, on October 5, 2007) following the short presentations—each reported as a separate article in the present volume—by Thomas Widmer, Ernest Geskin, James Keck, Noam Lior, Debjyoti Banerjee, Richard Peterson, Erik Ydstie, Ron Zevenhoven, Zhuomin Zhang, and Ahmed Ghoniem. All panelists and the audience were asked to address the following questions • Current state-of-the-art efficiency of combined-cycle energy conversion technology is about 60%. Based on the trend of historical data, some forecast that second-law efficiency of energy conversion will reach 80% by the end of the century. What technologies are at sight that might hold this promise? • Nanotechnologies and microtechnologies point towards the development of microscopic heat engines? How do second law limitations map down to these scales? • Combustion is the principal way of converting the chemical energy of fossil fuels to thermal energy, but it is highly irreversible. Are there promising ways to reduce combustion irreversibility? Are fuel cells the only alternative to combustion?

Panel discussion

International Nuclear Information System (INIS)

Anon.

1980-01-01

The panel discussion at the 10th Allianz Forum on 'Technology and Insurance' dealt with the following topics: New technologies: energy conversion (coal, petroleum, natural gas, nuclear energy, solar energy); infrastructure (transport, data processing); basic products (metallic materials, chemical products, pharmaceutical products); integrated products (microprocessors, production line machines) as well as new risks: political; general economic (financing, market structure); insurance-related, dangers to persons and property; reduction of risks. (orig.) [de

Knowledge of advance directive and perceptions of end-of-life care in Chinese-American elders: The role of acculturation.

Science.gov (United States)

Gao, Xiang; Sun, Fei; Ko, Eunjeong; Kwak, Jung; Shen, Huei-Wern

2015-12-01

This study aimed to describe knowledge of an advance directive (AD) and preferences regarding end-of-life (EoL) care communication, decision making, and designation of surrogates in Chinese-American elders and to examine the role of acculturation variables in AD awareness. Survey data were collected through face-to-face interviews on a sample of 385 Chinese-American elders aged 55 or above living in the Phoenix metropolitan area. The choice of language (Mandarin, Cantonese, or English) and place of interview (senior apartments, Chinese senior centers, or homes) was at the respondent's preference. Hierarchical logistic regression analysis was employed to examine the influence of acculturation variables on AD awareness. Some 21% of participants had heard about ADs, and only 10% had completed one. Elders with higher acculturation levels (OR = 1.04, p Acculturation levels influence awareness of an AD, and family values are crucial in EoL care decision making. Cultural factors should be considered in designing and delivering appropriate programs to promote knowledge of EoL care among Chinese-American elders and their families.

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?

Science.gov (United States)

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

2018-04-01

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.

How to report and discuss ADME data in medicinal chemistry publications: in vitro data or in vivo extrapolations?

Science.gov (United States)

Svennebring, Andreas M

2015-01-01

Early drug discovery projects often utilize data from ADME (absorption, distribution, metabolism, elimination) assays to benchmark data and guide discussion, rather than the predicted in vivo consequences of these data. Here, the two paradigms are compared, using evaluations of metabolic stability based on either microsomal clearance assay data or from the predicted in vivo hepatic clearance and half-life calculated through the combination of the venous well-stirred model and Øie-Tozer's model. The need for a shift in paradigm is presented, and its implications discussed. It is suggested that discussions about ADME data should revolve around potential clinical problems that are most likely to surface during the development phase, each benchmarked with a suitable variable derived from the assay data.

IRIS Toxicological Review of Hydrogen Cyanide and Cyanide Salts (Interagency Science Discussion Draft)

Science.gov (United States)

EPA is releasing the draft report, Toxicological Review of Hydrogen Cyanide (HCN) and Cyanide Salts, that was distributed to Federal agencies and White House Offices for comment during the Science Discussion step of the IRIS As...

Cultural competence in end-of-life care: terms, definitions, and conceptual models from the British literature.

Science.gov (United States)

Evans, Natalie; Meñaca, Arantza; Koffman, Jonathan; Harding, Richard; Higginson, Irene J; Pool, Robert; Gysels, Marjolein

2012-07-01

Cultural competency is increasingly recommended in policy and practice to improve end-of-life (EoL) care for minority ethnic groups in multicultural societies. It is imperative to critically analyze this approach to understand its underlying concepts. Our aim was to appraise cultural competency approaches described in the British literature on EoL care and minority ethnic groups. This is a critical review. Articles on cultural competency were identified from a systematic review of the literature on minority ethnic groups and EoL care in the United Kingdom. Terms, definitions, and conceptual models of cultural competency approaches were identified and situated according to purpose, components, and origin. Content analysis of definitions and models was carried out to identify key components. One-hundred thirteen articles on minority ethnic groups and EoL care in the United Kingdom were identified. Over half (n=60) contained a term, definition, or model for cultural competency. In all, 17 terms, 17 definitions, and 8 models were identified. The most frequently used term was "culturally sensitive," though "cultural competence" was defined more often. Definitions contained one or more of the components: "cognitive," "implementation," or "outcome." Models were categorized for teaching or use in patient assessment. Approaches were predominantly of American origin. The variety of terms, definitions, and models underpinning cultural competency approaches demonstrates a lack of conceptual clarity, and potentially complicates implementation. Further research is needed to compare the use of cultural competency approaches in diverse cultures and settings, and to assess the impact of such approaches on patient outcomes.

Maintaining family life balance while facing a child's imminent death-A mixed methods study.

Science.gov (United States)

Eskola, Katri; Bergstraesser, Eva; Zimmermann, Karin; Cignacco, Eva

2017-10-01

To understand parents' experiences and needs during a child's end-of-life care at home and to identify systemic factors that influence its provision. A child's end-of-life phase is an extremely difficult time for the whole family. Parents have specific needs, especially when they care for a dying child at home. Concurrent embedded mixed methods design. This sub-study of the nationwide survey, 'Paediatric End-of-Life Care Needs in Switzerland' (2012-2015) included 47 children who received EOL care at home from 2011-2012. We extracted quantitative data from patients' medical charts and obtained information via parental questionnaire and then compared parents whose child died at home or in hospital by computing generalized estimation equations. We thematically analysed interviews with parents who provided EOL care at home. Parents created an intimate lifeworld and a sense of normality for the child at home. They constantly balanced the family's lifeworld with the requirements and challenges posed by the outside world. This work exhausted parents. Parental 'readiness' and social support drove EOL care for children at home. Parents needed practical help with housekeeping and had negative experiences when dealing with insurance. In only 34.8% of cases was a child's EOL home care supported by paediatric palliative care team. Paediatric end-of-life care at home is only feasible if parents make extraordinary efforts. If family-centred end-of-life home care is provided by a hospital-based paediatric palliative home care team, which includes paid housekeeping help and psychological support, parents' needs could be better met. © 2017 John Wiley & Sons Ltd.

Multicultural long-term care nurses’ perceptions of factors influencing patient dignity at the end of life.

Science.gov (United States)

Periyakoil, Vyjeyanthi S; Stevens, Marguerite; Kraemer, Helena

2013-03-01

The goal of this mixed-methods study was to characterize the perceptions of multicultural long-term care nurses about patient dignity at the end-of-life (EOL). The study was conducted in a large, urban, long-term care (LTC) facility. Participants were 45 long-term care nurses and 26 terminally ill nursing home residents. Nurses completed an openended interview about their perceptions of the concept of dying with dignity, and the data were analyzed using grounded theory methods. Main themes identified as promoting resident dignity at the EOL included treating them with respect, helping them prepare for the EOL, promoting shared decision-making, and providing high-quality care. The nurses’ cultural and religious backgrounds influenced their perceptions of what constitutes dignity-conserving care. Foreign-born nurses stressed the need for EOL rituals, but this was strikingly absent in the statements of U.S.-born nurses. Foreign-born Catholic nurses stated that the dying experience should not be altered using analgesics to relieve suffering or by attempts to hasten death by forgoing curative therapy or by other means. Nurses and terminally ill individuals completed the Dignity Card-sort Tool (DCT). A comparison of the DCT responses of the LTC nurses cohort with those of the terminally ill participants revealed that the nurses felt patient dignity was eroded when patient wishes were not followed and when they were treated without respect. In contrast, dying LTC residents felt that poor medical care and loss of ability to choose care options were the most important factors leading to erosion of dignity.

Candy consumption patterns, effects on health, and behavioral strategies to promote moderation: summary report of a roundtable discussion.

Science.gov (United States)

Duyff, Roberta L; Birch, Leann L; Byrd-Bredbenner, Carol; Johnson, Susan L; Mattes, Richard D; Murphy, Mary M; Nicklas, Theresa A; Rollins, Brandi Y; Wansink, Brian

2015-01-01

Nearly all Americans (97%) report eating candy at least once per year; yet, on a given day, only approximately one-fourth of the US population aged ≥2 y consumes candy. Among all Americans, candy contributes a relatively small proportion of calories, added sugars, and saturated fat to the total diet, and recent research suggests that current levels of candy consumption are not associated with risk of weight gain and cardiovascular disease in children and adults. Providing guidance for the consumption of candy in moderation requires an understanding of various behavioral health-related factors that influence candy consumption. A roundtable of behavioral nutrition experts, researchers, and nutrition educators met to discuss recent data on intakes of candy, health outcomes associated with usual candy intake, and the impact of behavioral strategies, including restriction, education, and environmental awareness, on modifying eating behaviors to achieve moderate intakes of candy. Restricting access to palatable foods, whether self-imposed or by parental control, may have potentially negative consequences. Techniques and insight into how to adopt "moderation" in candy consumption, from effective parental practices to environmental strategies that facilitate behavior change without a high degree of effort, were identified as important next steps toward sustainable dietary guidance related to the role of candy and other treats in a healthy lifestyle. © 2015 American Society for Nutrition.

A randomized, controlled trial to increase discussion of breast cancer in primary care.

Science.gov (United States)

Kaplan, Celia P; Livaudais-Toman, Jennifer; Tice, Jeffrey A; Kerlikowske, Karla; Gregorich, Steven E; Pérez-Stable, Eliseo J; Pasick, Rena J; Chen, Alice; Quinn, Jessica; Karliner, Leah S

2014-07-01

Assessment and discussion of individual risk for breast cancer within the primary care setting are crucial to discussion of risk reduction and timely referral. We conducted a randomized controlled trial of a multiethnic, multilingual sample of women ages 40 to 74 years from two primary care practices (one academic, one safety net) to test a breast cancer risk assessment and education intervention. Patients were randomly assigned to control or intervention group. All patients completed a baseline telephone survey and risk assessment (via telephone for controls, via tablet computer in clinic waiting room before visit for intervention). Intervention (BreastCARE) patients and their physicians received an individualized risk report to discuss during the visit. One-week follow-up telephone surveys with all patients assessed patient-physician discussion of family cancer history, personal breast cancer risk, high-risk clinics, and genetic counseling/testing. A total of 655 control and 580 intervention women completed the risk assessment and follow-up interview; 25% were high-risk by family history, Gail, or Breast Cancer Surveillance Consortium risk models. BreastCARE increased discussions of family cancer history [OR, 1.54; 95% confidence interval (CI), 1.25-1.91], personal breast cancer risk (OR, 4.15; 95% CI, 3.02-5.70), high-risk clinics (OR, 3.84; 95% CI, 2.13-6.95), and genetic counseling/testing (OR, 2.22; 95% CI, 1.34-3.68). Among high-risk women, all intervention effects were stronger. An intervention combining an easy-to-use, quick risk assessment tool with patient-centered risk reports at the point of care can successfully promote discussion of breast cancer risk reduction between patients and primary care physicians, particularly for high-risk women. Next steps include scaling and dissemination of BreastCARE with integration into electronic medical record systems. ©2014 American Association for Cancer Research.

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

Science.gov (United States)

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

2016-09-01

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

Patient autonomy and advance care planning: a qualitative study of oncologist and palliative care physicians' perspectives.

Science.gov (United States)

Johnson, Stephanie B; Butow, Phyllis N; Kerridge, Ian; Tattersall, Martin H N

2018-02-01

Patients' are encouraged to participate in advance care planning (ACP) in order to enhance their autonomy. However, controversy exists as to what it means to be autonomous and there is limited understanding of how social and structural factors may influence cancer patients' ability to exercise their autonomy. The objective of this study is to explore oncologists' and palliative care physicians' understanding of patient autonomy, how this influences reported enactment of decision-making at the end of life (EOL), and the role of ACP in EOL care. Qualitative semi-structured interviews were conducted with consultant oncologists (n = 11) and palliative medicine doctors (n = 7) working in oncology centres and palliative care units across Australia. We found that doctors generally conceptualized autonomy in terms of freedom from interference but that there was a profound disconnect between this understanding of autonomy and clinical practice in EOL decision-making. The clinicians in our study privileged care, relationships and a 'good death' above patient autonomy, and in practice were reluctant to 'abandon' their patients to total non-interference in decision-making. Patient autonomy in healthcare is bounded, as while patients were generally encouraged to express their preferences for care, medical norms about the quality and 'reasonableness' of care, the availability of services and the patients' family relationships act to enhance or limit patients' capacity to realize their preferences. While for many, this disconnect between theory and practice did not diminish the rhetorical appeal of ACP; for others, this undermined the integrity of ACP, as well as its relevance to care. For some, ACP had little to do with patient autonomy and served numerous other ethical, practical and political functions. The ethical assumptions regarding patient autonomy embedded in academic literature and policy documents relating to ACP are disconnected from the realities of clinical care

Patient Discussion About Sexual Health With Health Care Providers After Cancer-A National Survey.

Science.gov (United States)

Ben Charif, Ali; Bouhnik, Anne-Déborah; Courbiere, Blandine; Rey, Dominique; Préau, Marie; Bendiane, Marc-Karim; Peretti-Watel, Patrick; Mancini, Julien

2016-11-01

A discussion about sexuality should become a routine part of the personalized care pathway for patients with cancer. To assess rates of patient discussion about sexuality with health care providers after cancer. We used data from the representative French nationwide 2012 VICAN survey, which included 4,349 adults 18 to 82 years old who were still alive 2 years after diagnosis at 12 cancer sites. Self-reported rates of discussion about sexuality with health care providers were assessed, and associated factors were tested after systematic adjustment for a sexual health indicator (created from six items of the Relationship and Sexuality Scale). Of 4,181 respondents to the question on a discussion about sexuality, 54.7% reported that nobody had proposed a discussion to them, 21.9% did not want any discussion, and 23.4% had had a discussion. Women had less discussion about sexuality with health care providers (11.1% vs 36.7% of men, P < .001) and were more likely to request a discussion at their own initiative (62.9% vs 48.0% of men, P < .001). Discussion about sexuality was more frequent with patients with prostate (56.3%) and cervical (39.6%) cancer, but increasing age was associated with a greater reluctance to discuss this issue (odds ratio = 1.17, 95% CI = 1.04-1.2). The likelihood of discussion increased with severe sexual problems, radiotherapy, general sequelae, having an information-seeker profile, previous professional psychological help, and initial treatment in private centers. Patients initially wishing for psychological help were more likely to desire a discussion about sexuality. Sexuality receives little attention in French patients with cancer. Inequalities in the discussion about sexuality were observed in relation to the type of care center where the patient was initially managed. Information on supportive interventions, including more systematic referral for professional psychological help, should be developed to facilitate discussion and should be

Brain plasticity, memory, and aging: a discussion

Energy Technology Data Exchange (ETDEWEB)

Bennett, E.L.; Rosenzweig, M.R.

1977-12-01

It is generally assumed that memory faculties decline with age. A discussion of the relationship of memory and aging and the possibility of retarding the potential decline is hampered by the fact that no satisfactory explanation of memory is available in either molecular or anatomical terms. However, this lack of description of memory does not mean that there is a lack of suggested mechanisms for long-term memory storage. Present theories of memory usually include first, neurophysiological or electrical events, followed by a series of chemical events which ultimately lead to long-lasting anatomical changes in the brain. Evidence is increasing for the biochemical and anatomical plasticity of the nervous system and its importance in the normal functioning of the brain. Modification of this plasticity may be an important factor in senescence. This discussion reports experiments which indicate that protein synthesis and anatomical changes may be involved in long-term memory storage. Environmental influences can produce quantitative differences in brain anatomy and in behavior. In experimental animals, enriched environments lead to more complex anatomical patterns than do colony or impoverished environments. This raises fundamental questions about the adequacy of the isolated animal which is frequently being used as a model for aging research. A more important applied question is the role of social and intellectual stimulation in influencing aging of the human brain.

Accelerating Cleanup: Focus on 2006. Discussion draft

International Nuclear Information System (INIS)

1997-01-01

This executive summary addresses the activities associated with the National Transuranic (TRU) Program managed by the Carlsbad Area Office (CAO). The CAO programmatically reports to the Assistant Secretary for Environmental Management and receives administrative support through the Albuquerque Operations Office. The mission of the Carlsbad Area Office (CAO) is to protect human health and the environment by opening and operating the Waste Isolation Pilot Plant for site disposal of TRU waste and by establishing an effective system for management of TRU waste from generation to disposal. It includes personnel assigned to the CAO, the Waste Isolation Pilot Plant (WIPP) site operations, and other activities associated with the National TRU Program. The CAO develops and directs implementation of the program, while the DOE Headquarters establishes policy and guidelines. The CAO assesses compliance with the program guidance, as well as the commonality of activities and assumptions among all the sites. Since the development of the February 28, 1997, database used to develop this Discussion Draft, the opening of the WIPP facility for receipt of Contact Handled waste has been delayed from November 1997 to May 1998. This slippage is significant enough to require a change in the milestones and volumes included in the documents to be reviewed by our stakeholders. Changes have been incorporated into this Discussion Draft and its supporting Project Baseline Summaries (PBSs)

Summary of discussion

International Nuclear Information System (INIS)

2006-01-01

This document provides summaries of the discussions occurred during the second international workshop on the indemnification of nuclear damage. It concerns the second accident scenario: a fire on board of a ship transporting enriched uranium hexafluoride along the Danube River. (A.L.B.)

Revision by means of computer-mediated peer discussions

Science.gov (United States)

Soong, Benson; Mercer, Neil; Er, Siew Shin

2010-05-01

In this article, we provide a discussion on our revision method (termed prescriptive tutoring) aimed at revealing students' misconceptions and misunderstandings by getting them to solve physics problems with an anonymous partner via the computer. It is currently being implemented and evaluated in a public secondary school in Singapore, and statistical analysis of our initial small-scale study shows that students in the experimental group significantly outperformed students in both the control and alternative intervention groups. In addition, students in the experimental group perceived that they had gained improved understanding of the physics concepts covered during the intervention, and reported that they would like to continue revising physics concepts using the intervention methods.

Highlights from panel discussion on key issues for future developments in microwave processing

International Nuclear Information System (INIS)

Gac, F.D.; Iskander, M.F.

1992-01-01

This paper reports on highlights from a panel discussion on Key Issues for Future Development in Microwave Processing. Although the panelists represented a mix of individuals from government, academia, and industry, only one aspect of industry was represented, namely microwave system manufacturers. For further panel discussions, it is recommended that the materials manufacturing (i.e., microwave user) sector also be represented. Three important points emerged from the panel discussion. The first deals with the credibility and usability of information, be it dielectric property measurements, experimental procedures, or microwave processing results. Second, a considerable communication and education gap continues to exist between the materials community and microwave engineers. Finally, a more realistic approach should be taken in identifying where microwave processing makes sense

Summary and Discussion.

Science.gov (United States)

Hetherington, E. Mavis

1992-01-01

Summarizes and discusses results of the longitudinal study that comprises this monograph issue. Results concern: (1) marital, parent-child, and sibling relationships in families with single and remarried mothers; (2) the relationship between parenting style and adolescent adjustment; and (3) the relationship between marital transitions and…

Interteaching: The Effects of Discussion Group Size on Undergraduate Student Performance and Preference

Science.gov (United States)

Gutierrez, Michael

2017-01-01

Interteaching is a college teaching method grounded in the principles of applied behavior analysis. Research on interteaching demonstrates that it improves academic performance, and students report greater satisfaction with interteaching as compared to traditional teaching styles. The current study investigates whether discussion group size, a…

Ethical issues in the use of in-depth interviews: literature review and discussion\\ud

OpenAIRE

Allmark, P.; Boote, J.; Chambers, E.; Clarke, A.; McDonnell, A.; Thompson, A.R.; Tod, A.

2009-01-01

This paper reports a literature review on the topic of ethical issues in in-depth interviews. The review returned three\\ud types of article: general discussion, issues in particular studies, and studies of interview-based research ethics. Whilst\\ud many of the issues discussed in these articles are generic to research ethics, such as confidentiality, they often had particular\\ud manifestations in this type of research. For example, privacy was a significant problem as interviews sometimes\\ud ...

Pipeline abandonment: a discussion paper on technical and environmental issues

International Nuclear Information System (INIS)

Etherington, K.

1996-01-01

Formation of government/industry joint steering committee to oversee a review of pipeline abandonment and preparation of a discussion paper was reported. The review became urgent in view of the fact that many of the pipeline systems are nearing the end of their useful life, and the current absence of guidelines in Canada to deal with pipeline abandonment, or to offer guidance on ways of assessing abandonment costs and funding. In view of this situation the safety and the environmental, financial, and legal implications of abandoned pipelines have become an increasing concern to regulatory authorities and the oil and gas industry. Issues to be dealt with in the discussion paper include subsidence, contamination, water crossing, erosion, land management, restoration, utility and pipeline crossings, creation of water conduits, the cost of abandonment, operator choice of abandonment options, and the level of surface disturbance associated with such options

Negotiated reorienting: a grounded theory of nurses' end-of-life decision-making in the intensive care unit.

Science.gov (United States)

Gallagher, Ann; Bousso, Regina Szylit; McCarthy, Joan; Kohlen, Helen; Andrews, Tom; Paganini, Maria Cristina; Abu-El-Noor, Nasser Ibrahim; Cox, Anna; Haas, Margit; Arber, Anne; Abu-El-Noor, Mysoon Khalil; Baliza, Michelle Freire; Padilha, Katia Grillo

2015-04-01

Intensive care units (ICUs) focus on treatment for those who are critically ill and interventions to prolong life. Ethical issues arise when decisions have to be made regarding the withdrawal and withholding of life-sustaining treatment and the shift to comfort and palliative care. These issues are particularly challenging for nurses when there are varying degrees of uncertainty regarding prognosis. Little is known about nurses' end-of-life (EoL) decision-making practice across cultures. To understand nurses' EoL decision-making practices in ICUs in different cultural contexts. We collected and analysed qualitative data using Grounded Theory. Interviews were conducted with experienced ICU nurses in university or hospital premises in five countries: Brazil, England, Germany, Ireland and Palestine. Semi-structured interviews were conducted with 51 nurses (10 in Brazil, 9 in England, 10 in Germany, 10 in Ireland and 12 nurses in Palestine). They were purposefully and theoretically selected to include nurses having a variety of characteristics and experiences concerning end-of-life (EoL) decision-making. The study used grounded theory to inform data collection and analysis. Interviews were facilitated by using key questions. The comparative analysis of the data within and across data generated by the different research teams enabled researchers to develop a deeper understanding of EoL decision-making practices in the ICU. Ethical approval was granted in each of the participating countries and voluntary informed consent obtained from each participant. The core category that emerged was 'negotiated reorienting'. Whilst nurses do not make the 'ultimate' EoL decisions, they engage in two core practices: consensus seeking (involving coaxing, information cuing and voice enabling); and emotional holding (creating time-space and comfort giving). There was consensus regarding the core concept and core practices employed by nurses in the ICUs in the five countries. However