Teenage pregnancy: a comparative study of teenagers choosing termination of pregnancy or antenatal care.

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Pearson, V A; Owen, M R; Phillips, D R; Gray, D J; Marshall, M N

1995-01-01

A comparative study of 167 pregnant teenagers in Devon attending either antenatal booking clinics or for National Health Service (NHS) termination of pregnancy was carried out to determine differences in their characteristics, use and experience of local family planning services. Teenagers presenting for termination of pregnancy were younger and more likely to say that they had wished to avoid getting pregnant. Whether the teenager was in a stable relationship was strongly associated with the outcome of the pregnancy, with single girls being more likely to choose a termination of pregnancy. The termination of pregnancy group were also more likely to be condom users, and to have learned about their method of contraception from school rather than from health care professionals. Teenagers' frequency of contact with family planning services suggested that teenagers choosing a termination were less likely than antenatal attenders to have attended regularly. This was mainly due to differences in behaviour among teenagers attending their general practitioner (GP) for contraceptive advice: teenagers having a termination were more likely to describe their visit to their GP as embarrassing. These findings have implications for local family planning services attempting to reduce the number of unwanted teenage pregnancies. PMID:7562806

When Terminal Illness Is Worse Than Death: A Multicenter Study of Health-Care Providers' Resuscitation Desires.

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Chavez, Luis O; Einav, Sharon; Varon, Joseph

2017-11-01

To investigate how a terminal illness may affect the health-care providers' resuscitation preferences. We conducted a cross-sectional survey in 9 health-care institutions located in 4 geographical regions in North and Central America, investigating attitudes toward end-of-life practices in health-care providers. Statistical analysis included descriptive statistics and χ 2 test for the presence of associations ( P < 0.05 being significant) and Cramer V for the strength of the association. The main outcome measured the correlation between the respondents' present code status and their preference for cardiopulmonary resuscitation (CPR) in case of terminal illness. A total of 852 surveys were completed. Among the respondents, 21% (n = 180) were physicians, 36.9% (n = 317) were nurses, 10.5% (n = 90) were medical students, and 265 participants were other staff members of the institutions. Most respondents (58.3%; n = 500) desired "definitely full code" (physicians 73.2%; n = 131), only 13.8% of the respondents (physicians 8.33%; n = 15) desired "definitely no code" or "partial support," and 20.9% of the respondents (n = 179; among physicians 18.4%; n = 33) had never considered their code status. There was an association between current code status and resuscitation preference in case of terminal illness ( P < .001), but this association was overall quite weak (Cramer V = 0.180). Subgroup analysis revealed no association between current code status and terminal illness code preference among physicians ( P = .290) and nurses ( P = .316), whereupon other hospital workers were more consistent ( P < .01, Cramer V = .291). Doctors and nurses have different end-of-life preferences than other hospital workers. Their desire to undergo CPR may change when facing a terminal illness.

Effect of nutritional support on terminally ill patients with cancer in a palliative care unit.

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Amano, Koji; Morita, Tatsuya; Baba, Mika; Kawasaki, Muneyoshi; Nakajima, Shinichiro; Uemura, Minako; Kobayashi, Yuka; Hori, Moeko; Wakayama, Hiroshi

2013-11-01

The role of nutritional support on terminally ill patients with cancer in a palliative care unit has not been clarified. A total of 63 patients were retrospectively investigated; the patients receiving individualized nutritional support (intervention group [n = 22]) were compared to the others (control group [n = 41]). The intervention group received individualized nutritional support. There were no significant differences in the characteristics of patients between the groups. The prevalence of bedsores was significantly lower in the intervention group (14% vs 46%, P = .012). The prevalence of edema and the use of antibiotic therapies tended to be lower in the intervention group than in the control group (36% vs 54%, P = .19; 14% vs 27%, P = .34, respectively). Some terminally ill patients with cancer in a palliative care unit might benefit from nutritional support.

Factors Associated With Caregivers' Resilience in a Terminal Cancer Care Setting.

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Hwang, In Cheol; Kim, Young Sung; Lee, Yong Joo; Choi, Youn Seon; Hwang, Sun Wook; Kim, Hyo Min; Koh, Su-Jin

2018-04-01

Resilience implies characteristics such as self-efficacy, adaptability to change, optimism, and the ability to recover from traumatic stress. Studies on resilience in family caregivers (FCs) of patients with terminal cancer are rare. This study aims to examine the factors associated with FCs' resilience in a terminal cancer care setting. This is a cross-sectional study of 273 FCs from 7 hospice and palliative care units in Korea. Resilience was categorized as high and low, and factors associated with resilience were grouped or categorized into subscales. A multivariate logistic regression analysis was used to examine relevant factors. High FCs' resilience was significantly associated with FCs' health status, depression, and social support. In a multivariate regression model, FCs' perception of good health (adjusted odds ratio [aOR] = 2.26, 95% confidence interval [CI] = 1.16-4.40), positive social support (aOR = 3.70, 95% CI = 1.07-12.87), and absence of depression (aOR = 3.12, 95% CI = 1.59-6.13) remained significantly associated with high FCs' resilience. Lack of family support is associated with and may be a cause of diminished resilience. And more concern should be paid to FCs to improve FCs' health and emotional status. Education programs might be effective for improving caregivers' resilience. Further research with supportive interventions is indicated.

Palliative care services for Indian migrants in Australia: Experiences of the family of terminally Ill patients

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Sujatha Shanmugasundaram

2009-01-01

Full Text Available Background: The way that health care systems in developing countries like India care for dying patients, has an impact on the expectations of such care for those who migrate to other countries faces. At the end of life, cultural issues may impact on the quality of life remaining and for that reason, it is important that particular cultural practices are understood. This paper describes a study that investigated the cultural issues of access to palliative care services for Indian migrants in Australia. Purpose of the Study: To investigate the experiences of the family members of terminally ill Indian migrants in Victoria, Australia. Objective of the Study: To explore the issues related to accessing palliative care services for Indian migrants; to identify the effectiveness of palliative care in supporting the patient and family and to recommend strategies for improving this care. Materials and Methods: A qualitative descriptive design was utilized. Up to 6 family members were selected for in-depth interviews in understanding cultural issues related to the palliative care services for a family member. Results: Analysis of the interviews revealed that families of Indian patients experience difficulties whilst receiving palliative care services, which fell into three main categories: Indian support systems, cultural issues, and caring experiences. Although each of these issues had a direct influence on the experience of terminal care that their family member received, cultural issues and support systems also influenced the caring experiences. Conclusion: Despite the successful implementation of palliative care services across Australia, there are still problems in accessing and receiving the services among minority and disadvantaged groups like various cultural groups.

[Compassionate care for terminally ill term and preterm infants].

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Schulze, A; Wermuth, I

2007-04-01

Involvement of the family in decisions to withhold or withdraw intensive care and parental involvement in care planning for terminally ill infants does not aggravate or prolong parents' grief responses, their feelings of guilt, or the incidence of pathological grief responses. Effective physical pain and symptom management is critically important. Compassionate care plans, however, need to implement a number of other and equally important components. Parents are not uniform in their perceived needs to make various kinds of contacts with their dying infant. They should be allowed to make their individual choices regarding contact with their baby during that time. The perinatal loss of a twin infant appears to evoke no less serious stress and risks to parents' compared to the loss of a singleton. The disruption of family life during a perinatal loss affects siblings of the baby, and their specific needs should be acknowledged. Post-death or post-autopsy meetings with the family should routinely be scheduled a few weeks after death, and bereavement support should actively be offered. Parents need to be informed about differences to be expected between maternal and paternal grief responses. The risk of pathological grief variants and chronic grief should be mentioned to parents because professional help is required in such occurrence.

Initial Efficacy Testing of an Autobiographical Memory Intervention on Advance Care Planning for Patients With Terminal Cancer.

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Brohard, Cheryl

2017-11-01

To test the efficacy of a novel intervention to facilitate advance care planning.
. Exploratory, quasiexperimental pilot study with two independent groups.
. A large hospice located in the southwestern United States. 
. A convenience sample of 50 participants with terminal cancer enrolled in hospice.
. An autobiographical memory (ABM) intervention used the participants' experiences with cancer and end of life for the purpose of directing advance care planning.
. Two domains of advance care planning, decision making and communication, were measured in relation to 11 variables. The ABM intervention was nonthreatening, short in duration, and easily completed with participants as they recalled, without hesitation, specific personal memories of family and friends who had died and their advance care plans. The Mann-Whitney nonparametric test revealed that participants in the experimental group had a higher average rank than those in the control group for communicating the decision about antibiotics, as well as exhibited a trend toward significance for five other advance care planning variables.
. Findings showed that directive ABMs may be effective in influencing the decision making and communication of advance care planning for terminally ill patients with cancer.
. The current level of understanding about using the ABM intervention suggests that nurses can initiate an advance care planning conversation using this approach.

The families evaluation on management, care and disclosure for terminal stage cancer patients

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Kalaidopoulou Ourania

2002-04-01

Full Text Available Abstract Background Quality of life is an important concept which is subjective and personal; what is an acceptable quality of life to one may be 'worse than death' to another. The objective of this study was to develop and validate a questionnaire to assess relatives' perceptions and attitudes towards their terminal stage cancer patients' management (information disclosure, treatment choice, hospitalization and support-communication and care including aspects regarding end-of-life and quality-of-life decisions. Methods The final study consisted of 146 relatives of advanced terminal stage cancer patients receiving palliation, attending a Pain Relief and Palliative Care Unit. The questionnaire incorporated 6 multi-item and 7 single-item scales, and was developed following a systematic review of measures appropriate for use in palliative care settings. Results Following analysis of the 25-item scale, the questionnaire has been validated as a shortened 21-item scale consisting of 5 multi-item and 5 single-item scales. Factor analysis was based upon information disclosure, hospitalization, and support-communication demonstrating Cronbach's alpha coefficients of 0.66, 0.5 and 0.70 respectively. Average item totals and inter-item scale correlations were between 0.62–0.70, with convergent validity correlations between 0.60–0.86. The questionnaire was well accepted by all subjects with an 8–10 minute completion time. Conclusion The shortened 21-item self-assessment questionnaire may provide acceptable and valid assessment of caregiver(s/Greek cancer patients' relatives perceptions on palliative care.

Using social exchange theory to understand non-terminal palliative care referral practices for Parkinson's disease patients.

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Prizer, Lindsay P; Gay, Jennifer L; Perkins, Molly M; Wilson, Mark G; Emerson, Kerstin G; Glass, Anne P; Miyasaki, Janis M

2017-10-01

A palliative approach is recommended in the care of Parkinson's disease patients; however, many patients only receive this care in the form of hospice at the end of life. Physician attitudes about palliative care have been shown to influence referrals for patients with chronic disease, and negative physician perceptions may affect early palliative referrals for Parkinson's disease patients. To use Social Exchange Theory to examine the association between neurologist-perceived costs and benefits of palliative care referral for Parkinson's disease patients and their reported referral practices. A cross-sectional survey study of neurologists. A total of 62 neurologists recruited from the National Parkinson Foundation, the Medical Association of Georgia, and the American Academy of Neurology's clinician database. Participants reported significantly stronger endorsement of the rewards ( M = 3.34, SD = 0.37) of palliative care referrals than the costs ( M = 2.13, SD = 0.30; t(61) = -16.10, p < 0.0001). A Poisson regression found that perceived costs, perceived rewards, physician type, and the number of complementary clinicians in practice were significant predictors of palliative care referral. Physicians may be more likely to refer patients to non-terminal palliative care if (1) they work in interdisciplinary settings and/or (2) previous personal or patient experience with palliative care was positive. They may be less likely to refer if (1) they fear a loss of autonomy in patient care, (2) they are unaware of available programs, and/or (3) they believe they address palliative needs. Initiatives to educate neurologists on the benefits and availability of non-terminal palliative services could improve patient access to this care.

Meaning of care for terminally Ill HIV-infected patients by HIV-infected peer caregivers in a simulation-based training program in South Korea.

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Kim, Sunghee; Shin, Gisoo

2015-01-01

The purpose of this study was to develop a simulation-based training program for people living with HIV (PLWH) as peer caregivers who would take care of terminally ill, HIV-infected patients. We used qualitative research methods and standardized patients to explore the meaning of caring for patients as peer caregivers. Study participants included 32 patients registered as PLWH at the South Korea Federation for HIV/AIDS. The meanings of peer caregiving were categorized into four dimensions: physical, psychological, relational, and economic. Our study had benefits in knowledge acquisition for caregivers as well as care recipients, empathy with HIV-infected care recipients, improvement in self-esteem and social participation, and financial self-sufficiency to enable independent living for caregivers. The simulation training program for PLWH peer caregivers for terminally ill HIV-infected patients demonstrated value, for both PLWH caregivers and terminally ill HIV-infected patients in South Korea, to improve the quality of care. Copyright © 2015 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.

Impact of palliative care consultative service on disease awareness for patients with terminal cancer.

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Chou, Wen-Chi; Hung, Yu-Shin; Kao, Chen-Yi; Su, Po-Jung; Hsieh, Chia-Hsun; Chen, Jen-Shi; Liau, Chi-Ting; Lin, Yung-Chang; Liaw, Chuang-Chi; Wang, Hung-Ming

2013-07-01

Awareness of the status of disease among terminally ill cancer patients is an important part of the end-of-life care. We have evaluated how palliative care consultative service (PCCS) affects patient disease awareness and determined who may benefit from such services in Taiwan. In total, 2,887 terminally ill cancer patients consecutively received PCCS between January 2006 and December 2010 at a single medical center in Taiwan, after which they were evaluated for disease awareness. At the beginning of PCCS, 31 % of patients (n = 895) were unaware of their disease status. The characteristics of these 895 patients were analyzed retrospectively to determine variables pertinent to patient disease awareness after PCCS. In total, 485 (50 %) of the 895 patients became aware of their disease at the end of PCCS. Factors significantly associated with higher disease awareness included a longer interval between the date of hospital admission and that of PCCS referral (>4 weeks versus ≤2 weeks), a longer duration of PCCS (>14 days versus ≤7 days), the male gender, divorced marital status (versus married), and family awareness (versus lack of family awareness). Lower disease awareness was associated with older age (age > 75 years versus age = 18-65 years), referral from non-oncology departments, and primary cancer localization (lung, colon-rectum, or urological versus liver). Disease awareness is affected by multiple factors related to the patients, their families, and the clinicians. The promotion of PCCS increased disease awareness among terminally ill cancer patients in Taiwan.

Development of a Medical Care Terminal for Efficient Monitoring of Bedridden Subjects

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Filipe Pereira

2016-01-01

Full Text Available This work is developed in the context of Ambient Assisted Living (AAL and has as main objective the development of a mechatronic system that allows the care of bedridden patients with ongoing medical care handled by a single person. The developed Medical Care Terminal (MCT improves autonomy in home care, safety, comfort, and hygiene of bedridden patients. The MCT has six biomedical sensors and four environmental sensors. Data acquisition and processing is performed using Arduino and LabVIEW platforms, respectively. The proposed solution has, as main feature, its adaptability to the patient needs. One of the MCT functionalities is the remote access to the patient data through the web. The caregiver may request help from a specialist who sends back information in real time to perform first aid assistance. This device has a flexible configuration allowing a fast and cheap reconfiguration according the specific needs of the patient. The proposed mechatronic system intends to meet the needs of bedridden patients improving their quality of life, health, safety, and comfort, while enabling the remote monitoring of the patients.

The impact of awareness of terminal illness on quality of death and care decision making: a prospective nationwide survey of bereaved family members of advanced cancer patients.

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Ahn, Eunmi; Shin, Dong Wook; Choi, Jin Young; Kang, Jina; Kim, Dae Kyun; Kim, Hyesuk; Lee, Eunil; Hwang, Kwan Ok; Oh, Bumjo; Cho, BeLong

2013-12-01

We aimed to assess whether awareness of a terminal illness can affect care decision making processes and the achievement of a good death in advanced cancer patients receiving palliative care services. Awareness of terminal illness at the time of palliative care service admission was assessed by the health care professionals during the routine initial comprehensive assessment process and was recorded in the national terminal cancer patient registry. A follow-up nationwide bereavement survey was conducted, which contained questions regarding decision making processes and the Korean version of the Good Death Inventory. Among the 345 patients included in the final analysis, the majority (68.4%) of the patients were aware of the terminal illness. Awareness of the terminal illness tended to reduce discordances in care decision making (adjusted odds ratio = 0.55; 95% CI: 0.29-1.07), and increased the patients' own decision making when there were discordances between patients and their families (adjusted odds ratio = 3.79; 95% CI: 1.31-10.94). The Good Death Inventory score was significantly higher among patients who were aware of their terminal illnesses compared with those who were not (5.04 vs. 4.80; p = 0.013) and especially in the domains of 'control over the future' (5.18 vs. 4.04; p Awareness of the terminal illness had beneficial effect on the harmonious decision making, patient autonomy, and patient's quality of death. Disclosure of terminal illness should be encouraged. Copyright © 2013 John Wiley & Sons, Ltd.

25 CFR 11.1114 - Termination.

Science.gov (United States)

2010-04-01

... Minor-in-Need-of-Care Procedure § 11.1114 Termination. (a) Parental rights to a child may be terminated... rights if, following efforts to prevent or eliminate the need to remove the minor, it finds such efforts... alternatives: (1) If parental rights to a child are terminated, the children's court shall place the minor in a...

Dying in Palliative Care Units and in Hospital: A Comparison of the Quality of Life of Terminal Cancer Patients.

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Viney, Linda L.; And Others

1994-01-01

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

Estrategia educativa para cuidadoras de familiares con enfermedad terminal Educational strategy for female care givers who attend terminally ill relatives

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Yamilé Benítez Lambert

2011-10-01

Full Text Available Se realizó una intervención educativa desde julio de 2008 hasta enero de 2010 en el Policlínico Docente "Ramón López Peña" de Santiago de Cuba para aplicar una estrategia capacitante sobre cuidados paliativos, dirigida a 24 mujeres encargadas de atender a igual número de familiares con enfermedad terminal. Antes de ser instruidas al efecto, la mayoría de las cuidadoras desconocían cómo controlar los síntomas en sus parientes y su propio estrés, carecían de preparación psicológica para enfrentar el duelo, no habían adquirido las habilidades comunicativas necesarias y muchas se mostraban insatisfechas con el apoyo profesional recibido, entre otros factores; sin embargo, los encuentros programados permitieron brindarles la orientación y el asesoramiento requeridos para asumir con seguridad y confianza el rol que debían desempeñar responsablemente en esa humana labor.An educational intervention was carried out from July, 2008 to January, 2010 at "Ramóm López Peña" Teaching Polyclinic in Santiago de Cuba in order to apply an effective strategy on hospice care so as to train 24 women in charge of attending the same number of terminally ill family members. Before the training, most of female care givers did not know how to control symptoms of their ill relatives, not even their own stress; they had no psychological training to face the challenge; they had not developed the necessary communicative skills; and most of them were not satisfied with the professional aid received; among other factors. However, the scheduled meetings allowed health workers to offer the required orientation and expert advice to these care givers so they could assume their roles with confidence and security taking into account they had to perform a human task with a lot of responsibility.

[Anesthetic care for fibrobronchoscopy in patients with chronic terminal respiratory insufficiency undergoing evaluation for isolated lung transplantation].

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Solca, M; Elena, A; Croci, M; Damia, G

1993-01-01

During the first 18 month operation of the isolated lung transplantation program at or Institution, eight patients with terminal chronic respiratory failure underwent fiberoptic bronchoscopy and broncho-alveolar lavage as part of their evaluation for isolated lung transplantation. Four patients had severe obstructive, three restrictive, and one mixed, obstructive and restrictive, disease; all of them were on continuous supplemental oxygen. Procedures were performed under topical anaesthesia, with either light sedation or simple monitored anaesthesia care. Monitoring included non-invasive blood pressure measurement, pulse oximeter and precordial stethoscope. No adverse events were recorded, except in one case, when pulse oximeter reading precipitously dropped below 80%, to a minimum of 68-69%. The procedures was terminated short of its completion, and the patient was briefly assisted with manual bag ventilation on oxygen 100%. Pulse oximeter quickly returned to normal levels (above 90%), and the patient promptly recovered, without complications. The importance of monitored anaesthesia care during fiberoptic bronchoscopy (a usually benign procedure) in critically ill patients is greatly emphasized.

Wound Documentation by Using 3G Mobile as Acquisition Terminal: An Appropriate Proposal for Community Wound Care.

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Ge, Kui; Wu, Minjie; Liu, Hu; Gong, Jiahong; Zhang, Yi; Hu, Qiang; Fang, Min; Tao, Yanping; Cai, Minqiang; Chen, Hua; Wang, Jianbo; Xie, Ting; Lu, Shuliang

2015-06-01

The increasing numbers of cases of wound disease are now posing a big challenge in China. For more convenience of wound patients, wound management in community health care centers under the supervision of a specialist at general hospitals is an ideal solution. To ensure an accurate diagnosis in community health clinics, it is important that "the same language" for wound description, which may be composed of unified format description, including wound image, must be achieved. We developed a wound information management system that was built up by acquisition terminal, wound description, data bank, and related software. In this system, a 3G mobile phone was applied as acquisition terminal, which could be used to access to the data bank. This documentation system was thought to be an appropriate proposal for community wound care because of its objectivity, uniformity, and facilitation. It also provides possibility for epidemiological study in the future. © The Author(s) 2014.

Terminal patients in Belgian nursing homes: a cost analysis.

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Simoens, Steven; Kutten, Betty; Keirse, Emmanuel; Vanden Berghe, Paul; Beguin, Claire; Desmedt, Marianne; Deveugele, Myriam; Léonard, Christian; Paulus, Dominique; Menten, Johan

2013-06-01

Policy makers and health care payers are concerned about the costs of treating terminal patients. This study was done to measure the costs of treating terminal patients during the final month of life in a sample of Belgian nursing homes from the health care payer perspective. Also, this study compares the costs of palliative care with those of usual care. This multicenter, retrospective cohort study enrolled terminal patients from a representative sample of nursing homes. Health care costs included fixed nursing home costs, medical fees, pharmacy charges, other charges, and eventual hospitalization costs. Data sources consisted of accountancy and invoice data. The analysis calculated costs per patient during the final month of life at 2007/2008 prices. Nineteen nursing homes participated in the study, generating a total of 181 patients. Total mean nursing home costs amounted to 3,243 € per patient during the final month of life. Total mean nursing home costs per patient of 3,822 € for patients receiving usual care were higher than costs of 2,456 € for patients receiving palliative care (p = 0.068). Higher costs of usual care were driven by higher hospitalization costs (p < 0.001). This study suggests that palliative care models in nursing homes need to be supported because such care models appear to be less expensive than usual care and because such care models are likely to better reflect the needs of terminal patients.

Cuidando de pacientes em fase terminal: a perspectiva de alunos de enfermagem El cuidando de pacientes en fase terminal: la perspectiva de los alumnos de enfermería Taking care of terminal patients: nursing student's perspective

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Maria Lúcia Araújo Sadala

2009-06-01

to understand how nursing undergraduates perceive themselves while care delivery to terminal patients and expose the meaning of the experience they have. Fourteen students were interviewed, and answered the following question: What is the image you have about caring for a terminal patient? Students always consider this to be a painful experience, one that puts them face to face with their weaknesses and insecurities. They attribute their difficulties to their personal incapacity to accept death and to their lack of preparation and their inexperience. They report a lack of support from professionals with whom they share this care. In terms of professional development, for some, the experience was positive, despite the difficulties; others evaluate it as negative, resulting in a rejection of similar situations. Further studies on this subject are needed with a view to a deeper and broader reflection on nursing education in Brazil.

PROSPECTIVE ANALYTICAL STUDY ON THE MEDICAL TERMINATION OF PREGNANCIES IN A TERTIARY CARE CENTRE

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S. Gayathriedevi Sellathamby

2017-06-01

Full Text Available BACKGROUND This study is carried out to estimate incidence of medical termination of pregnancies in a tertiary care centre, to analyse the causes of medical termination of pregnancies, to analyse the success of the methods of abortion and adoption family planning procedures in a tertiary care centre (Government Rajaji Hospital, Madurai. This may provide the baseline measures for safe abortion practices and to increase the awareness among men and women of reproductive age, the availability of safe abortion services at locality. The aim of the study is to know the incidence of medical termination of pregnancies in a tertiary level hospital, to study the causes for seeking MTP, to analyse the success of the methods of abortion and adoption of family planning methods. MATERIALS AND METHODS This study was carried out in Government Rajaji Hospital, Madurai, during the period of 12 months from September 2011- August 2012. Of 3516 patients attending the family planning OP, 496 women seek MTP. Among them, every 5 th women were selected and thus 100 cases were included in this study. Social parameters like age, education, residence, marital status, family pattern, number of living children, sex of the living children, obstetric parameters like parity, trimester of abortion, methods of abortion, causes for MTP, adoption of family planning methods, basic investigation like Hb%, BT, CT, urine albumin, RFT, blood sugar, blood grouping and typing and VCTC were included. RESULTS Induced abortions were common in women in 20-29-year age group, more in third gravid, Hindus, from rural areas, living in nuclear family, married and educated. Most of the women seek 1 st trimester abortion with underlying social cause. Majority had surgical abortion. Majority adopted transabdominal tubectomy as the concurrent family planning method. Second trimester abortions common in unmarried, uneducated women. CONCLUSION The variables analysed in this study bring into light the

Health care utilization during terminal child illness in squatter settlements of Karachi.

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Hasan, I J; Khanum, A

2000-12-01

Information on health seeking behavior and health care utilization has important policy implications in health systems development. The paper presents some of the issues related to health care utilization and health seeking behavior in case of terminal child illness in seven squatter settlements of Karachi. From seven squatter settlements of Karachi, with a population of 100,000 approximately, we collected information, using pretested structured questionnaire, from the mothers on health care utilization during the final illness of under five children dying during 1995-1996. These deaths were identified from an earlier baseline health and demographic survey in these areas. Interviews were completed for 259 infant and child deaths of which 57% were boys. Of all deaths 72% were taken to a health care provider, of which 82% went as soon as the child got ill. Private sector is the most preferred first choice i.e., 83%. Of all those who had been to a health care provider, 65% were referred to some other place and 72% of them took more than 12 hours altogether to reach the referred facility. Children in older age categories (OR 4.4 95% CI 2.22-8.67 and OR 5.0, 95% CI 2.09-12.31), boys (OR 2.6, 95% CI 1.46-4.77) and those with appropriate or incomplete immunization (OR 4.1, 95% CI 2.13-7.94) were significantly associated with the health care utilization as compared to their counterparts. Living in urban areas does not ensure accessibility to effective health care. In poor urban communities, referral to other facility delay the initiation of effective treatment in case of child illness leading to death which could be prevented otherwise. Private sector constitutes an important segment of our health care system, which requires strengthening and back up support. Furthermore, the study finding is suggestive of gender discrimination in health seeking behavior.

Palliativ behandling af patienter med terminal kronisk obstruktiv lungesygdom

DEFF Research Database (Denmark)

von Plessen, Christian; Nielsen, Thyge L; Steffensen, Ida E

2011-01-01

Terminal chronic obstructive pulmonary disease (COPD) and advanced cancer have similar prognosis and symptom burden. However, palliative care of patients with terminal COPD has been neglected in Denmark. We describe the symptoms of terminal COPD and suggest criteria for defining the palliative...

Age-dependent values of N-terminal pro-B-type natriuretic peptide are superior to a single cut-point for ruling out suspected systolic dysfunction in primary care

DEFF Research Database (Denmark)

Hildebrandt, Per; Collinson, Paul O; Doughty, Robert N

2010-01-01

The study evaluated the use of age-related decision limits for N-terminal pro-B-type natriuretic peptide (NT-proBNP), for ruling out suspected systolic dysfunction in symptomatic patients in primary care, compared with the present standards.......The study evaluated the use of age-related decision limits for N-terminal pro-B-type natriuretic peptide (NT-proBNP), for ruling out suspected systolic dysfunction in symptomatic patients in primary care, compared with the present standards....

Impact of caregivers' unmet needs for supportive care on quality of terminal cancer care delivered and caregiver's workforce performance.

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Park, Sang Min; Kim, Young Jin; Kim, Samyong; Choi, Jong Soo; Lim, Ho-Yeong; Choi, Youn Seon; Hong, Young Seon; Kim, Si-Young; Heo, Dae Seog; Kang, Ki Moon; Jeong, Hyun Sik; Lee, Chang Geol; Moon, Do Ho; Choi, Jin-Young; Kong, In Sik; Yun, Young Ho

2010-06-01

Family caregivers play an important role in caring for cancer patients, but the impact of caregivers' unmet needs on the quality of end-of-life (EOL) care they deliver and on their workplace performance are less understood. We identified 1,662 family caregivers of cancer patients who had died at any of 17 hospitals in Korea during 2004. The caregivers answered a telephone questionnaire about needs that were not met when they delivered terminal cancer care and how those unmet their needs affected their workplace performance; they also answered the Quality Care Questionnaire-End of Life (QCQ-EOL). Compared with caregivers who did not have unmet needs, caregivers who had unmet needs for symptom management, financial support, or community support showed poorer QCQ-EOL scores (P < 0.01). Caregivers who had unmet needs for financial support (adjusted odds ratio (aOR) = 7.55; 95% confidential interval (CI) 3.80-15.00), psychosocial support (aOR = 6.24; 95% CI 2.95-13.05), symptom management (aOR = 3.21; 95% CI 2.26-4.54), community support (aOR = 3.82; 95% CI 2.38-6.11), or religious support (aOR = 4.55; 95% CI 1.84-11.26) were more likely to experience work limitations. Caregivers of patients receiving conventional hospital care were more likely to have unmet needs for symptom management (aOR = 1.21; 95% CI 1.00-1.47), psychosocial support (aOR = 1.99; 95% CI 1.37-2.88), and religious support (aOR = 1.73; 95% CI 1.08-2.78) than those of patients receiving palliative hospice care. Caregivers' unmet needs negatively affected both the quality of EOL care they delivered and their workplace performance. More investment in caregiver support and public policies that meet caregiver needs are needed, and hospice use should be encouraged.

Religious care required for Japanese terminally ill patients with cancer from the perspective of bereaved family members.

Science.gov (United States)

Okamoto, Takuya; Ando, Michiyo; Morita, Tatsuya; Hirai, Kei; Kawamura, Ryo; Mitsunori, Miyashita; Sato, Kazuki; Shima, Yasuo

2010-02-01

The aim of this study was to explore the most suitable religious care for Japanese terminally ill patients with cancer based on the opinions of bereaved family members. A multicenter questionnaire survey on palliative care service was sent to 592 bereaved family members of patients with cancer who were admitted to palliative care units in Japan, and 430 responded by mail. In the section of the questionnaire about religious care, 382 responses were used for quantitative analysis, and 71 responses about religious care for qualitative analysis. In the current study, the 71 responses were grouped into families with and without a religion and were analyzed qualitatively. Families with a religion (N = 28) chose answers such as ''Instrumental care'' such as music or a religious event, ''Freedom of choice of kinds for religious care,'' ''Staff involvement of religious care,'' ''Meeting with a pastoral care workers,'' and ''Burden of offering a different kind of personal religion.'' In contrast, families without a religion (N = 44) chose answers such as ''Instrumental care,'' ''Freedom of choice whether patients receive religious care or not,'' ''Spiritual care,'' ''Not being able to accept religious care,'' and ''Burden of thinking about a religion and nuisance.'' These findings suggest that Japanese bereaved families with a religion generally regard religious care positively and prefer care through their own religion, whereas some families without a religion require religious care but some do not prefer it.

[Home parenteral nutrition for terminal stage of cancer patient].

Science.gov (United States)

Takamura, S; Sakuyama, T; Nakamura, Y; Takahashi, N; Hattori, M

1997-12-01

In the last 6 years, we have experienced 20 cancer patients who received home parenteral nutrition for terminal stage. The patients had 13 gastric cancers, 3 esophageal cancers and 5 others. The prognosis of upper G-I cancer is known to be poorer than that of colon cancer. The home care of our cases, the gastric cancer lasted 25 days on average, which was shorter than others. So the home care for patients in the terminal stage of gastric cancer is very short. Therefore we decide the home care for the terminal stage of gastric cancer as soon as possible. We conducted a questionnaire survey of our cases and family. We finally found that the most important thing is the safety of patient for the maintenance of home care. Our home care system is made up of a 3-way relationship among the patient, support system and doctor. The doctor is on call for the problems of the patient for 24 hours. Therefore, we believe that this system is comfortable for both the patient and family.

A Structured Approach to End-of-Life Decision Making Improves Quality of Care for Patients With Terminal Illness in a Teaching Hospital in Ghana.

Science.gov (United States)

Edwin, Ama Kyerewaa; Johnson McGee, Summer; Opare-Lokko, Edwina Addo; Gyakobo, Mawuli Kotope

2016-03-01

To determine whether a structured approach to end-of-life decision-making directed by a compassionate interdisciplinary team would improve the quality of care for patients with terminal illness in a teaching hospital in Ghana. A retrospective analysis was done for 20 patients who consented to participate in the structured approach to end-of-life decision-making. Twenty patients whose care did not follow the structured approach were selected as controls. Outcome measures were nociceptive pain control, completing relationships, and emotional response towards dying. These measures were statistically superior in the study group compared to the control group. A structured approach to end-of-life decision-making significantly improves the quality of care for patients with terminal illness in the domains of pain control, completing relationships and emotional responses towards dying. © The Author(s) 2014.

Comparative economic evaluation of home-based and hospital-based palliative care for terminal cancer patients.

Science.gov (United States)

Kato, Koki; Fukuda, Haruhisa

2017-11-01

To quantify the difference between adjusted costs for home-based palliative care and hospital-based palliative care in terminally ill cancer patients. We carried out a case-control study of home-care patients (cases) who had died at home between January 2009 and December 2013, and hospital-care patients (controls) who had died at a hospital between April 2008 and December 2013. Data on patient characteristics were obtained from insurance claims data and medical records. We identified the determinants of home care using a multivariate logistic regression analysis. Cox proportional hazards analysis was used to examine treatment duration in both types of care, and a generalized linear model was used to estimate the reduction in treatment costs associated with home care. The case and control groups comprised 48 and 99 patients, respectively. Home care was associated with one or more person(s) living with the patient (adjusted OR 6.54, 95% CI 1.18-36.05), required assistance for activities of daily living (adjusted OR 3.61, 95% CI 1.12-10.51), non-use of oxygen inhalation therapy (adjusted OR 12.75, 95% CI 3.53-46.02), oral or suppository opioid use (adjusted OR 5.74, 95% CI 1.11-29.54) and transdermal patch opioid use (adjusted OR 8.30, 95% CI 1.97-34.93). The adjusted hazard ratio of home care for treatment duration was not significant (adjusted OR 0.95, 95% CI 0.59-1.53). However, home care was significantly associated with a reduction of $7523 (95% CI $7093-7991, P = 0.015) in treatment costs. Despite similar treatment durations between the groups, treatment costs were substantially lower in the home-care group. These findings might inform the policymaking process for improving the home-care support system. Geriatr Gerontol Int 2017; 17: 2247-2254. © 2017 Japan Geriatrics Society.

Changes in health-related quality of life and quality of care among terminally ill cancer patients and survival prediction: Multicenter prospective cohort study.

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Lee, Myung Kyung; Lee, Woo Jin; Do, Young Rok; Lee, Keun Seok; Jung, Kyung Hae; Heo, Dae Seog; Kim, Sam Yong; Park, Sang Yoon; Jeong, Hyun Sik; Kang, Jung Hun; Kim, Si-Young; Park, Sook Ryun; Yun, Young Ho

2015-08-01

This study examined changes in health-related quality of life (HRQoL) and quality of care (QoC) as perceived by terminally ill cancer patients and a stratified set of HRQoL or QoC factors that are most likely to influence survival at the end of life (EoL). We administered questionnaires to 619 consecutive patients immediately after they were diagnosed with terminal cancer by physicians at 11 university hospitals and at the National Cancer Center in Korea. Subjects were followed up over 161.2 person-years until their deaths. We measured HRQoL using the core 30-item European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, and QoC using the Quality Care Questionnaire-End of Life (QCQ-EoL). We evaluated changes in HRQoL and QoC issues during the first three months after enrollment, performing sensitivity analysis by using data generated via four methods (complete case analysis, available case analysis, the last observation carried forward, and multiple imputation). Emotional and cognitive functioning decreased significantly over time, while dyspnea, constipation, and pain increased significantly. Dignity-conserving care, care by healthcare professionals, family relationships, and QCQ-EoL total score decreased significantly. Global QoL, appetite loss, and Eastern Cooperative Oncology Group Performance Status (ECOG-PS) scores were significantly associated with survival. Future standardization of palliative care should be focused on assessment of these deteriorated types of quality. Accurate estimates of the length of life remaining for terminally ill cancer patients by such EoL-enhancing factors as global QoL, appetite loss, and ECOG-PS are needed to help patients experience a dignified and comfortable death.

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

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

2005-12-01

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

Barriers and facilitators to care for the terminally ill: a cross-country case comparison study of Canada, England, Germany, and the United States.

Science.gov (United States)

Klinger, Christopher A; Howell, Doris; Zakus, David; Deber, Raisa B

2014-02-01

Why do many patients not die at their preferred location? Analyze system-level characteristics influencing the ability to implement best practices in delivering care for terminally ill adults (barriers and facilitators). Cross-country comparison study from a "most similar-most different" perspective, triangulating evidence from a scoping review of the literature, document analyses, and semi-structured key informant interviews. Case study of Canada, England, Germany, and the United States. While similar with regard to leading causes of death, patient needs, and potential avenues to care, different models of service provision were employed in the four countries studied. Although hospice and palliative care services were generally offered with standard care along the disease continuum and in various settings, and featured common elements such as physical, psycho-social, and spiritual care, outcomes (access, utilization, etc.) varied across jurisdictions. Barriers to best practice service provision included legislative (including jurisdictional), regulatory (e.g. education and training), and financial issues as well as public knowledge and perception ("giving up hope") challenges. Advance care planning, dedicated and stable funding toward hospice and palliative care, including caregiver benefits, population aging, and standards of practice and guidelines to hospice and palliative care, were identified as facilitators. Successful implementation of effective and efficient best practice approaches to care for the terminally ill, such as shared care, requires concerted action to align these system-level characteristics; many factors were identified as being essential but not sufficient. Policy implementation needs to be tailored to the respective health-care system(s), monitored, and fine-tuned.

Shared Care in Basic Level Palliative Home Care: Organizational and Interpersonal Challenges

DEFF Research Database (Denmark)

Neergaard, Mette Asbjørn; Olesen, Frede; Jensen, Anders Bonde

2010-01-01

Little is known about the existing barriers to cooperation among health professionals in basic level palliative care for terminally ill patients with cancer in primary health care.......Little is known about the existing barriers to cooperation among health professionals in basic level palliative care for terminally ill patients with cancer in primary health care....

Does subsequent criminal justice involvement predict foster care and termination of parental rights for children born to incarcerated women?

Science.gov (United States)

Kubiak, Sheryl Pimlott; Kasiborski, Natalie; Karim, Nidal; Schmittel, Emily

2012-01-01

This longitudinal study of 83 incarcerated women, who gave birth during incarceration and retained their parental rights through brief sentences, examines the intersection between subsequent criminal justice involvement postrelease and child welfare outcomes. Ten years of multiple state-level administrative data sets are used to determine if arrest or conviction predict foster care and/or termination of parental rights. Findings indicate that only felony arrest is a significant predictor of foster care involvement. Additionally, 69% of mothers retained legal custody, despite subsequent criminal involvement for many, suggesting supportive parenting programs and resources need to be available to these women throughout and after incarceration.

Struggling to adapt: caring for older persons while under threat of organizational change and termination notice.

Science.gov (United States)

Fläckman, Birgitta; Hansebo, Görel; Kihlgren, Annica

2009-03-01

Organizational changes are common in elder care today. Such changes affect caregivers, who are essential to providing good quality care. The aim of the present study was to illuminate caregivers' experiences of working in elder care while under threat of organizational change and termination notice. Qualitative content analysis was used to examine interview data from 11 caregivers. Interviews were conducted at three occasions during a two-year period. The findings show a transition in their experiences from 'having a professional identity and self-confidence', to 'being a professional in a threatening situation caused by someone else' and to 'struggling to adapt to a changed working environment as a person and a professional'. The caregivers experienced a loss of pride and satisfaction. Previous literature indicates that this may have consequences for the quality of care and that employees may be at risk of negative health effects. However, the caregivers continued to struggle, doing their best to complete their duties. The study has implications for high-level decision-makers, managers and caregivers in similar work-life situations in that it deals with factors that facilitate or impede similar transitions.

The experience of Chinese immigrant women in caring for a terminally ill family member in Australia.

Science.gov (United States)

Heidenreich, Mary T; Koo, Fung Kuen; White, Kate

2014-01-01

The Chinese community, a heterogeneous, highly visible non-English speaking ethnic group in Australia, remains mostly hidden and underrepresented in palliative care service delivery along with participation in health research despite being the fastest growing such group in the country. There is a lack of Australian research information concerning the impact of migration on the caregiving experience of women carers within the Chinese cultural framework and the Australian palliative care context. This paper aims to explore the influence of Chinese cultural norms and immigration on the experience of immigrant women of Chinese ancestry caring for a terminally ill family member at home in Sydney. This study also seeks to identify factors that may present access barriers to palliative care support services. A qualitative approach was used in this study. Data were collected from semi-structured interviews with five home-based Chinese women carers and were analysed using thematic analysis. Findings identified that the participants found being a carer is a lonely and isolating experience. Sources of isolation and loneliness included social isolation experienced as a solitary carer without meaningful family and social relationships; loss of familiar cultural understandings and family values; and emotional isolators expressed in response to the physical and emotional role commitment and other constraints. The study results suggest the need for palliative care educational programmes designed to help nurses to understand the impact of cultural background within the palliative care context. Results also indicate that health care professionals should provide culturally appropriate and competent palliative care services, sensitive to the diverse socio-cultural influences and individual needs of Chinese migrants.

Medical futility in the care of non-competent terminally ill patient: nursing perspectives and responsibilities.

Science.gov (United States)

Scanlon, Andrew; Murphy, Maria

2014-05-01

Debate continues on the use of medical technology to prolong life independent of the quality of the outcomes. As a consequence, acute care nurses often find themselves in situations where they are asked to carry out physician's orders, in the context of a patient's deteriorating condition, which may be at odds with professional and personal ethical standards. This can cause nurses to become distressed when struggling with the ethical dilemmas involved with medical futility. This paper is a perspective on nursing considerations of our Code of Ethics and the concept of medical futility in acute nursing care. The utility of the Code is examined through a clinical vignette. A database search using the keywords medical futility and acute care limited to 2008 to 2012 and a secondary hand search of these references identified thirty journal publications. The Code of Ethics was examined via a clinical scenario pertinent to an acute environment. This paper examines the ethical principles that underpin nursing and illustrates how the code of ethics may serve as sign posts when faced with caring for a terminally ill patient that is inappropriately managed. Understanding how individual nurses may address ethical dilemmas when faced with medical futility can better enable the nurse to fulfil their role as patient advocate, health promoter and alleviator of suffering. Ongoing education and communication to decrease any ambiguity or anguish associated with a patient's impending death optimises apt outcomes. Copyright © 2012 Australian College of Critical Care Nurses Ltd. All rights reserved.

Palliativ behandling af patienter med terminal kronisk obstruktiv lungesygdom

DEFF Research Database (Denmark)

von Plessen, Christian; Nielsen, Thyge L; Steffensen, Ida E

2011-01-01

Terminal chronic obstructive pulmonary disease (COPD) and advanced cancer have similar prognosis and symptom burden. However, palliative care of patients with terminal COPD has been neglected in Denmark. We describe the symptoms of terminal COPD and suggest criteria for defining the palliative...... phase of the disease. Furthermore we discuss the prognostic and ethical challenges for patients, their families and their caregivers. Finally, we summarize the current evidence for palliative treatment of dyspnoea and ways to evaluate response to treatment....

Palliativ behandling af patienter med terminal kronisk obstruktiv lungesygdom

DEFF Research Database (Denmark)

von Plessen, Christian; Nielsen, Thyge L; Steffensen, Ida E

2011-01-01

Terminal chronic obstructive pulmonary disease (COPD) and advanced cancer have similar prognosis and symptom burden. However, palliative care of patients with terminal COPD has been neglected in Denmark. We describe the symptoms of terminal COPD and suggest criteria for defining the palliative ph...... phase of the disease. Furthermore we discuss the prognostic and ethical challenges for patients, their families and their caregivers. Finally, we summarize the current evidence for palliative treatment of dyspnoea and ways to evaluate response to treatment....

Vital Signs Monitoring System Using Radio Frequency Communication: A Medical Care Terminal for Beddridden People Support

Directory of Open Access Journals (Sweden)

Fábio FERREIRA

2015-02-01

Full Text Available In this paper, the data transmission of an acquisition system for biomedical vital signs via Radio Frequency (RF communication is explored. This system can be considered a medical care terminal (MCT. It was developed a platform capable of recording the patient's physiological signals to check if any medical evolution/change occurred. The system allows also acquiring the environment data, as for example the room temperature and luminosity. The main achievement of this paper is the patients’ real-time health condition monitoring by the medical personnel or caregivers that will contribute to prevent health problems, especially for bedridden people with reduced mobility.

The termination phase of psychoanalysis as seen through the lens of the dream.

Science.gov (United States)

Grenell, Gary

2002-01-01

The decision about when to terminate analysis has long been underpinned by a theory-driven criterion model, which may steer the analytic dialogue away from its customary activities of free association, empathic listening, and interpretation. As a remedy to this situation, the author proposes that by paying careful attention to less consciously crafted patient communications such as dreams, the analytic dyad can consider readiness to set a termination date from a perspective that is context-sensitive and less encumbered by preordained criteria. Tracing the dreams of one analysand from the vantage point of contemporary dream theory, the author demonstrates how careful attention to the dream elucidated the patient's readiness to terminate and her complex feelings about the termination process. Finally, the author challenges the notion that the termination phase is of greater evaluative than therapeutic importance, and provides clinical material as evidence that this is not the case.

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

NARCIS (Netherlands)

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

2005-01-01

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

Terminal Disease: A Biolaw Management

Directory of Open Access Journals (Sweden)

Francisco Rivas García

2017-10-01

Full Text Available There are numerous and varied pathologies that can lead to a state of terminal illness, provoking numerous bioethical dilemmas that are inherent and specific to each circumstance. The objective of the present work has been to provide a current and useful analysis that can help to understand the main bioethical problems, from the perspective of biolaw that must be solved in the inevitable path towards the end of life that any terminal illness implies. The methodology used included a study of bibliographic documentation in the main databases of interest in bioethics. It can be concluded that the biolaw is a very useful tool that helps health care professionals and relatives when it comes to the analysis and decision making regarding a terminal illness. Independently of medical practice based on protocols and scientific knowledge, it is necessary to ensure that not everything that can legally be carried out is accepted in the field of biolaw.

Accurate Prognostic Awareness Facilitates, Whereas Better Quality of Life and More Anxiety Symptoms Hinder End-of-Life Care Discussions: A Longitudinal Survey Study in Terminally Ill Cancer Patients' Last Six Months of Life.

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

2018-04-01

Terminally ill cancer patients do not engage in end-of-life (EOL) care discussions or do so only when death is imminent, despite guidelines for EOL care discussions early in their disease trajectory. Most studies on patient-reported EOL care discussions are cross sectional without exploring the evolution of EOL care discussions as death approaches. Cross-sectional studies cannot determine the direction of association between EOL care discussions and patients' prognostic awareness, psychological well-being, and quality of life (QOL). We examined the evolution and associations of accurate prognostic awareness, functional dependence, physical and psychological symptom distress, and QOL with patient-physician EOL care discussions among 256 terminally ill cancer patients in their last six months by hierarchical generalized linear modeling with logistic regression and by arranging time-varying modifiable variables and EOL care discussions in a distinct time sequence. The prevalence of physician-patient EOL care discussions increased as death approached (9.2%, 11.8%, and 18.3% for 91-180, 31-90, and 1-30 days before death, respectively) but only reached significance in the last month. Accurate prognostic awareness facilitated subsequent physician-patient EOL care discussions, whereas better patient-reported QOL and more anxiety symptoms hindered such discussions. The likelihood of EOL care discussions was not associated with levels of physical symptom distress, functional dependence, or depressive symptoms. Physician-patient EOL care discussions for terminally ill Taiwanese cancer patients remain uncommon even when death approaches. Physicians should facilitate EOL care discussions by cultivating patients' accurate prognostic awareness early in their cancer trajectory when they are physically and psychologically competent, with better QOL, thus promoting informed and value-based EOL care decision making. Copyright © 2017 American Academy of Hospice and Palliative

Participation in prenatal screening tests and intentions concerning selective termination in Finnish maternity care

DEFF Research Database (Denmark)

Santalahti, P; Hemminki, E; Aro, A R

1999-01-01

AIMS: The study examined how prenatal screening tests are presented to women, factors associated with women's participation in screening, their experience of decision-making and intentions concerning pregnancy termination, and hospital data on rates of selective terminations. METHODS: Questionnai......AIMS: The study examined how prenatal screening tests are presented to women, factors associated with women's participation in screening, their experience of decision-making and intentions concerning pregnancy termination, and hospital data on rates of selective terminations. METHODS...... as a routine procedure. Most women (92%) underwent serum screening and most (86%) found the decision to participate or not easy. In almost every aspect of presentation and participation studied, serum and ultrasound screening differed from each other. 85% of respondents to ultrasound screening answered...... in screening and with intentions about selective termination, women's perceptions of lives of the disabled should receive more attention in future studies....

Trajectories of Terminally Ill Patients' Cardiovascular Response to Receptive Music Therapy in Palliative Care.

Science.gov (United States)

Warth, Marco; Kessler, Jens; Hillecke, Thomas K; Bardenheuer, Hubert J

2016-08-01

Relaxation interventions are frequently used to promote symptom relief in palliative care settings, but little is known about the underlying mechanisms. The present analysis aimed at examining the psychophysiological pathways of terminally ill patients' cardiovascular response to a live music therapy vs. prerecorded mindfulness exercise. Eighty-four patients of a palliative care unit were randomly assigned to either of the two interventions. Multilevel modeling was used to analyze trajectories of physiological change. Vagally mediated heart rate variability (VM-HRV) and blood volume pulse amplitude (BVP-A) served as indices of autonomic nervous system response. Participants' gender, age, baseline scores, self-rated pain, and assignment to treatment were entered to the models as predictors. Both VM-HRV and BVP-A showed significant linear and quadratic trends over time, as well as substantial heterogeneity among individuals' trajectories. Baseline scores, pain, and treatment significantly accounted for random variation in VM-HRV intercepts. BVP-A levels were significantly higher in women than in men. Moreover, assignment to treatment significantly accounted for differences in the linear slopes of peripheral blood flow. Higher levels of VM-HRV in the music therapy group highlight the importance of a therapeutic relationship for the effectiveness of relaxation interventions in end-of-life care settings. Music therapy caused significantly stronger reductions of vascular sympathetic tone and, therefore, may be indicated in the treatment of pain and stress-related symptoms in palliative care. Initial self-ratings of pain moderated patients' physiological response and need to be taken into account in clinical practice and future theory building. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

The use of life review to enhance spiritual well-being in patients with terminal illnesses: An integrative review.

Science.gov (United States)

Kwan, Cecilia W M; Ng, Marques S N; Chan, Carmen W H

2017-12-01

To conduct an integrative review of the current literature on using life review as an intervention to address the spiritual need of patients with terminal illnesses. Palliative care highlights the holistic approach of care including the spiritual aspect. Life review has been used in palliative nursing intending to enhance patients' emotional and spiritual well-being, and quality of life. However, there is a lack of publications that provide a structured overview on life review programmes and their effectiveness. Integrative review. The Whittemore and Knafl integrative review method was used. Five major online databases were included in our literature search. The keywords used were "life review" and "palliative care, terminal care, terminally ill, death & dying, hospice, spiritual wellbeing, spirituality". Seven primary papers were identified, critically appraised and synthesised in the final review. There are limited clinical studies on life review programmes for patients with terminal illness. The research design of these studies is too widely varied for meta-analysis. Here, we identified two major programmes of life review as an intervention to address the spiritual well-being of patients with terminal illness. However, repeated studies on the effectiveness of these two programmes are lacking. The shorter programme of life review is more likely to be applicable and effective for terminal patients. Further research in this area is required to provide strong evidence on the effectiveness and applicability of life review in patients receiving palliative care. This review adds weight to the need of a better understanding on the use of life review in addressing the spiritual needs of patients with terminal illness. Such understanding would provide evidence for the use of life review as an alternative approach in palliative care delivery. © 2017 John Wiley & Sons Ltd.

Review paper. Terminal lucidity

Directory of Open Access Journals (Sweden)

Chiriboga-Oleszczak Boris Alejandro

2017-03-01

Full Text Available Terminal lucidity is a term used in the medical literature to determine the improvement of mental functioning shortly before death, even among patients with serious and long-term disorders. In 19th century, cases of mind clarity recovery shortly before death, were often recognized by doctors and interpreted as a sign of an impending death. In 20th century, the interest in this phenomenon decreased and then, virtually disappear. In recent years, on the wave of publications concerning near death experiences and related events such as the end of life experiences, papers about the improvement of mental functioning shortly before death, exponentially grew and got a new name, terminal lucidity. In this paper, an overview of the available literature is presented to outline the historical, phenomenological and clinical picture of this phenomenon and its possible implications for medical care and future studies.

The role of UK district nurses in providing care for adult patients with a terminal diagnosis: a meta-ethnography.

Science.gov (United States)

Offen, John

2015-03-01

To explore the role of UK district nurses in providing care for adult patients with a terminal diagnosis by reviewing qualitative research. Meta-ethnography was used to conduct the synthesis. CINAHL, MEDLINE and British Nursing Index (BNI) were searched comprehensively for primary research relating to the role of UK district nurses in palliative care. The abstracts and titles of 700 papers were screened against inclusion criteria, of these 97 full papers were appraised. Some 24 studies reported in 25 papers were selected for inclusion in the synthesis. In total, five key themes were identified: valuing the role; practical role; relationships with patients and families; providing psychological support; and role uncertainty. Further synthesis yielded two 'lines of argument'. The concept of the 'expert friend' argues that the atypical relationship district nurses cultivate with patients underpins district nurses' provision of palliative care and profoundly influences the nature of psychological support given. Secondly, the concept of 'threat and opportunity' encapsulates the threat district nurses can feel to their traditional role in palliative care through changing health and social policy, while recognising the benefits that access to specialist knowledge and better training can bring. The findings have implications for understanding the motivators and barriers experienced by district nurses delivering palliative care in a time of unprecedented change to community health services.

Effectiveness of palliative home-care services in reducing hospital admissions and determinants of hospitalization for terminally ill patients followed up by a palliative home-care team: a retrospective cohort study.

Science.gov (United States)

Riolfi, Mirko; Buja, Alessandra; Zanardo, Chiara; Marangon, Chiara Francesca; Manno, Pietro; Baldo, Vincenzo

2014-05-01

It has been demonstrated that most patients in the terminal stages of cancer would benefit from palliative home-care services. The aim of this study was to assess the effectiveness of appropriate palliative home-care services in reducing hospital admissions, and to identify factors predicting the likelihood of patients treated at home being hospitalized. Retrospective cohort study. We enrolled all 402 patients listed by the Local Health Authority No. 5, Veneto Region (North-East Italy), as dying of cancer in 2011. Of the cohort considered, 39.9% patients had been taken into care by a palliative home-care team. Irrespective of age, gender, and type of tumor, patients taken into care by the palliative home-care team were more likely to die at home, less likely to be hospitalized, and spent fewer days in hospital in the last 2 months of their life. Among the patients taken into care by the palliative home-care team, those with hematological cancers and hepatocellular carcinoma were more likely to be hospitalized, and certain symptoms (such as dyspnea and delirium) were predictive of hospitalization. Our study confirms the effectiveness of palliative home care in enabling patients to spend the final period of their lives at home. The services of a palliative home-care team reduced the consumption of hospital resources. This study also provided evidence of some types of cancer (e.g. hematological cancers and hepatocellular carcinoma) being more likely to require hospitalization, suggesting the need to reconsider the pathways of care for these diseases.

The Ethical and Legal Dilemma in Terminating the Physician-Patient Relationship.

Science.gov (United States)

Senderovitch, Helen

2016-05-01

A physician-patient relationship is essential for the well-being of the patient, for without a strong and trusting relationship between both individuals, the patient may not receive the best care that they deserve. There are many legal policies and ethical principles a physician must follow when caring for a patient. It is both the legal and moral duty of the physician to act in the best interests of their patients, while making sure to respect them regardless of background and personal behaviours. The relationship is secured with both trust and respect, for without trust, the patient may hold back from stating their conditions which will result in the physician not providing them with all the care they require. Sometimes, lack of some of these key characteristics of the physician-patient relationship and other circumstances, may cause either the patient or the physician to terminate the relationship. Termination of a relationship creates a difficult situation for the patient, and therefore there are only specific situations where a physician may have permission to follow through and terminate their relationship. Both the law and ethical principles play a role in the decisions made by the physician in regards to their relationship with the patient, but regardless, the physician has the obligation to make sure their patient is receiving care by one means or another.

Preference for place-of-death among terminally ill cancer patients in Denmark

DEFF Research Database (Denmark)

Neergaard, Mette Asbjørn; Jensen, Anders Bonde; Sondergaard, Jens

2011-01-01

Scand J Caring Sci; 2011 Preference for place-of-death among terminally ill cancer patients in Denmark Achieving home death is often seen as an important endpoint in palliative care, but no studies of the preferred place-of-death have yet been conducted in Scandinavia. Furthermore, we do not know...... if professionals' report on deceased patients' preference of place-of-death is a valid information. The aim of this study was to describe where terminally ill Danish cancer patients prefer to die and to determine if their preference changed during the palliative period, as reported retrospectively by bereaved...... GPs and CNs) report retrospectively that most terminally ill cancer patients wish to die at home. The preference weakened significantly as death approached. The agreement between relatives' and GPs' accounts on patients' preferences at the end of the palliative period was 'substantial', whereas...

[Sedation in the terminal phase of life].

Science.gov (United States)

Verhagen, E H; Eliel, M R; de Graeff, A; Teunissen, S C

1999-12-25

In 2 patients, a woman aged 38 years and a man aged 48 years, in the terminal phase of life due to metastasized+ malignancy, palliative care failed. They suffered seriously from pain, delirium, restlessness, nausea, and fear. Deep sedation was given to induce almost continuous sleep without the intention of causing death. After one and five quiet days respectively the patients died. Deep sedation is an option when palliative care fails to diminish serious suffering. Midazolam, given by continuous subcutaneous infusion is the drug of choice.

[A Maternal Health Care System Based on Mobile Health Care].

Science.gov (United States)

Du, Xin; Zeng, Weijie; Li, Chengwei; Xue, Junwei; Wu, Xiuyong; Liu, Yinjia; Wan, Yuxin; Zhang, Yiru; Ji, Yurong; Wu, Lei; Yang, Yongzhe; Zhang, Yue; Zhu, Bin; Huang, Yueshan; Wu, Kai

2016-02-01

Wearable devices are used in the new design of the maternal health care system to detect electrocardiogram and oxygen saturation signal while smart terminals are used to achieve assessments and input maternal clinical information. All the results combined with biochemical analysis from hospital are uploaded to cloud server by mobile Internet. Machine learning algorithms are used for data mining of all information of subjects. This system can achieve the assessment and care of maternal physical health as well as mental health. Moreover, the system can send the results and health guidance to smart terminals.

The termination phase of psychoanalysis in a narcissistic personality.

Science.gov (United States)

Warnes, H

This paper describes a patient whose termination phase of analysis activated an intense mourning reaction that helped to overcome the stalemate of therapy. After I attempted to demonstrate how her narcissistic armouring yielded when the termination of analysis was agreed upon, the psychological reenactment of a split off (disavowed) trauma of an early loss (her father) and the failure of essential attributes in maternal care became manifested behind her narcissistic defenses. The reconstruction of these events was possible during the process of mourning. At the termination phase she behaved as if she "had lost the war"; from the point of view of her masochism it was a Pyrrhic victory, "a victory through defeat". Contrary to mother, I let her go but then she refused to go, which created a situation that activated a profound mourning reaction leading to important structural changes. A review of the pertinent psychoanalytic literature on termination along with clinical material derived from the termination phase of a patient with a narcissistic personality is presented.

42 CFR 1008.45 - Rescission, termination or modification.

Science.gov (United States)

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Rescission, termination or modification. 1008.45 Section 1008.45 Public Health OFFICE OF INSPECTOR GENERAL-HEALTH CARE, DEPARTMENT OF HEALTH AND HUMAN... was promptly, diligently, and in good faith discontinued in accordance with reasonable time frames...

The quality of service in passenger transport terminals

Science.gov (United States)

Oprea, C.; Roşca, E.; Popa, M.; Ilie, A.; Dinu, O.; Roşca, M.

2016-11-01

The quality of service in transport terminals is differently perceived by engineers, economists, transport operators and sociologists. The traveler's perception is nevertheless decisive. The quality of service is well connected with the inside design of terminals, with the facilities in terminals and with the provided service standards. In order to provide a high level of service, the activities taking place in the public transport terminal and the maximum travelers flow size must be carefully analyzed and dimensioned. The purpose of modelling is to find the best route for each traveler from origin (entrance) to destination (exit) through all the intermediate service points, taking into consideration the instant network conditions. In developing the model we consider the walking, the waiting and the serving time. Using a simulation program written in ARENA we determine the waiting time. For validation, the model is used to evaluate the performance level in Bucharest Basarab station. By comparing the total walking distance for the possible routes and the utility function that describes the utility of all activities from entrance to exit we can find the optimal route.

Prospective Study on Music Therapy in Terminally Ill Cancer Patients during Specialized Inpatient Palliative Care.

Science.gov (United States)

Kordovan, Sarah; Preissler, Pia; Kamphausen, Anne; Bokemeyer, Carsten; Oechsle, Karin

2016-04-01

This study was a prospective evaluation of feasibility, acceptance, and potential beneficial effects of music therapy in terminally ill cancer patients on a specialized palliative care inpatient ward. Intervention had to consist of at least two sessions, but frequency and duration was left to the patients` decision. Different music therapy methods were offered to the patient at the beginning of every session. Patients rated their subjective benefit. Disease-related and sociodemographic factors were considered as potentially influencing factors. A total of 166 music therapy sessions were performed with 41 patients (average, 4; range, 2-10). Average session duration was 41 minutes (range, 20-70). Most favored methods were therapeutic conversation in 84% of sessions; listening to relaxing music, 39%; playing an instrument, 31%; and music-lead imagination, 11%. Receptive music therapy was applied in 45%, active forms in 25%, a combination of both in 7%, and therapeutic conversation only in 23%. Music therapy was rated to be "helpful" in 68%. Positive effects were significantly associated with frequency (p = 0.009) and duration (p = 0.040), living in a partnership (p = 0.017), having children (p = 0.035), psycho-oncologic therapy (p = 0.043), experience with music therapy (p = 0.007), role of music in life (p = 0.035), playing an instrument (p = 0.021), and singing regularly (p = 0.003). Music therapy techniques, especially receptive methods, are feasible and well accepted in terminally ill cancer patients. Therapeutic conversation seems to play an important role. Frequency and duration of music therapy, previous experience with music and music therapy, as well as sociodemographic factors influence positive effects of music therapy.

Amino-terminal pro-brain natriuretic peptide as a predictor of outcome in patients admitted to intensive care. A prospective observational study.

Science.gov (United States)

De Geer, Lina; Fredrikson, Mats; Oscarsson, Anna

2012-06-01

Amino-terminal pro-brain-type natriuretic peptide is known to predict outcome in patients with heart failure, but its role in an intensive care setting is not yet fully established. To assess the incidence of elevated amino-terminal pro-brain natriuretic peptide (NT-pro-BNP) on admission to intensive care and its relation to death in the ICU and within 30 days. Prospective, observational cohort study. A mixed non-cardiothoracic tertiary ICU in Sweden. NT-pro-BNP was collected from 481 consecutive patients on admission to intensive care, in addition to data on patient characteristics and outcome. A receiver-operating characteristic curve was used to identify a discriminatory level of significance, a stepwise logistic regression analysis to correct for other clinical factors and a Kaplan-Meier analysis to assess survival. The correlation between Simplified Acute Physiology Score (SAPS) 3, Sequential Organ Failure Assessment score (SOFA) and NT-pro-BNP was analysed using Spearman's correlation test. Quartiles of NT-pro-BNP elevation were compared for baseline data and outcome using a logistic regression model. An NT-pro-BNP more than 1380 ng -l on admission was an independent predictor of death in the ICU and within 30 days [odds ratio (OR) 2.6; 95% confidence interval (CI), 1.5 to 4.4] and was present in 44% of patients. Thirty-three percent of patients with NT-pro-BNP more than 1380 ng -1, and 14.6% of patients below that threshold died within 30 days (log rank P=0.005). NT-pro-BNP correlated moderately with SAPS 3 and with SOFA on admission (Spearman's ρ 0.5552 and 0.5129, respectively). In quartiles of NT-pro-BNP elevation on admission, severity of illness and mortality increased significantly (30-day mortality 36.1%; OR 3.9; 95% CI, 2.0 to 7.3 in the quartile with the highest values, vs. 12.8% in the lowest quartile). We conclude that NT-pro-BNP is commonly elevated on admission to intensive care, that it increases with severity of illness and that it is an

Terminally ill patients as customers: the patient's perspective.

Science.gov (United States)

Seibel, Katharina; Valeo, Sara Celestina; Xander, Carola; Adami, Sandra; Duerk, Thorsten; Becker, Gerhild

2014-01-01

Consumerism in health care defines patients as self-determined, rational customers. Yet, it is questionable whether vulnerable patients, such as the terminally ill, also fulfill these criteria. Vulnerable contexts and the patient's perspective on being a customer remain relatively unexplored. The present study addresses this research gap by analyzing terminally ill patients' views on being customers. To explore the ways in which patients in palliative care refer to themselves as patients/customers, and how the patients' concepts of self-determination are related to their attitudes toward the patient/customer role. Qualitative interviews were conducted. Data were analyzed in three steps: narrative analysis, thematic content analysis, and typology construction. Researchers recruited 25 patients via the Department of Palliative Care, University Medical Center Freiburg, Germany. In many ways, palliative patients contradict the image of a self-determined customer. The palliative patient role is characterized by the concept of relational self-determination rather than an unrestricted self-determination. Self-attribution as a customer still occurs when positively associated with a person-centered, individualized treatment. Thus, the customer and patient role overlap within the palliative care setting because of the focus on the individual. The idealized customer role cannot be arbitrarily applied to all medical fields. Palliative patients are dependent on the physician, regardless of whether the customer or patient role is preferred. Hence, self-determination must be understood in relational terms, and physicians must recognize their crucial role in promoting patients' self-determination in the context of shared decision-making.

Nurses' attitudes to terminally ill patients.

Science.gov (United States)

Román, E M; Sorribes, E; Ezquerro, O

2001-05-01

The care of terminally ill patients is a challenge for nurses that has raised special interest in recent years. Several studies have shown a stereotyped negative attitude in nurses towards terminally ill patients. However, all have used methods with several limitations. The aim of the study presented in this paper was to identify the nurses' attitude to the terminally ill patient in Catalonia, Spain, and the relationship of this attitude to different socio-demographic data (type of centre, shift, years of experience, age and sex) by means of a new quantitative method based on the free word-association test. One hundred and seventy-five nurses working in 18 hospitals and hospices in Catalonia, Spain were included in the study. Data were analysed by the Associative Semantic Field Differential method by means of the computer programme CONTEXT and a quantitative evaluation of the degree of attitudes positivity was obtained. The study revealed a general slight negative trend in attitudes towards the terminally ill patient. A more positive attitude was observed in older caregivers and in women. The positivity in attitude decreased from morning to night shift. No differences were observed between nurses working in hospitals and those working in hospices. We conclude that nursing attitudes can be analysed by methods such as that used in this study. Attempts can be made to modify this attitude in caregivers by means of training programmes and stimulating awareness of an adequate professional approach.

Relationships between personal attitudes about death and communication with terminally ill patients: How oncology clinicians grapple with mortality.

Science.gov (United States)

Rodenbach, Rachel A; Rodenbach, Kyle E; Tejani, Mohamedtaki A; Epstein, Ronald M

2016-03-01

Clinician discomfort with death may affect care of patients but has not been well-studied. This study explores oncology clinicians' attitudes surrounding their own death and how these attitudes both affect and are affected by their care of dying patients and their communication with them. Qualitative interviews with physicians (n=25), nurse practitioners (n=7), and physician assistants (n=1) in medical or hematologic oncology clinical practices about communication styles, care of terminally ill patients, and personal perspectives about mortality. Clinicians described three communication styles used with patients about death and dying: direct, indirect, or selectively direct. Most reported an acceptance of their mortality that was "conditional," meaning that that they could not fully know how they would respond if actually terminally ill. For many clinicians, caring for dying patients affected their outlook on life and death, and their own perspectives on life and death affected their approach to caring for dying patients. An awareness of personal mortality may help clinicians to discuss death more openly with patients and to provide better care. Efforts to promote self-awareness and communication training are key to facilitating clear communication with and compassionate care of terminally ill patients. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Termination of pregnancy services: experiences of gynaecological nurses.

Science.gov (United States)

Nicholson, Jackie; Slade, Pauline; Fletcher, Joanne

2010-10-01

This paper is a report of a study to identify the experience of gynaecological nurses involved with termination of pregnancy. Staff involved with termination of pregnancy have been found to experience both positive and negative views. Varying processes and experiences for staff have been identified, from termination of pregnancy work being emotionally draining and stressful to there being a process of care that evolves with greater experience. A purposive sample of seven gynaecological nurses currently working in a termination of pregnancy service was recruited. Data were collected between October 2007 and January 2008 using interviews and standardized questionnaires. Transcripts of the interviews were analysed using Interpretive Phenomenological Analysis. Eight superordinate themes emerged from the analysis: (1) Unconditional acceptance and understanding of termination of pregnancy, (2) Strategies for managing the demands and challenges, (3) What we do for patients and job satisfaction, (4) Challenges to unconditional acceptance, (5) Juggling the contrasting needs and demands of patients, (6) The most demanding aspects of the role, (7) The significance of personal experience and (8) The service context. Some of the experiences were interpreted as ways in which nurses justified their role. The themes were understood in terms of a balance between strains, coping and contextual influences. Providing a recognized supportive supervisory environment might allow for the acknowledgement of the unique challenges staff in termination of pregnancy services face, and might enhance a sense of validation within the organization and hence staff wellbeing. © 2010 The Authors. Journal of Advanced Nursing © 2010 Blackwell Publishing Ltd.

Palliative care guidelines in oncology

International Nuclear Information System (INIS)

Krizanova, K.

2006-01-01

Palliative care has its roots in hospice movement arising in the 1970s in Europe and later also in America. From its beginning it has had connection with patients in terminal phase of cancer disease who suffered from many serious symptoms. Nowadays palliative care is also being provided to patients in terminal phase of certain neurological disorders, AIDS, exceptionally for patients with heart, lung or kidney failure. It has become part of modern medicine and of good clinical practice. (author)

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

Science.gov (United States)

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

2015-02-01

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

Assessing the Decision-Making Capacity of Terminally Ill Patients with Cancer.

Science.gov (United States)

Kolva, Elissa; Rosenfeld, Barry; Saracino, Rebecca

2018-05-01

Despite the clinical, ethical, and legal magnitude of end-of-life decision-making, the capacity of terminally ill patients to make the medical decisions they often face is largely unknown. In practice, clinicians are responsible for determining when their patients are no longer competent to make treatment decisions, yet the accuracy of these assessments is unclear. The purpose of this study was to explore decision-making capacity and its assessment in terminally ill cancer patients. Fifty-five patients with advanced cancer receiving inpatient palliative care and 50 healthy adults were administered the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) to evaluate decision-making capacity with regard to the four most commonly used legal standards: Choice, Understanding, Appreciation, and Reasoning. Participants made a hypothetical treatment decision about whether to accept artificial nutrition and hydration for treatment of cachexia. Participants' physicians independently rated their decision-making capacity. Terminally ill participants were significantly more impaired than healthy adults on all MacCAT-T subscales. Most terminally ill participants were able to express a treatment choice (85.7%), but impairment was common on the Understanding (44.2%), Appreciation (49.0%), and Reasoning (85.4%) subscales. Agreement between physician-rated capacity and performance on the MacCAT-T subscales was poor. The use of the MacCAT-T revealed high rates of decisional impairment in terminally ill participants. Participants' physicians infrequently detected impairment identified by the MacCAT-T. The findings from the present study reinforce the need for engagement in advance care planning for patients with advanced cancer. Copyright © 2018 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

1º Forum do Grupo de Estudos do Fim da Vida do Cone Sul: proposta para atendimento do paciente portador de doença terminal internado em UTI 1st Forum of the Southern Cone End-of-Life Study Group: proposal for care of patients, bearers of terminal disease staying in the ICU

Directory of Open Access Journals (Sweden)

Rachel Duarte Moritz

2009-08-01

Full Text Available As condutas de limitação de tratamento oferecidas a pacientes portadores de doenças terminais, internados em Unidades de Terapia Intensiva, tem aumentado a sua freqüência nos últimos anos em todo o mundo. Apesar disto, ainda existe uma grande dificuldade dos intensivistas brasileiros em oferecer o melhor tratamento àqueles pacientes que não se beneficiariam com terapêuticas curativas. O objetivo deste comentário é apresentar uma sugestão de fluxograma para atendimento de pacientes com doenças terminais que foi elaborado, baseado na literatura e experiência de experts, pelos membros do comitê de ética e de terminalidade da AMIB.Withholding of treatment in patients with terminal disease is increasingly common in intensive care units, throughout the world. Notwithstanding, Brazilian intensivists still have a great difficulty to offer the best treatment to patients that have not benefited from curative care. The objective of this comment is to suggest an algorithm for the care of terminally ill patients. It was formulated based upon literature and the experience of experts, by members of the ethics committee and end-of-life of AMIB - Brazilian Association of Intensive Care.

Managed care: mastering the moving parts.

Science.gov (United States)

Boyd, Dawn; Finman, Larry

2010-05-01

A hospital's success with managed care depends on how thoroughly the hospital understands its interrelated aspects, including: Managed care strategy Contract negotiations. Contract language. Key performance indicators. Modeling. Contract termination provisions. Movement from wholesale to retail health care.

Termination of pregnancy for fetal abnormality: a meta-ethnography of women's experiences.

Science.gov (United States)

Lafarge, Caroline; Mitchell, Kathryn; Fox, Pauline

2014-11-01

Due to technological advances in antenatal diagnosis of fetal abnormalities, more women face the prospect of terminating pregnancies on these grounds. Much existing research focuses on women's psychological adaptation to this event. However, there is a lack of holistic understanding of women's experiences. This article reports a systematic review of qualitative studies into women's experiences of pregnancy termination for fetal abnormality. Eight databases were searched up to April 2014 for peer-reviewed studies, written in English, that reported primary or secondary data, used identifiable and interpretative qualitative methods, and offered a valuable contribution to the synthesis. Altogether, 4,281 records were screened; 14 met the inclusion criteria. The data were synthesised using meta-ethnography. Four themes were identified: a shattered world, losing and regaining control, the role of health professionals and the power of cultures. Pregnancy termination for fetal abnormality can be considered as a traumatic event that women experience as individuals, in their contact with the health professional community, and in the context of their politico-socio-legal environment. The range of emotions and experiences that pregnancy termination for fetal abnormality generates goes beyond the abortion paradigm and encompasses a bereavement model. Coordinated care pathways are needed that enable women to make their own decisions and receive supportive care. Copyright © 2014 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

Care of terminally-ill patients: an opinion survey among critical care ...

African Journals Online (AJOL)

EB

aggressive intervention. Objective: To .... b) Withdraw meaning complete or partial removal of aggressive therapy. 12. 6. 0.46 .... medical and nursing care for patients labeled no code. Intensivists .... Adib S, Hanadeh G. Attitudes of Lebanese.

Health benefits for the terminally ill: reality and perception.

Science.gov (United States)

Gabel, J R; Hurst, K M; Hunt, K A

1998-01-01

This paper examines the availability and scope of hospice benefits as well as employers' attitudes and knowledge about care for the terminally ill. Data are drawn from a national random sample of 1,502 employers with 200 or more workers and from focus groups with employee benefits managers and their insurance advisers, brokers, and consultants. Major findings are that 83 percent of employers offer explicit hospice benefits, with most other firms covering hospice through high-cost case management. Most employers support the concept of hospice care because they believe that it reduces medical expenses.

OA24 Support for terminally-ill cancer patients: perceptions of religious leaders about end-of-life spiritual care in lagos, nigeria.

Science.gov (United States)

Onibogi, Olanrewaju

2015-04-01

Religious leaders are well respected in most Nigerian communities and are often called in to provide support for terminally-ill patients. Many Nigeria communities still view cancer as a stigmatised disease. This study sought to elicit the perceptions of Christian and Islamic religious leaders and explore problems associated with their involvement in end-of-life care for cancer patients. Participants were recruited among 114 religious leaders. Four focus group discussion sessions were then conducted with open-ended questions on previous involvement in end-of-life care of cancer patients and whether they would like to do more. There were thirty (30) willing participants in all. The discussions were audiotaped, transcribed and coded using the NUDIST software. Ninety of the respondents (62%) would not be involved in end-of-life care. This is because of the fear of peer pressure. The responses could be classified under three major themes were identified: (1) Care supposed to be provided by all religious leaders (2) End-of-Life care in institutions are safer (3) End-of-Life care consumes time. Statements made by respondents include "I will fall out with many if I am found ministering to dying patients". We observe that peer pressure played an important role in the acceptability of end-of-life activities in this group. This could be used in the positive light in designing interventions. © 2015, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

On-surface construction of low-dimensional nanostructures with terminal alkynes: Linking strategies and controlling methodologies

Institute of Scientific and Technical Information of China (English)

Jing Liu; Qi-Wei Chen; Kai Wu

2017-01-01

Bottom-up approach to constructing low-dimensional nanostructures on surfaces with terminal alkynes has drawn great interest because of its potential applications in fabricating advanced functional nanomaterials.The diversity of the achieved products manifests rich chemistry of terminal alkynes and hence careful linking strategies and proper controlling methodologies are required for selective preparations of high-quality target nanoarchitectures.This review summarizes various on-surface linking strategies for terminal alkynes,including non-bonding interactions as well as organometallic and covalent bonds,and presents examples to show effective control of surface assemblies and reactions of terminal alkynes by variations of the precursor structures,substrates and activation modes.Systematic studies of the on-surface linkage of terminal alkynes may help efficient and predictable preparations of surface nanomaterials and further understanding of surface chemistry.

Presence of biofilm containing viable multiresistant organisms despite terminal cleaning on clinical surfaces in an intensive care unit.

Science.gov (United States)

Vickery, K; Deva, A; Jacombs, A; Allan, J; Valente, P; Gosbell, I B

2012-01-01

Despite recent attention to surface cleaning and hand hygiene programmes, multiresistant organisms (MROs) continue to be isolated from the hospital environment. Biofilms, consisting of bacteria embedded in exopolymeric substances (EPS) are difficult to remove due to their increased resistance to detergents and disinfectants, and periodically release free-swimming planktonic bacteria back into the environment which may may act as an infection source. To establish whether reservoirs of MROs exist in the environment as biofilms. Following terminal cleaning, equipment and furnishings were removed aseptically from an intensive care unit (ICU) and subjected to culture and scanning electron microscopy (SEM). Samples were placed in 5 mL of tryptone soya broth, sonicated for 5 min before plate culture on horse blood agar, Brillance MRSA and Brilliance VRE agar plates. Samples for SEM were fixed in 3% glutaraldehyde and hexamethyldisilizane (HMDS) prior to sputter-coating with gold and examination in an electron microscope. Biofilm was demonstrated visually on the sterile supply bucket, the opaque plastic door, the venetian blind cord, and the sink rubber, whereas EPS alone was seen on the curtain. Viable bacteria were grown from three samples, including MRSA from the venetian blind cord and the curtain. Biofilm containing MROs persist on clinical surfaces from an ICU despite terminal cleaning, suggesting that current cleaning practices are inadequate to control biofilm development. The presence of MROs being protected within these biofilms may be the mechanism by which MROs persist within the hospital environment. Copyright © 2011 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Rough Set Theory based prognostication of life expectancy for terminally ill patients.

Science.gov (United States)

Gil-Herrera, Eleazar; Yalcin, Ali; Tsalatsanis, Athanasios; Barnes, Laura E; Djulbegovic, Benjamin

2011-01-01

We present a novel knowledge discovery methodology that relies on Rough Set Theory to predict the life expectancy of terminally ill patients in an effort to improve the hospice referral process. Life expectancy prognostication is particularly valuable for terminally ill patients since it enables them and their families to initiate end-of-life discussions and choose the most desired management strategy for the remainder of their lives. We utilize retrospective data from 9105 patients to demonstrate the design and implementation details of a series of classifiers developed to identify potential hospice candidates. Preliminary results confirm the efficacy of the proposed methodology. We envision our work as a part of a comprehensive decision support system designed to assist terminally ill patients in making end-of-life care decisions.

Osteogenic cell differentiation on H-terminated and O-terminated nanocrystalline diamond films

Directory of Open Access Journals (Sweden)

Liskova J

2015-01-01

Full Text Available Jana Liskova,1 Oleg Babchenko,2 Marian Varga,2 Alexander Kromka,2 Daniel Hadraba,1 Zdenek Svindrych,1 Zuzana Burdikova,1 Lucie Bacakova1 1Institute of Physiology, Academy of Sciences of the Czech Republic, Prague, Czech Republic; 2Institute of Physics, Academy of Sciences of the Czech Republic, Prague, Czech Republic Abstract: Nanocrystalline diamond (NCD films are promising materials for bone implant coatings because of their biocompatibility, chemical resistance, and mechanical hardness. Moreover, NCD wettability can be tailored by grafting specific atoms. The NCD films used in this study were grown on silicon substrates by microwave plasma-enhanced chemical vapor deposition and grafted by hydrogen atoms (H-termination or oxygen atoms (O-termination. Human osteoblast-like Saos-2 cells were used for biological studies on H-terminated and O-terminated NCD films. The adhesion, growth, and subsequent differentiation of the osteoblasts on NCD films were examined, and the extracellular matrix production and composition were quantified. The osteoblasts that had been cultivated on the O-terminated NCD films exhibited a higher growth rate than those grown on the H-terminated NCD films. The mature collagen fibers were detected in Saos-2 cells on both the H-terminated and O-terminated NCD films; however, the quantity of total collagen in the extracellular matrix was higher on the O-terminated NCD films, as were the amounts of calcium deposition and alkaline phosphatase activity. Nevertheless, the expression of genes for osteogenic markers – type I collagen, alkaline phosphatase, and osteocalcin – was either comparable on the H-terminated and O-terminated films or even lower on the O-terminated films. In conclusion, the higher wettability of the O-terminated NCD films is promising for adhesion and growth of osteoblasts. In addition, the O-terminated surface also seems to support the deposition of extracellular matrix proteins and extracellular matrix

Organizational Relationship Termination Competence

DEFF Research Database (Denmark)

Ritter, Thomas; Geersbro, Jens

2011-01-01

termination are found to significantly affect a firm's relationship termination competence. The findings suggest that managers should regard termination as a legitimate option in customer relationship management. In order to decrease the number of unwanted customers, managers must accept termination......Most firms are involved in a number of customer relationships that drain the firm's resources. However, many firms are hesitant to address this problem. This paper investigates customer relationship termination at the organizational level. We develop and analyze the organizational dimensions...... of organizational termination in order to improve our understanding of the management of termination. The impact of these termination dimensions on the percentage of unwanted customers is developed and tested using PLS on data gathered from a cross-sectional survey of more than 800 sales representatives. We find...

Should heart failure be regarded as a terminal illness requiring palliative care? A study of heart failure patients', carers' and clinicians' understanding of heart failure prognosis and its management.

Science.gov (United States)

Stocker, Rachel; Close, Helen; Hancock, Helen; Hungin, A Pali S

2017-12-01

Communication and planning for heart failure (HF) care near the end of life is known to be complex. Little is known about how the patient experience of palliative assessment and communication needs change over time, and how this might inform management. Our aim was to explore experiences of giving or receiving a prognosis and advanced palliative care planning (ACP) for those with HF. We carried out a longitudinal grounded theory study, employing in-depth interviews with 14 clinicians (primary and secondary care) and observations of clinic and home appointments, followed by a series of interviews with 13 patients with HF and 9 carers. Overall, the majority of participants rejected notions of HF as a terminal illness in favour of a focus on day-to-day management and maintenance, despite obvious deterioration in disease stage and needs over time. Clinicians revealed frustration about the uncertain nature of HF prognosis, leading to difficulties in planning. Others highlighted the need to deliver problem-based, individualised care but felt constrained sometimes by the lack of multidisciplinary ACP. Patients reported an absence of prognostic discussions with clinicians. This is the first study exploring the experiences of prognostic communication at all stages of HF. Findings raise questions regarding the pragmatic utility of the concept of HF as a terminal illness and have implications for future HF care pathway development. Findings support the incorporation of a problem-based approach to management, which recognises the importance of everyday functioning for patients and carers as well as the opportunity for ACP. © 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.

Kitimat LNG terminal

International Nuclear Information System (INIS)

Schmaltz, I.; Boulton, R.

2007-01-01

Kitimat Liquefied Natural Gas (LNG) terminal is a terminal development company owned by Galveston LNG, a privately owned Canadian energy development company. This presentation provided information on Kitimat LNG with particular reference to its terminal located in Bish Cove on the Douglas Channel in British Columbia. This LNG terminal is reported to be the only fully permitted regasification terminal on the west coast of Canada and the United States. The presentation addressed market fundamentals including several graphs, such as world natural gas proved reserves in 2006; LNG supplements to Canadian gas supplies; global LNG demand for 2005-2020; average annual United States LNG imports; and global LNG liquefaction projects. Other market fundamentals were described, including that Kitimat is the only other approved terminal aside from the Costa Azul terminal in Mexico; Kitimat is the only west coast LNG import terminal that connects to midwest and eastern North American markets through existing gas pipelines; LNG producers are looking for destination diversification; and markets and marketers are looking for supply diversification. The authors noted that by 2010, western Canadian gas demand will exceed Californian demand. Other topics that were discussed in the presentation included Canadian natural gas field receipts; unadjusted bitumen production outlook; oil sands gas demand; forward basis fundamentals; and the commercial drivers of the Kitimat LNG terminal. The presentation also discussed the pacific trail pipelines, a partnership between Galveston LNG and Pacific Northern Gas to develop the natural gas transmission line from Kitimat to Summit. The presentation concluded with a discussion of the benefits of Kitimat LNG terminal such as providing access to the largest natural gas markets in the world via major gas transmission lines with spare capacity. figs

Reflexiones en torno a los problemas éticos y bioéticos en el tratamiento del paciente en fase terminal Reflections about the ethical and bioethical problems in treatment presenting with a terminal disease

Directory of Open Access Journals (Sweden)

Marilyn Sánchez Muñiz

2009-12-01

Full Text Available Se realizó una revisión bibliográfica sobre aspectos éticos y bioéticos en el tratamiento del paciente en estado terminal. Es un derecho de todos los ciudadanos que se les atienda y proteja su salud, teniendo como referencia el marco legal y el concepto actual de salud, en el que cobran vigencia los 3 principios fundamentales que forman el triángulo bioético: autonomía, justicia y beneficencia. La actuación ética con estos pacientes que reciben cuidados paliativos no difiere de los principios rectores de cualquier otro acto relacionado con la atención médica,ya que toda acción debe estar dirigida al beneficio del ser humano sin provocar daños. Existe considerable confusión y controversia en cuanto a la ética del cuidado terminal, particularmente en las áreas más polémicas de resucitación, en el inicio y cese de tratamientos, la alimentación y la eutanasia. El enfermo terminal tiene derecho a vivir hasta su máximo potencial físico, emocional, espiritual, vocacional y social, compatible con el estado resultante de la progresión de la enfermedad. Estos son los aspectos que se tratan en este trabajo.A bibliographic review was conducted about ethical and bioethical features in treatment of patient presenting a terminal disease. It is a right of all citizens the care and protection of his health within the legal framework and the current concept of health, with validity of the three fundamental principles included in bioethical triangle: autonomy, justice and charity. Ethical conduct with these patients receiving palliative cares not differs of the governing principles of any act related to medical care, since all action must to be directed to benefit of human being without cause damages. There is much confusion and controversy as regards the terminal care ethics, particularly in the more controversial areas of resuscitation, at onset and end of treatments, feeding and euthanasia. Patient presenting with a terminal disease has

[Music in human terminality: the family members' conceptions].

Science.gov (United States)

Sales, Catarina Aparecida; da Silva, Vladimir Araujo; Pilger, Calíope; Marcon, Sonia Silva

2011-03-01

This qualitative study was performed using the multiple case study method and Heidegger's existential phenomenology for data analysis. The objective was to understand how family members perceive the influence of musical experiences on the physical and mental health of a relative living with a terminal illness. Participants were seven individuals belonging to two families. Data collection was performed through interviews and observation from May to June 2009. Results showed that using music while providing care to beings living with cancer can provide well-being to patients as well as their caregivers. Considering the deficit of leisure and the monotony of the home environment, using music contemplates the philosophical and humanitarian precepts of palliative care, thus being characterized as a complementary resource to nursing care, as besides being a communication resource, it improves the interpersonal relationship between patients and their families.

Termination of life support after major trauma.

Science.gov (United States)

Sullivan, D J; Hansen-Flaschen, J

2000-06-01

As the population continues to age, greater numbers and more severely injured elderly patients require care in ICUs. With the attendant increase in the medical complexity of such patients, investigators anticipate that trauma and critical care resources will become increasingly stretched. Because of economic and societal forces, it will become increasingly important for trauma surgeons to appropriately counsel patients and their families regarding the outcome from their injuries and to become comfortable approaching families about withdrawal of support when medical futility is recognized. The authors propose the following guidelines for discussing limitation or termination of life support with patients and their families. Physicians should (1) discuss the patient's wishes regarding life support on admission or early in the hospital course; (2) at the initial discussion, establish who the decision maker will be if the patient is or becomes incapacitated; (3) maintain regular communication and continuity of care; and (4) inevitably, when conflict occurs, involve consultants and a hospital ethics committee for assistance in its resolution.

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

Science.gov (United States)

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

2011-01-01

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

[Euthanasia in history and the present - in the spectrum between euthanasia and terminal care].

Science.gov (United States)

von Engelhardt, Dietrich

2010-01-01

Euthanasia signifies in antiquity an easy and happy death and not at all an active termination of life, which was forbidden in the Hippocratic oath, but justified by philosophers. In the Christian middle ages active euthanasia and abortion are explicitly refused. At the beginnings of modern times MORE (1516) and BACON (1623) plead for euthanasia and differentiate for the first time between "euthanasia interior" as a mental preparation and "euthanasia exterior" as a physical and direct termination of life. Around 1900 a change takes place--in medicine as well as in the humanities and arts. The lawyer Karl BINDING and the psychiatrist Alfred HOCHE (1920) support active euthanasia in the case of mental deficiency; similar views are taken by the population. Under the "Third Reich" euthanasia unlawfully is carried out as termination of life without or even against consent. Today oaths, declarations and laws are intended to prevent such a "medicine without humanity" (MITSCHERLICH and MIELKE 1947). Active voluntary euthanasia is under certain conditions allowed by the legislation in some countries (Netherlands, Belgium, Luxembourg). Essential seem the consideration of different types of euthanasia and above all a psychical-mental assistance in the process of dying. The height of culture is measured by dealing with death and dying.

Knowledge of Dementia: Do family members understand dementia as a terminal condition?

Science.gov (United States)

Andrews, Sharon; McInerney, Fran; Toye, Christine; Parkinson, Camillus-Anthony; Robinson, Andrew

2017-07-01

Current research identifies advanced dementia to be the terminal phase of this progressive and incurable condition. However, there has been relatively little investigation into how family members of people with advanced dementia understand their relative's condition. In this article, we report on semi-structured interviews with 10 family members of people with advanced dementia, in a residential aged care facility. Using a qualitative, descriptive design, we explored family members' understandings of dementia, whether they were aware that it was a terminal condition, and the ways they developed their understandings. Findings revealed that the majority of family members could not recognize the terminal nature of dementia. Relying on predominantly lay understandings, they had little access to formal information and most failed to conceptualize a connection between dementia and death. Moreover, family members engaged in limited dialogue with aged care staff about such issues, despite their relatives being in an advanced stage of the disease. Findings from our study suggest that how family members understand their relative's condition requires greater attention. The development of staff/family partnerships that promote shared communication about dementia and dying may enhance family members' understandings of the dementia trajectory and the types of decisions they may be faced with during the more advanced stages of the disease.

CONTAINER TERMINALS IN EUROPE

Directory of Open Access Journals (Sweden)

Bart W. WIEGMANS

2001-01-01

Full Text Available This paper aims to address the linkage between logistics (in particular, the management of marketing channel flows and transport markets, while also the interaction between these two markets and intermodal container terminals is analysed. The marketing channel theory is used to describe all relevant actors and flows that run through marketing channels, starting with customer needs and ending with customer satisfaction. Porter's theory of competitive advantages is used to review competitive forces in both markets. Finally, a competitor analysis is performed for the logistics and transport market. These theories are applied so as to be able to determine the competitive position of intermodal container terminals with a view to the management of marketing channel flows and the physical transport of freight flows. Hence, the central question of this paper is: Which markets are served by intermodal container terminals and with whom are they competing? At present, neither the maritime container terminals nor the continental container terminals appear to have a significant influence in the logistics service market; they concentrate mainly on the physical movement of containers (transshipment. Furthermore, maritime container terminals and continental container terminals are not dominant players in the transport service market. Our conclusion is that continental terminals are predominantly competing with unimodal road transport, with neighbouring continental terminals and with barge transport companies.

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.

Visual communication and terminal equipment

International Nuclear Information System (INIS)

Kang, Cheol Hui

1988-06-01

This book is divided two parts about visual communication and terminal equipment. The first part introduces visual communication, which deals with foundation of visual communication, technique of visual communication, equipment of visual communication, a facsimile and pictorial image system. The second part contains terminal equipment such as telephone, terminal equipment for data transmission on constitution and constituent of terminal equipment for data transmission, input device and output device, terminal device and up-to-date terminal device.

Visual communication and terminal equipment

Energy Technology Data Exchange (ETDEWEB)

Kang, Cheol Hui

1988-06-15

This book is divided two parts about visual communication and terminal equipment. The first part introduces visual communication, which deals with foundation of visual communication, technique of visual communication, equipment of visual communication, a facsimile and pictorial image system. The second part contains terminal equipment such as telephone, terminal equipment for data transmission on constitution and constituent of terminal equipment for data transmission, input device and output device, terminal device and up-to-date terminal device.

Special not different: general practitioners' accounts of their care of dying people.

Science.gov (United States)

Field, D

1998-05-01

In modern Britain the majority of terminal care occurs in people's own homes and many dying people and their carers would prefer the death itself to occur in the home. The quality of terminal care in the home and the possibility of a home death depend to a great extent upon the care provided by GPs and community nurses. This paper reports on GPs' experiences of caring for dying people and their attitudes towards such work. It is based on unstructured interviews with 25 GPs who graduated from the 1979 entry cohort to the University of Leicester medical school. The respondents were recruited via a questionnaire following up previous research with this cohort on 'fear of death'. Although self-selecting, interviewees were not significantly different from those who did not volunteer for interview in any of the statistical analyses of the questionnaire data. There were a number of similarities in their accounts of their care of dying people. Common themes were that the care of dying people was important, rewarding and satisfying; that the GPs saw themselves as part of a team of carers, frequently as team co-ordinators; good working relationships with district nurses but less satisfactory relationships with hospitals and social workers; that patient and family were both recipients of care; and honesty in communication with dying people, albeit tempered. Three issues of contemporary relevance were: tensions over the role of hospice and specialist terminal care services; care of people with chronic terminal illnesses other than cancer; and the role of GPs in the social construction of bereavement.

Antecedents and Consequences of Parental Rights Termination for Abused and Neglected Children.

Science.gov (United States)

Borgman, Robert

1981-01-01

This study of 29 adopted children examines the consequences of parental rights termination (PRT) for neglected or abused children in relation to antecedent characteristics of children, parents, and circumstances in the foster care process. Suggests alternative plans for children whose PRT has not been followed by permanent adoptive placement.…

Rating the elderly with terminal cancer disease

International Nuclear Information System (INIS)

Riveros Rios, M.

2012-01-01

Full text: Introduction: In over 60 years are diagnosed more than 50% of tumors and 60% die because of this that only represents 20 % the total number of successes in this population group. However, currently there are few non-oncology geriatric patients who benefit of this model of care. This is because, in addition to palliative care have been developed mainly since Oncology, to it difficult to establish the concept of not being able to complete their basic survival and to predict the final stages of the disease chronicles are made ​​by different disciplines The intention of this study is to evaluate the variety oncology in the Department of Oncology at University Hospital and the focus on the Rating and care have been given to elderly patients with end-stage neoplastic disease or who are liable to care palliative for various reasons. Objective: • Determine the epidemiological profile of older adults with terminal cancer diagnosis attending Department of Hospital Oncology Clinic and if were evaluated globally and received palliative care. Methodology: • Design: Observational descriptive retrospective analytical component. • Universe: Young adults of both sexes attending the Oncology Department of the Hospital de Clinical in a period of the last 24 years • Sample: 191 Older adults of both sexes with oncological disease and 54 criteria that are terminally attended the Department of Oncology in the period of 24 years RESULTS: • The epidemiological characteristics of 191 elderly Less than half are predominantly male young seniors and the type of cancer most frequent pathology was i lung cancer, colon cancer, stomach cancer and unknown primary. More than half are female predominance of young and elderly oncological pathology type was most frequent cancer breast, colon, ovarian and lymphoma cancer • Less than half of older men terminalidad presented some criteria, being among the most frequent esophageal cancer with lung metastases of prostate cancer

Antecedents of Customer Relationship Termination

DEFF Research Database (Denmark)

Geersbro, Jens; Ritter, Thomas

To end business relationships, or to more actively terminate relationships, has long been acknowledged as part of customer relationship management. However, compared to other elements such as initiation and maintenance of relationships, little is known about the termination of business...... relationships as a managerial task. This paper contributes by (1) developing a conceptualization of relationship termination competence and (2) analyzing its antecedents. The empirical results identify termination acceptance, definition non-customers, organizational relationship termination routines......, and motivation as significant antecedents. Because of this, managers need to develop their organizations in order to use relationship termination as a vital strategy....

Patterns of Cost for Patients Dying in the Intensive Care Unit and Implications for Cost Savings of Palliative Care Interventions.

Science.gov (United States)

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

2016-11-01

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

Facilitating advance care planning in community palliative care: conversation starters across the client journey.

Science.gov (United States)

Blackford, Jeanine; Street, Annette F

2013-03-01

This paper describes the development of a tool for palliative care nurses to initiate and facilitate advance care planning (ACP) conversations in community palliative care practice. Seven community palliative care services located across Australia participated in a multi-site action research project. Data included participant observation, individual and focus group interviews with palliative care health professionals, and medical record audit. A directed content analysis used a pre-established palliative care practice framework of referral, admission, ongoing management, and terminal/discharge care. From this framework a Conversation Starter Tool for ACP was developed. The Tool was then used in orientation and continuing nurse education programmes. It provided palliative care nurses the opportunity to introduce and progress ACP conversations.

Faced with a dilemma: Danish midwives' experiences with and attitudes towards late termination of pregnancy.

Science.gov (United States)

Christensen, Anne Vinggaard; Christiansen, Anne Hjøllund; Petersson, Birgit

2013-12-01

The introduction of prenatal screening for all pregnant women in Denmark in 2004 has lead to an increase in the number of late terminations of pregnancy after the 12th week of pregnancy. Midwives' experiences with late termination of pregnancy (TOP) are still poorly described in the scientific literature. To explore Danish midwives' experiences with and attitudes towards late TOP. Focus was on how midwives perceive their own role in late TOP, and how their professional identity is influenced by working with late TOP in a time where prenatal screening is rapidly developing. A qualitative study consisting of ten individual interviews with Danish midwives, all of whom had taken part in late TOP. Current practice of late TOP resembles the practice of normal deliveries and is influenced by a growing personalisation of the aborted foetus. The midwives strongly supported women's legal right to choose TOP and considerations about the foetus' right to live were suppressed. Midwives experienced a dilemma when faced with aborted foetuses that looked like newborns and when aborted foetuses showed signs of life after a termination. Furthermore, they were critical of how physicians counsel women/couples after prenatal diagnosis. The midwives' practice in relation to late TOP was characterised by an acknowledgement of the growing ethical status of the foetus and the emotional reactions of the women/couples going through late TOP. Other professions as well as structural factors at the hospital highly influenced the midwives' ability to organize their work with late terminations. There is a need for more thorough investigation of how to secure the best possible working conditions for midwives, and how to optimise the care for women/couples going through late TOP. © 2012 The Authors Scandinavian Journal of Caring Sciences © 2012 Nordic College of Caring Science.

Intensive care unit team perception of palliative care: the discourse of the collective subject.

Science.gov (United States)

Gulini, Juliana El Hage Meyer de Barros; Nascimento, Eliane Regina Pereira do; Moritz, Rachel Duarte; Rosa, Luciana Martins da; Silveira, Natyele Rippel; Vargas, Mara Ambrosina de Oliveira

2017-05-25

To learn the perception of health professionals in an intensive care unit towards palliative care. This was a descriptive and qualitative study based on the converging care approach conducted at an intensive care unit in the South of Brazil. Semi-structured interviews were used to investigate the understanding of the professionals about palliative care in this unit. The data were organized and analyzed using the discourse of the collective subject method with the help of Qualiquantisoft® software. Participants included 37 professionals (12 nurses, 11nursing technicians, 5 physical therapists and 9 doctors). The key ideas extracted from the interviews were: care in the end stage of life that avoids futile measures; comfort care; lack of standardized care and lack of team training. The professionals perceived palliative care as appropriate in the last stages of life, with no need for futile treatment or as comfort measures. However, they are aware of the lack of standardization and lack of capacity building in this area, which leads them to conceive palliative care as terminal care, and measures are recommended to break with this stigma. Conhecer a percepção dos profissionais de saúde de uma Unidade de Terapia Intensiva acerca do cuidado paliativo. Pesquisa descritiva, qualitativa do tipo Convergente Assistencial realizada em uma Unidade de Terapia Intensiva da região sul do Brasil. Utilizou-se de entrevista semiestruturada que investigou o entendimento e a compreensão sobre cuidado paliativo nesta unidade. Os dados foram organizados e analisados pela técnica do discurso do sujeito coletivo com auxílio do software Qualiquantisoft®. Participaram do estudo 37 profissionais (12 enfermeiros, 11 técnicos de enfermagem, cinco fisioterapeutas e nove médicos). As ideias centrais extraídas dos relatos: cuidado na fase terminal da vida sem medidas fúteis; cuidados de conforto; falta uniformizar a assistência e falta capacitação para a equipe. Os profissionais

The use of music in facilitating emotional expression in the terminally ill.

Science.gov (United States)

Clements-Cortes, Amy

2004-01-01

The expression and discussion of feelings of loss and grief can be very difficult for terminally ill patients. Expressing their emotions can help these patients experience a more relaxed and comfortable state. This paper discusses the role of music therapy in palliative care and the function music plays in accessing emotion. It also describes techniques used in assisting clients to express their thoughts and feelings. Case examples of three in-patient palliative care clients at Baycrest Centre for Geriatric Care are presented. The goals set for these patients were to decrease depressive symptoms and social isolation, increase communication and self-expression, stimulate reminiscence and life review, and enhance relaxation. The clients were all successful in reaching their individual goals.

LNG TERMINAL SAFE OPERATION MANAGEMENT

Directory of Open Access Journals (Sweden)

Andrzej ADAMKIEWICZ

2012-07-01

Full Text Available This article presents the significance of LNG terminal safety issues in natural gas sea transport. It shows particular requirements for LNG transmission installations resulting from the specific properties of LNG. Out of the multi‐layer critical safety areas comprising structural elements of the terminal safety system, possibilities to decrease the risk of emergency occurrence on LNG terminals have been selected. Tasks performed by the LNG terminal, together with its own personnel and the outside one, have been defined. General theses for LNG terminal safety have been formulated.

Caring devices: about warmth, coldness and 'fit'

NARCIS (Netherlands)

Pols, J.

2010-01-01

Healthcare technologies are often put in opposition to warm human care and contact. This paper explores the assumed coldness of medical technologies by presenting the case of a technology that is experienced as particularly caring by the patients using them. This is a device to support terminal

Basic principles in approaching patient and his family in the terminal phase of cancer

International Nuclear Information System (INIS)

Bencova, V.

2016-01-01

Serious life threatening disease including cancer appears to be not exclusively a medical problem. The stepwise treatment failure opens up a dilemma for patient and physician on how to cope with the new situation. Especially, disclosure of the reality by health care providers with an emphatic feeling is coupled with emotional pressure that is for many caregivers difficult to accept. The decision around the termination of curative treatment and the transition to palliative care is the most stressful event in the relation of caregivers to the the patient and his family. The patient being in the terminal phase of his disease is suffering from deep psychosocial crisis and the doctor patient communication remains the only possibility of helping patient to accept the reality of approaching death. The disclosure of „bad news“ is a stressful moment for caregivers themselves, that, besides of empathy, deserve communication skills and theoretical and professional preparedness. The aim of this paper is to open up a discussion about the most stressful life phase – dying and death – in the context of biomedical and psychosocial care of patients with serious life threatening disease. (author)

Nonleaking battery terminals.

Science.gov (United States)

Snider, W. E.; Nagle, W. J.

1972-01-01

Three different terminals were designed for usage in a 40 ampere/hour silver zinc battery which has a 45% KOH by weight electrolyte in a plastic battery case. Life tests, including thermal cycling, electrical charge and discharge for up to three years duration, were conducted on these three different terminal designs. Tests for creep rate and tensile strength were conducted on the polyphenylene oxide plastic battery cases. Some cases were unused and others containing KOH electrolyte were placed on life tests. The design and testing of nonleaking battery terminals for use with a KOH electrolyte in a plastic case are considered.

Effect of an intervention based on basic Buddhist principles on the spiritual well-being of patients with terminal cancer.

Science.gov (United States)

Chimluang, Janya; Thanasilp, Sureeporn; Akkayagorn, Lanchasak; Upasen, Ratchaneekorn; Pudtong, Noppamat; Tantitrakul, Wilailuck

2017-12-01

To evaluate the effect of an intervention based on basic Buddhist principles on the spiritual well-being of patients with terminal cancer. This quasi-experimental research study had pre- and post-test control groups. The experimental group received conventional care and an intervention based on basic Buddhist principles for three consecutive days, including seven activities based on precept activities, concentration activities and wisdom activities. The control group received conventional care alone. Forty-eight patients participated in this study: 23 in the experimental group and 25 in the control group. Their mean age was 53 (standard deviation 10) years. The spiritual well-being of participants in the experimental group was significantly higher than that of participants in the control group at the second post-test (P principles improved the spiritual well-being of patients with terminal cancer. This result supports the beneficial effects of implementing this type of intervention for patients with terminal cancer. Copyright © 2017 Elsevier Ltd. All rights reserved.

EDITORIAL Palliative care is on the move – masihambe!

African Journals Online (AJOL)

2006-02-02

Feb 2, 2006 ... members of the Hospice Palliative Care Association (HPCA) of South Africa. These hospices have some 600 beds available for admission. Patients are admitted to a hospice bed for three main reasons, namely symptom control, family relief (respite care), and terminal care. The article presenting the ...

[Hospice and palliative care in the outpatient department].

Science.gov (United States)

Ikenaga, M; Tsuneto, S

2000-10-01

In the medical environment, information disclosure to patients and respect of autonomy have spread rapidly. Today, many terminally-ill cancer patients wish to spend as much time at home as possible. In such situations the patient who has been informed that curative treatments are no longer expected to be beneficial can now hope to receive home care and visiting care from hospice/palliative care services. The essential concepts of hospice/palliative care are symptom management, communication, family care and a multidisciplinary approach. These concepts are also important in the outpatient department. In particular, medical staff need to understand and utilize management strategies for common symptoms from which terminally-ill cancer patients suffer (ex. cancer pain, anorexia/fatigue, dyspnea, nausea/vomiting, constipation, hypercalcemia and psychological symptoms). They also need to know how to use continuous subcutaneous infusion for symptom management in the patients last few days. The present paper explains the clinical practices of hospice/palliative care in the outpatient department. Also discussed is support of individual lives so that maximum QOL is provided for patients kept at home.

Therapeutical Intervention, Relaxation, Mental Images, and Spirituality (RIME for Spiritual Pain in Terminal Patients. A Training Program

Directory of Open Access Journals (Sweden)

Ana Catarina de Araújo Elias

2006-01-01

Full Text Available Therapeutic intervention involving the technique of Relaxation, Mental Images, and Spirituality (RIME can foster the redefinition of spiritual pain in terminal patients. A training course was developed to instruct health care professionals in its use, and the results were followed up by evaluating reactions of professionals to its use in intervention with patients. Six subjects (a nurse, a doctor, three psychologists, and an alternative therapist, all skilled in palliative care, were invited to take part in the experience. They worked with 11 terminal patients in public hospitals of the cities of Campinas, Piracicaba, and São Paulo, located in Brazil. The theoretical basis for the study involves action research and phenomenology, and the results were analyzed using both qualitative and quantitative methods. The analysis of the experience of the professionals revealed 5 categories and 15 subcategories. The analysis of the nature of spiritual pain revealed 6 categories and 11 subcategories. The administration of RIME revealed statistically significant differences (p < 0.0001, i.e., patients reported a greater level of well-being at the end than at the beginning of sessions, which suggests that RIME led to the redefinition of spiritual pain for these terminal patients. The training program proposed has shown itself to be effective in preparing health care professionals for the use of RIME intervention.

Bariéry v komunikaci mezi sestrou a dětským pacientem v terminálním stadiu onemocnění

OpenAIRE

IMRAMOVSKÁ, Simona

2016-01-01

Nursing care for paediatric terminally ill patients in the Czech Republic is continuously evolving and developing. It is important for the nurses to learn to use suitable communication. Theoretical part of this work includes information on terminal stages of illnesses in children and the corresponding care that should be provided. It further focuses on communication with the child and his/her parents. The theoretical background for this work is the conceptual Callista Roy Adaptation model for...

Volume of hydration in terminal cancer patients.

Science.gov (United States)

Bruera, E; Belzile, M; Watanabe, S; Fainsinger, R L

1996-03-01

In this retrospective study we reviewed the volume and modality of hydration of consecutive series of terminal cancer patients in two different settings. In a palliative care unit 203/290 admitted patients received subcutaneous hydration for 12 +/- 8 days at a daily volume of 1015 +/- 135 ml/day. At the cancer center, 30 consecutive similar patients received intravenous hydration for 11.5 +/- 5 days (P > 0.2) but at a daily volume of 2080 +/- 720 ml/day (P palliative care unit patients required discontinuation of hydration because of complications. Hypodermoclysis was administered mainly as a continuous infusion, an overnight infusion, or in one to three 1-h boluses in 62 (31%), 98 (48%) and 43 (21%) patients, respectively. Our findings suggest that, in some settings, patients may be receiving excessive volumes of hydration by less comfortable routes such as the intravenous route. Increased education and research in this area are badly needed.

Intrinsic terminators in Mycoplasma hyopneumoniae transcription.

Science.gov (United States)

Fritsch, Tiago Ebert; Siqueira, Franciele Maboni; Schrank, Irene Silveira

2015-04-08

Mycoplasma hyopneumoniae, an important pathogen of swine, exhibits a low guanine and cytosine (GC) content genome. M. hyopneumoniae genome is organised in long transcriptional units and promoter sequences have been mapped upstream of all transcription units. These analysis provided insights into the gene organisation and transcription initiation at the genome scale. However, the presence of transcriptional terminator sequences in the M. hyopneumoniae genome is poorly understood. In silico analyses demonstrated the presence of putative terminators in 82% of the 33 monocistronic units (mCs) and in 74% of the 116 polycistronic units (pCs) considering different classes of terminators. The functional activity of 23 intrinsic terminators was confirmed by RT-PCR and qPCR. Analysis of all terminators found by three software algorithms, combined with experimental results, allowed us to propose a pattern of RNA hairpin formation during the termination process and to predict the location of terminators in the M. hyopneumoniae genome sequence. The stem-loop structures of intrinsic terminators of mycoplasma diverge from the pattern of terminators found in other bacteria due the low content of guanine and cytosine. In M. hyopneumoniae, transcription can end after a transcriptional unit and before its terminator sequence and can also continue past the terminator sequence with RNA polymerases gradually releasing the RNA.

Possibility of Cooper-pair formation controlled by multi-terminal spin injection

Science.gov (United States)

Ohnishi, K.; Sakamoto, M.; Ishitaki, M.; Kimura, T.

2018-03-01

A multi-terminal lateral spin valve consisting of three ferromagnetic nanopillars on a Cu/Nb bilayer has been fabricated. We investigated the influence of the spin injection on the superconducting properties at the Cu/Nb interface. The non-local spin valve signal exhibits a clear spin insulation signature due to the superconducting gap of the Nb. The magnitude of the spin signal is found to show the probe configuration dependence. From the careful analysis of the bias current dependence, we found the suppression of the superconductivity due to the exchange interaction between the Cooper pair and accumulated spin plays an important role in the multi-terminal spin injections. We also discuss about the possibility of the Cooper-pair formation due to the spin injection from the two injectors with the anti-parallel alignment.

LNG TERMINAL SAFE OPERATION MANAGEMENT

OpenAIRE

Andrzej ADAMKIEWICZ; Włodzimierz KAMIŃSKI

2012-01-01

This article presents the significance of LNG terminal safety issues in natural gas sea transport. It shows particular requirements for LNG transmission installations resulting from the specific properties of LNG. Out of the multi‐layer critical safety areas comprising structural elements of the terminal safety system, possibilities to decrease the risk of emergency occurrence on LNG terminals have been selected. Tasks performed by the LNG terminal, together with its own personnel and the out...

Healing ministry and palliative care in Christianity.

Science.gov (United States)

Jayard, S Stephen; Irudayadason, Nishant A; Davis, J Charles

2017-01-01

Death is inevitable, but that does not mean it can be planned or imposed. It is an ethical imperative that we attend to the unbearable pain and suffering of patients with incurable and terminal illnesses. This is where palliative care plays a vital role. Palliative care has been growing faster in the world of medicine since its emergence as a specialty in the last decade. Palliative care helps to reduce physical pain while affirming the aspect of human suffering and dying as a normal process. The goal of palliative care is to improve the quality of life both of the patient and the family. Palliative care resonates with the healing ministry of Christianity that affirms the sanctity and dignity of human life from the moment of conception to natural death. Christianity is convinced that patients at the very end of their lives, with all their ailments and agonies, are still people who have been created in the image and likeness of God. The human person is always precious, even when marked by age and sickness. This is one of the basic convictions that motivate Christians to take care of the sick and the dying. Palliative care is a great opportunity for Christians to manifest God's unfailing love for the terminally ill and the dying.

Termination unit

Energy Technology Data Exchange (ETDEWEB)

Traeholt, Chresten; Willen, Dag; Roden, Mark; Tolbert, Jerry C.; Lindsay, David; Fisher, Paul W.; Nielsen, Carsten Thidemann

2016-05-03

Cable end section comprises end-parts of N electrical phases/neutral, and a thermally-insulation envelope comprising cooling fluid. The end-parts each comprises a conductor and are arranged with phase 1 innermost, N outermost surrounded by the neutral, electrical insulation being between phases and N and neutral. The end-parts comprise contacting surfaces located sequentially along the longitudinal extension of the end-section. A termination unit has an insulating envelope connected to a cryostat, special parts at both ends comprising an adapter piece at the cable interface and a closing end-piece terminating the envelope in the end-section. The special parts houses an inlet and/or outlet for cooling fluid. The space between an inner wall of the envelope and a central opening of the cable is filled with cooling fluid. The special part at the end connecting to the cryostat houses an inlet or outlet, splitting cooling flow into cable annular flow and termination annular flow.

Randomized multicentre feasibility trial of intermediate care versus standard ward care after emergency abdominal surgery (InCare trial)

DEFF Research Database (Denmark)

Vester-Andersen, M; Waldau, T; Wetterslev, J

2015-01-01

BACKGROUND: Emergency abdominal surgery carries a considerable risk of death and postoperative complications. Early detection and timely management of complications may reduce mortality. The aim was to evaluate the effect and feasibility of intermediate care compared with standard ward care...... ward within 24 h of emergency abdominal surgery. Participants were randomized to either intermediate care or standard surgical ward care after surgery. The primary outcome was 30-day mortality. RESULTS: In total, 286 patients were included in the modified intention-to-treat analysis. The trial...... was terminated after the interim analysis owing to slow recruitment and a lower than expected mortality rate. Eleven (7·6 per cent) of 144 patients assigned to intermediate care and 12 (8·5 per cent) of 142 patients assigned to ward care died within 30 days of surgery (odds ratio 0·91, 95 per cent c.i. 0·38 to 2...

Planned and unplanned terminations of foster care placements in the Netherlands: Relationships with characteristics of foster children and foster placements

NARCIS (Netherlands)

van Rooij, F.; Maaskant, A.; Weijers, I.; Weijers, D.; Hermanns, J.

2015-01-01

This study examined the role of placement and child characteristics in the unplanned termination of foster placements. Data were used from 169 foster children aged 0 to 20. Results showed that 35% of all foster placement terminations were unplanned. Outcomes of logistic regression analyses

Attitudes on euthanasia, physician-assisted suicide and terminal sedation--a survey of the members of the German Association for Palliative Medicine.

Science.gov (United States)

Müller-Busch, H C; Oduncu, F S; Woskanjan, S; Klaschik, E

2004-01-01

Due to recent legislations on euthanasia and its current practice in the Netherlands and Belgium, issues of end-of-life medicine have become very vital in many European countries. In 2002, the Ethics Working Group of the German Association for Palliative Medicine (DGP) has conducted a survey among its physician members in order to evaluate their attitudes towards different end-of-life medical practices, such as euthanasia (EUT), physician-assisted suicide (PAS), and terminal sedation (TS). An anonymous questionnaire was sent to the 411 DGP physicians, consisting of 14 multiple choice questions on positions that might be adopted in different hypothetical scenarios on situations of "intolerable suffering" in end-of-life care. For the sake of clarification, several definitions and legal judgements of different terms used in the German debate on premature termination of life were included. For statistical analysis t-tests and Pearson-correlations were used. The response rate was 61% (n = 251). The proportions of the respondents who were opposed to legalizing different forms of premature termination of life were: 90% opposed to EUT, 75% to PAS, 94% to PAS for psychiatric patients. Terminal sedation was accepted by 94% of the members. The main decisional bases drawn on for the answers were personal ethical values, professional experience with palliative care, knowledge of alternative approaches, knowledge of ethical guidelines and of the national legal frame. In sharp contrast to similar surveys conducted in other countries, only a minority of 9.6% of the DGP physicians supported the legalization of EUT. The misuse of medical knowledge for inhumane killing in the Nazi period did not play a relevant role for the respondents' negative attitude towards EUT. Palliative care needs to be stronger established and promoted within the German health care system in order to improve the quality of end-of-life situations which subsequently is expected to lead to decreasing requests

klax Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kprc Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

katl Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kmcn Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kogb Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kama Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

ptkk Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kiwa Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kavp Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kdca Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kbwg Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kdfw Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kssi Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

pahn Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

ksrq Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kpvd Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kisp Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kttd Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

pmdy Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kmgm Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

khib Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

pavd Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kfar Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kluk Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kwwr Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

klse Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

ksts Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

koth Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kbfl Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

ksgf Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

klch Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kpkb Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

krog Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kbjc Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

ksea Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kbwi Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kftw Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kpuw Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kabq Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

ksny Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

khio Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

klaf Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kfoe Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

ksmx Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kipt Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

ktrk Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kwmc Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

katy Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

tjmz Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kdet Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kcxp Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kbur Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

krkd Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

pawg Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kloz Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kcec Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kdec Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

paor Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kavl Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kdrt Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kstl Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kbfi Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

khsv Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

pafa Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kekn Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

tncm Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kith Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kgnv Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

ktoi Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kgso Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

nstu Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kpbi Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kgdv Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kcmx Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kdls Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

koaj Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

krhi Terminal Aerodrome Forecast

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National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kbpk Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

khuf Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kont Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kyng Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kcwa Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kflg Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

ktup Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

ktop Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kink Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

krut Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kbli Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kaoo Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

klit Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

panc Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

ktcl Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

pgwt Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kpsp Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kbih Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kdnl Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kart Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kilm Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kpne Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kabi Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

ptpn Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kblf Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kosh Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kpdt Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kewr Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kiso Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kpga Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kbkw Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kmyl Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

krbg Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kril Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

ksus Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

padq Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kbil Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

krfd Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kdug Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

ktix Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kcod Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kslk Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kgfl Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kguc Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kmlu Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kbff Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

ksmn Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kdro Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kmce Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

ktpa Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kmot Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kcre Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

klws Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kotm Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

khqm Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kabr Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

klal Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kelp Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kecg Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

khbg Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kpbf Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

konp Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

pkwa Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

ktvf Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

paga Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

khks Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kdsm Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kpsm Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kgrb Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kgmu Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

papg Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kbgm Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

pamc Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

klrd Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

ksan Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

patk Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kowb Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

klru Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kfxe Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kjct Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kcrg Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

paaq Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kaex Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

klbx Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kmia Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kpit Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kcrw Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

paen Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kast Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kuin Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kmht Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

krsw Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kbpi Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kcys Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kflo Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kphx Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

pakn Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

pabt Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

krdg Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

khdn Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

kjac Terminal Aerodrome Forecast

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — TAF (terminal aerodrome forecast or terminal area forecast) is a format for reporting weather forecast information, particularly as it relates to aviation. TAFs are...

Effect of automated ultraviolet C-emitting device on decontamination of hospital rooms with and without real-time observation of terminal room disinfection.

Science.gov (United States)

Penno, Katie; Jandarov, Roman A; Sopirala, Madhuri M

2017-11-01

We studied the effectiveness of an ultraviolet C (UV-C) emitter in clinical settings and compared it with observed terminal disinfection. We cultured 22 hospital discharge rooms at a tertiary care academic medical center. Phase 1 (unobserved terminal disinfection) included cultures of 11 high-touch environmental surfaces (HTSs) after terminal room disinfection (AD) and after the use of a UV-C-emitting device (AUV). Phase 2 (observed terminal disinfection) included cultures before terminal room disinfection (BD), AD, and AUV. Zero-inflated Poisson regression compared mean colony forming units (CFU) between the groups. Two-sample proportion tests identified significance of the observed differences in proportions of thoroughly cleaned HTSs (CFU cleaning significantly reduced microbial burden and improved the thoroughness of terminal disinfection. We found no further benefit to UV-C use if standard terminal disinfection was observed. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Ports and Terminals : Planning and Functional Design

NARCIS (Netherlands)

Groenveld, R.; Velsink, H.

1993-01-01

1. Maritime transport, means and commodities 3. Principles of integrated port planning 4. Planning and design of a port's water areas 5. Port terminals - introduction 6. Conventional general cargo terminals 7. Container terminals 8. Oil & liquid gas terminals 9. Dry bulk cargo terminals 10. Fishery

Assessing Hopelessness in Terminally Ill Cancer Patients: Development of the Hopelessness Assessment in Illness Questionnaire

Science.gov (United States)

Rosenfeld, Barry; Pessin, Hayley; Lewis, Charles; Abbey, Jennifer; Olden, Megan; Sachs, Emily; Amakawa, Lia; Kolva, Elissa; Brescia, Robert; Breitbart, William

2011-01-01

Hopelessness has become an increasingly important construct in palliative care research, yet concerns exist regarding the utility of existing measures when applied to patients with a terminal illness. This article describes a series of studies focused on the exploration, development, and analysis of a measure of hopelessness specifically intended…

Tandem Terminal Ion Source

International Nuclear Information System (INIS)

Harper, G.C.; Lindner, C.E.; Myers, A.W.; Wechel, T.D. van

2000-01-01

OAK-B135 Tandem Terminal Ion Source. The terminal ion source (TIS) was used in several experiments during this reporting period, all for the 7 Be(γ) 8 B experiment. Most of the runs used 1 H + at terminal voltages from 0.3 MV to 1.5 MV. One of the runs used 2 H + at terminal voltage of 1.4 MV. The other run used 4 He + at a terminal voltage of 1.37 MV. The list of experiments run with the TIS to date is given in table 1 below. The tank was opened four times for unscheduled source repairs. On one occasion the tank was opened to replace the einzel lens power supply which had failed. The 10 kV unit was replaced with a 15 kV unit. The second time the tank was opened to repair the extractor supply which was damaged by a tank spark. On the next occasion the tank was opened to replace a source canal which had sputtered away. Finally, the tank was opened to replace the discharge bottle which had been coated with aluminum sputtered from the exit canal

Tandem Terminal Ion Source

International Nuclear Information System (INIS)

None

2000-01-01

OAK-B135 Tandem Terminal Ion Source. The terminal ion source (TIS) was used in several experiments during this reporting period, all for the(sup 7)Be((gamma))(sup 8)B experiment. Most of the runs used(sup 1)H(sup+) at terminal voltages from 0.3 MV to 1.5 MV. One of the runs used(sup 2)H(sup+) at terminal voltage of 1.4 MV. The other run used(sup 4)He(sup+) at a terminal voltage of 1.37 MV. The list of experiments run with the TIS to date is given in table 1 below. The tank was opened four times for unscheduled source repairs. On one occasion the tank was opened to replace the einzel lens power supply which had failed. The 10 kV unit was replaced with a 15 kV unit. The second time the tank was opened to repair the extractor supply which was damaged by a tank spark. On the next occasion the tank was opened to replace a source canal which had sputtered away. Finally, the tank was opened to replace the discharge bottle which had been coated with aluminum sputtered from the exit canal

Kajian Kinerja Terminal Batu Ampar Kota Balikpapan

Directory of Open Access Journals (Sweden)

Randha Alief Chikita

2018-01-01

Full Text Available Batu Ampar Terminal Balikpapan is the only type A passenger terminal in Balikpapan City. The purpose of this study is to determine the operational performance of the terminal at this time and also to determine the level of service in the terminal. The results of this study indicate that for FIFO queue discipline analysis on AKDP and AKAP bus lines, it is known that ρ <1 means that there is currently no queue in the terminal. For the analysis of terminal facilities it is known that there are still some terminal facilities that are not yet available from the main facilities and supporting facilities, therefore the need for additional facilities in order to meet the standard of passenger terminal type A. In the next 15 years analysis for traffic intensity value is approaching 1 which means in the future will cause the queue in the terminal, so it is necessary for the improvement of terminal performance. For the service performance with IPA method there are 35 variables that there are 7 variables that enter in quadrant I. In the next step to do analysis to know the priority of handling by using QFD method. Keywords: Batu Ampar Terminal Balikpapan, IPA, terminal performance, QFD

St. James marine terminal facility description

Energy Technology Data Exchange (ETDEWEB)

1993-10-01

The US Department of Energy (DOE) currently owns and operates a marine terminal on the west bank of the Mississippi River at St. James, Louisiana. The St. James facility was constructed by the Department to provide marine services associated with the fill and drawdown of the Strategic Petroleum Reserve (SPR) crude oil storage facilities located at Bayou Choctaw and Weeks Island, Louisiana. Although strategic to the mission of the SPR in the event of a national emergency, the St. James terminal is situated such that it has a high potential to also serve the commercial industry`s needs for crude oil terminalling and storage. The St. James terminal is located approximately 45 miles west of New Orleans and 30 miles southeast of Baton Rouge, and approximately 160 miles upstream from the mouth of the Mississippi River. Construction of the St. James terminal was initiated in 1978 and was completed in 1980. Since then, the terminal has received and transferred over 125 million barrels of crude oil to the SPR sites for storage. For crude oil distribution, the St. James terminal was connected to the neighboring LOCAP terminal by a 0.1 mile 36-inch pipeline in 1981 and to the Capline terminal by a 0.5 mile 30-inch pipeline in 1988. The terminal also has a 30-inch pipeline connection to the Koch oil terminal which was used for initial fill purposes; however, this pipeline has been disconnected and is currently inactive. A complete description of the St. James terminal facilities, operational capabilities, operational certifications, and future Government requirements are presented in Sections 2, 3, 4, and 5 respectively.

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.

Withholding or termination of resuscitation in pediatric out-of-hospital traumatic cardiopulmonary arrest.

Science.gov (United States)

Fallat, Mary E

2014-04-01

This multiorganizational literature review was undertaken to provide an evidence base for determining whether or not recommendations for out-of-hospital termination of resuscitation could be made for children who are victims of traumatic cardiopulmonary arrest. Although there is increasing acceptance of out-of-hospital termination of resuscitation for adult traumatic cardiopulmonary arrest when there is no expectation of a good outcome, children are routinely excluded from state termination-of-resuscitation protocols. The decision to withhold resuscitative efforts in a child under specific circumstances (decapitation or dependent lividity, rigor mortis, etc) is reasonable. If there is any doubt as to the circumstances or timing of the traumatic cardiopulmonary arrest, under the current status of limiting termination of resuscitation in the field to persons older than 18 years in most states, resuscitation should be initiated and continued until arrival to the appropriate facility. If the patient has arrested, resuscitation has already exceeded 30 minutes, and the nearest facility is more than 30 minutes away, involvement of parents and family of these children in the decision-making process with assistance and guidance from medical professionals should be considered as part of an emphasis on family-centered care, because the evidence suggests that either death or a poor outcome is inevitable.

Educating medical students about the personal meaning of terminal illness using the film, "Wit".

Science.gov (United States)

Ozcakir, Alis; Bilgel, Nazan

2014-08-01

Addressing the emotional needs of dying patients is rarely found to have a place in formal medical curriculum and is also a difficult area to teach through classical medical lectures. "Cinemeducation" is a wonderful way to educate health care providers about the magnitude of emotions that arise during those difficult situations. The aims of this study were to test the relevance and usefulness of the movie 'Wit' in teaching medical students about the personal meaning of terminal illness and to assess the impact of this teaching method on students' attitudes toward palliative care. This was an education study using qualitative and quantitative data analysis of 518 first-year medical students in a single medical faculty in Turkey. Students watched the entire film, filled out an evaluation questionnaire, and answered questions about the film. Students also expressed their own feelings and thoughts about palliative care. Overall, 88% rated the film as excellent, very good, or good. According to 54% of the students, the emotions of terminally ill patients were fully portrayed in the film and in a very realistic way. Approximately 61.4% of the students found this film emotional. Most students (80.5%) stated that this film made them think about the emotional and spiritual suffering that dying patients go through and found this learning approach about palliative care more useful than didactic lectures and journal article readings but not more useful than bedside rounds. It was thought that caring for dying patients would be very or fairly personally satisfying for 65.3% of the students. The film 'Wit' gave the students an opportunity to explore their beliefs, values and attitudes in terms of the bio-psycho-social-spiritual aspects of health care and encouraged them to think more about the humanitarian issues of the medical profession.

Aging and the shape of cognitive change before death: terminal decline or terminal drop?

Science.gov (United States)

MacDonald, Stuart W S; Hultsch, David F; Dixon, Roger A

2011-05-01

Relative to typical age-related cognitive decrements, the terms "terminal decline" and "terminal drop" refer to the phenomenon of increased cognitive decline in proximity to death. Given that these terms are not necessarily synonymous, we examined the important theoretical distinction between the two alternative trajectories or shapes of changes they imply. We used 12-year (5-wave) data from the Victoria Longitudinal Study to directly test whether pre-death cognitive decrements follow a terminal decline (generally gradual) or a terminal drop (more abrupt) shape. Pre-death trajectories of cognitive decline for n=265 decedents (Mage = 72.67 years, SD = 6.44) were examined separately for 5 key cognitive constructs (verbal speed, working memory, episodic memory, semantic memory, and crystallized ability). Several classes of linear mixed models evaluated whether cognitive decline increased per additional year closer to death. Findings indicated that the shape of pre-death cognitive change was predominantly characterized by decline that is steeper as compared with typical aging-related change, but still best described as slow and steady decline, especially as compared with precipitous drop. The present findings suggest that terminal decline and terminal drop trajectories may not be mutually exclusive but could rather reflect distinct developmental trajectories within the same individual.

42 CFR 489.53 - Termination by CMS.

Science.gov (United States)

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Termination by CMS. 489.53 Section 489.53 Public... Reinstatement After Termination § 489.53 Termination by CMS. (a) Basis for termination of agreement with any provider. CMS may terminate the agreement with any provider if CMS finds that any of the following failings...

The effects of hospice-shared care for gastric cancer patients.

Science.gov (United States)

Huang, Kun-Siang; Wang, Shih-Ho; Chuah, Seng-Kee; Rau, Kun-Ming; Lin, Yu-Hung; Hsieh, Meng-Che; Shih, Li-Hsueh; Chen, Yen-Hao

2017-01-01

Hospice care has been proved to result in changes to the medical behaviors of terminally ill patients. The aim of this study was to evaluate the effects and medical behavior changes of hospice-shared care intervention among terminally ill gastric cancer patients. A total of 174 patients who died of gastric cancer between 2012 and 2014 were identified. These patients were divided into two groups: a hospice-shared care group (n = 93) and a control group (n = 81). Among the 174 patients, 84% had advanced stage (stage III or stage IV) cancer. The females and the patients cared by medical oncologists had a higher percentage of hospice-shared care than the males (71% vs 44%, p = 0.001) and those cared by other physicians (63% vs 41%, p = 0.004). Compared to the control group, the hospice-shared care group underwent lower incidence of life sustaining or aggressive medical treatments, including intensive care unit admission (2% vs 26%, pgastric cancer patients could increase the rate of signed DNR orders, decrease the use of life sustaining and aggressive/palliative treatments, and improve quality of life.

Lazy Productivity via Termination

NARCIS (Netherlands)

Endrullis, J.; Hendriks, R.D.A.

2011-01-01

We present a procedure for transforming strongly sequential constructor-based term rewriting systems (TRSs) into context-sensitive TRSs in such a way that productivity of the input system is equivalent to termination of the output system. Thereby automated termination provers become available for

Nontraumatic terminal ileal perforation

Directory of Open Access Journals (Sweden)

Wani Rauf A

2006-03-01

Full Text Available Abstract Background There is still confusion and controversy over the diagnosis and optimal surgical treatment of non traumatic terminal ileal perforation-a cause of obscure peritonitis. Methods This study was a prospective study aimed at evaluating the clinical profile, etiology and optimal surgical management of patients with nontraumatic terminal ileal perforation. Results There were 79 cases of nontraumatic terminal ileal perforation; the causes for perforation were enteric fever(62%, nonspecific inflammation(26%, obstruction(6%, tuberculosis(4% and radiation enteritis (1%. Simple closure of the perforation (49% and end to side ileotransverse anastomosis(42% were the mainstay of the surgical management. Conclusion Terminal ileal perforation should be suspected in all cases of peritonitis especially in developing countries and surgical treatment should be optimized taking various accounts like etiology, delay in surgery and operative findings into consideration to reduce the incidence of deadly complications like fecal fistula.

Factors affecting caregiver burden of terminally ill adults in the home setting - A systematic review.

Science.gov (United States)

He Leow, Mabel Qi; Wai Chi Chan, Sally

Background: Terminally ill people have complex physical and psychological needs. As a result, their caregivers may experience high levels of burden, and some caregivers are unable to cope with the burden. Thus, it is important to determine the various factors that may influence caregiver burden, so that healthcare professionals may implement strategies to reduce caregiver burden. In this review, "caregiver burden" was expanded to include "caregiver stress" and "caregiver strain", as the two terms were related to caregiver burden. The objective of this systematic review was to identify the factors that may influence caregiver burden of a terminally ill adult in the home setting. Types of participants: This review considered adult participants (above age 18) who were the main caregivers of a terminally ill adult in the home setting, and providing care for the terminally ill person at the point of participation in the study.Types of intervention: There was no specific intervention of interest for the study.Types of outcomes: The focus of study was the factors that affected caregiver burden of the terminally ill person.Types of studies: Quantitative studies such as randomised controlled trials (RCTs), controlled clinical trials (CCTs), interrupted time series (ITSs), controlled before after designs (CBAs), observational design (cohort, case-control), and descriptive surveys were included in the study. This review was limited to papers in English and Mandarin. A literature search from the inception of the database to October 2010 was conducted using major electronic databases. The databases used were CINAHL, MEDLINE, PsycINFO (Ovid), Scopus, SpringerLink, ScienceDirect, Web of Science, Mosby's Nursing Consult, Mednar: Deep web medical search, Proquest Dissertations and Theses and China Journal Net.Methodological quality: The quality of the potential studies was assessed by two independent reviewers using the critical appraisal checklists for descriptive/case studies

Binding motif of terminal alkynes on gold clusters.

Science.gov (United States)

Maity, Prasenjit; Takano, Shinjiro; Yamazoe, Seiji; Wakabayashi, Tomonari; Tsukuda, Tatsuya

2013-06-26

Gold clusters protected by terminal alkynes (1-octyne (OC-H), phenylacetylene (PA-H) and 9-ethynyl-phenanthrene (EPT-H)) were prepared by the ligand exchange of small (diameter alkynes on Au clusters was investigated using various spectroscopic methods. FTIR and Raman spectroscopy revealed that terminal hydrogen is lost during the ligand exchange and that the C≡C bond of the alkynyl group is weakened upon attachment to the Au clusters. Acidification of the water phase after the ligand exchange indicated that the ligation of alkynyl groups to the Au clusters proceeds via deprotonation of the alkynes. A series of precisely defined Au clusters, Au34(PA)16, Au54(PA)26, Au30(EPT)13, Au35(EPT)18, and Au(41-43)(EPT)(21-23), were synthesized and characterized in detail to obtain further insight into the interfacial structures. Careful mass analysis confirmed the ligation of the alkynes in the dehydrogenated form. An upright configuration of the alkynes on Au clusters was suggested from the Au to alkyne ratios and photoluminescence from the excimer of the EPT ligands. EXAFS analysis implied that the alkynyl carbon is bound to bridged or hollow sites on the cluster surface.

The practice of terminal discharge.

Science.gov (United States)

Radha Krishna, Lalit Kumar; Murugam, Vengadasalam; Quah, Daniel Song Chiek

2017-01-01

'Terminal discharges' are carried out in Singapore for patients who wish to die at home. However, if due diligence is not exercised, parallels may be drawn with euthanasia. We present a theoretical discussion beginning with the definition of terminal discharges and the reasons why they are carried out in Singapore. By considering the intention behind terminal discharges and utilising a multidisciplinary team to deliberate on the clinical, social and ethical intricacies with a patient- and context-specific approach, euthanasia is avoided. It is hoped that this will provide a platform for professionals in palliative medicine to negotiate challenging issues when arranging a terminal discharge, so as to avoid the pitfall of committing euthanasia in a country such as Singapore where euthanasia is illegal. It is hoped that a set of guidelines for terminal discharges may someday be realised to assist professionals in Singapore and around the world.

[Terminal sedation: consultation with a second physician as is the case in euthanasia and assisted suicide].

Science.gov (United States)

Ponsioen, B P; Schuurman, W H A Elink; van den Hurk, A J P M; van der Poel, B N M; Runia, E H

2005-02-26

In terminally-ill patients in the Netherlands deep sedation by means of a continuous subcutaneous infusion with midazolam occurs more frequently than euthanasia and assisted suicide. Deep terminal sedation is applied to relieve symptoms during the phase of dying, but in contrast to euthanasia and assisted suicide, does not hasten death. In three terminally-ill patients, a 65-year-old man suffering from pulmonary carcinoma, a 94-year-old woman with general malaise, nausea and anorexia, and a 79-year-old woman in the final stage of ovarian carcinoma, a general-practitioner advisor was consulted about an end-of-life decision--deep terminal sedation versus euthanasia or assisted suicide. The first two patients were given deep sedation until death, in both cases a day and a half later. The third patient's request for euthanasia was considered to meet the legal criteria for euthanasia. Compliance with the Dutch statutory criteria for due care in euthanasia and assisted suicide might also be helpful when deciding about terminal deep sedation, but the role and responsibility of the attending physician may differ. However, the radical effects of sedation on the terminally-ill patient and the rapid changes in the clinical situation of the patient when the decision to sedate is taken, both emphasize the need for consultation with another physician.

Termination of cycle rewriting

NARCIS (Netherlands)

Zantema, H.; König, B.; Bruggink, H.J.S.; Dowek, G.

2014-01-01

String rewriting can not only be applied on strings, but also on cycles and even on general graphs. In this paper we investigate termination of string rewriting applied on cycles, shortly denoted as cycle rewriting, which is a strictly stronger requirement than termination on strings. Most

78 FR 5717 - Safety Zone; Military Ocean Terminal Concord Safety Zone, Suisun Bay, Military Ocean Terminal...

Science.gov (United States)

2013-01-28

...-AA00 Safety Zone; Military Ocean Terminal Concord Safety Zone, Suisun Bay, Military Ocean Terminal... Guard is establishing a safety zone in the navigable waters of Suisun Bay near Military Ocean Terminal Concord, CA in support of military onload and offload operations. This safety zone is established to...

[Providing regular relief; considerations for palliative care in the Netherlands

NARCIS (Netherlands)

Crul, B.J.P.; Weel, C. van

2001-01-01

Over the last few decades the attention devoted to the palliative aspects of medicine, particularly those in hospital care, has declined due to the emphasis on medical technology. In Anglo-Saxon countries a review of this development resulted in structured palliative care that benefited terminally

46 CFR 525.2 - Terminal schedules.

Science.gov (United States)

2010-10-01

... domestic law and international conventions and agreements adopted by the United States; such terminal... their own negligence, or that impose upon others the obligation to indemnify or hold-harmless the terminals from liability for their own negligence. (2) Enforcement of terminal schedules. Any schedule that...

Physician self-care | Kirby | South African Medical Journal

African Journals Online (AJOL)

They make significant sacrifices in family life, sleep, personal time and hobbies to be able to pursue this ideal. Moving away from cure to compassionate care of dying patients, is a paradigm shift. This can be particularly difficult when caring for children with terminal illness. It is easier to accept death in the elderly as it is part ...

Concept Layout Model of Transportation Terminals

Directory of Open Access Journals (Sweden)

Li-ya Yao

2012-01-01

Full Text Available Transportation terminal is the key node in transport systems. Efficient terminals can improve operation of passenger transportation networks, adjust the layout of public transportation networks, provide a passenger guidance system, and regulate the development of commercial forms, as well as optimize the assembly and distribution of modern logistic modes, among others. This study aims to clarify the relationship between the function and the structure of transportation terminals and establish the function layout design. The mapping mechanism of demand, function, and structure was analyzed, and a quantitative relationship between function and structure was obtained from a design perspective. Passenger demand and terminal structure were decomposed into several demand units and structural elements following the principle of reverse engineering. The relationship maps between these two kinds of elements were then analyzed. Function-oriented concept layout model of transportation terminals was established using the previous method. Thus, a technique in planning and design of transportation structures was proposed. Meaningful results were obtained from the optimization of transportation terminal facilities, which guide the design of the functional layout of transportation terminals and improve the development of urban passenger transportation systems.

Diagnosis of Fetal Anomaly and the Increased Maternal Psychological Toll Associated with Pregnancy Termination.

Science.gov (United States)

Coleman, Priscilla K

2015-01-01

Approximately 4% of U.S. abortions occur in desired pregnancies, with many resulting from fetal anomalies. The majority of terminations occur in the second trimester; however in recent years first-trimester ultrasound measurement for nuchal translucency, calculation of risk based on maternal age, and biochemistry at 11-14 weeks gestation, have resulted in earlier prenatal diagnoses for chromosomal abnormalities. First trimester ultrasound can also now lead to diagnoses of major structural abnormalities including anecephaly, ventral wall defects, and limb abnormalities. The American College of Medical Genetics released recommendations underscoring the crucial importance of ethical counseling and substantive communication with parents facing a prenatal diagnosis of fetal anomaly. Unfortunately, the inability of health care providers to understand and empathize with the ardent desire of some parents to refuse termination is likely to be a large factor in the common practice of professionals attempting to steer expectant parents toward termination. Perinatal hospice is family-centered, comprehensive, and integrative in nature. The care provided by perinatal hospice units is delivered by an interdisciplinary team of obstetricians, pediatricians, nurses, social workers and chaplains in 130 locations throughout the U.S. Support is offered from diagnosis until death and beyond with time for "bonding, loving, and losing." "Hospice care is an interactive, and at times intense, form of care. Rather than simply 'letting nature take its course,' this approach empowers the family to take control of some of the consequences of their unfortunate situation." A primary focus of perinatal hospice is on fear reduction. Parents facing the death of an infant often fear isolation and abandonment in addition to worrying about their child experiencing pain. Parents are assured that they will be cared for and supported throughout this entire chapter of their lives, as their babies are kept

An exploration of pregnant teenagers' views of the future and their decisions to continue or terminate their pregnancy: implications for nursing care.

Science.gov (United States)

Bell, Emily R; Glover, Lesley; Alexander, Tim

2014-09-01

To explore teenagers' views of the future in relation to their choices to continue or terminate pregnancy. Despite recent decreases in the numbers of teenage pregnancies, across the world, the teenage pregnancy rate remains high. Consideration of views of the future (future orientation) appears to play an important part in teenage girls' decisions to continue with pregnancy. To date, no study has explored this in teenage pregnant girls at the time they make their decision to continue with or terminate their pregnancy. Cross-sectional mixed methods design. Three groups were included: termination of pregnancy (n = 19), antenatal (n = 9) and never pregnant (n = 23). Participants were 13-18 years old. The termination of pregnancy and antenatal groups were interviewed, and the never pregnant group completed postal questionnaires. Groups differed in individual aspects of future orientation, that is, education, career and family, and reasons for pregnancy resolution choice. The termination group had more clearly developed and longer-term plans for the future with a focus on career. The never pregnant group shared aspects of their future orientation with both the antenatal and termination of pregnancy groups. The impact of negative discourses about teenage pregnancy from others was identified as a significant issue. How pregnant teenage girls view the future has a relationship with their decision to terminate or continue with their pregnancy. The findings suggest that working with teenage girls to clarify their views of the future may be useful both in preventing future unwanted pregnancy and in supporting teenagers in making pregnancy decisions. Supporting pregnant teenagers in distancing themselves from negative stereotypes of teenage mothers may also be beneficial. © 2013 John Wiley & Sons Ltd.

Psychological process from hospitalization to death among uninformed terminal liver cancer patients in Japan

Directory of Open Access Journals (Sweden)

Kobori Eiko

2006-09-01

Full Text Available Abstract Background Although the attitude among doctors toward disclosing a cancer diagnosis is becoming more positive, informing patients of their disease has not yet become a common practice in Japan. We examined the psychological process, from hospitalization until death, among uninformed terminal cancer patients in Japan, and developed a psychological model. Methods Terminal cancer patients hospitalized during the recruiting period voluntarily participated in in-depth interviews. The data were analyzed by grounded theory. Results Of the 87 uninformed participants at the time of hospitalization, 67% (N = 59 died without being informed of their diagnosis. All were male, 51–66 years of age, and all experienced five psychological stages: anxiety and puzzlement, suspicion and denial, certainty, preparation, and acceptance. At the end of each stage, obvious and severe feelings were observed, which were called "gates." During the final acceptance stage, patients spent a peaceful time with family, even talking about their dreams with family members. Conclusion Unlike in other studies, the uninformed patients in this study accepted death peacefully, with no exceptional cases. Despite several limitations, this study showed that almost 70% of the uninformed terminal cancer patients at hospitalization died without being informed, suggesting an urgent need for culturally specific and effective terminal care services for cancer patients in Japan.

Mobile Termination and Mobile Penetration

OpenAIRE

Hurkens, Sjaak; Jeon, Doh-Shin

2009-01-01

In this paper, we study how access pricing affects network competition when subscription demand is elastic and each network uses non-linear prices and can apply termination-based price discrimination. In the case of a fixed per minute termination charge, we find that a reduction of the termination charge below cost has two oppos- ing effects: it softens competition but helps to internalize network externalities. The former reduces mobile penetration while the latter boosts it. We find that fi...

Mobile termination and mobile penetration

OpenAIRE

Hurkens, Sjaak

2009-01-01

In this paper, we study how access pricing affects network competition when subscription demand is elastic and each network uses non-linear prices and can apply termination-based price discrimination. In the case of a fixed per minute termination charge, we find that a reduction of the termination charge below cost has two opposing effects: it softens competition but helps to internalize network externalities. The former reduces mobile penetration while the latter boosts it. We find that firm...

49 CFR 374.309 - Terminal facilities.

Science.gov (United States)

2010-10-01

... 49 Transportation 5 2010-10-01 2010-10-01 false Terminal facilities. 374.309 Section 374.309... REGULATIONS Adequacy of Intercity Motor Common Carrier Passenger Service § 374.309 Terminal facilities. (a... attendants and be regularly patrolled. (b) Outside facilities. At terminals and stations that are closed when...

Prematurely terminated slug tests

International Nuclear Information System (INIS)

Karasaki, K.

1990-07-01

A solution of the well response to a prematurely terminated slug test (PTST) is presented. The advantages of a PTST over conventional slug tests are discussed. A systematized procedure of a PTST is proposed, where a slug test is terminated in the midpoint of the flow point, and the subsequent shut-in data is recorded and analyzed. This method requires a downhole shut-in device and a pressure transducer, which is no more than the conventional deep-well slug testing. As opposed to slug tests, which are ineffective when a skin is present, more accurate estimate of formation permeability can be made using a PTST. Premature termination also shortens the test duration considerably. Because in most cases no more information is gained by completing a slug test to the end, the author recommends that conventional slug tests be replaced by the premature termination technique. This study is part of an investigation of the feasibility of geologic isolation of nuclear wastes being carried out by the US Department of Energy and the National Cooperative for the Storage of Radioactive Waste of Switzerland

9 CFR 3.91 - Terminal facilities.

Science.gov (United States)

2010-01-01

... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Terminal facilities. 3.91 Section 3.91... Primates 2 Transportation Standards § 3.91 Terminal facilities. (a) Placement. Any persons subject to the... with inanimate cargo or with other animals in animal holding areas of terminal facilities. Nonhuman...

9 CFR 3.18 - Terminal facilities.

Science.gov (United States)

2010-01-01

... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Terminal facilities. 3.18 Section 3.18... Cats 1 Transportation Standards § 3.18 Terminal facilities. (a) Placement. Any person subject to the... inanimate cargo in animal holding areas of terminal facilities. (b) Cleaning, sanitization, and pest control...

Emergency Department Visits at the End of Life of Patients With Terminal Cancer: Pattern, Causes, and Avoidability.

Science.gov (United States)

Alsirafy, Samy A; Raheem, Ahmad A; Al-Zahrani, Abdullah S; Mohammed, Amrallah A; Sherisher, Mohamed A; El-Kashif, Amr T; Ghanem, Hafez M

2016-08-01

Frequent emergency department visits (EDVs) by patients with terminal cancer indicates aggressive care. The pattern and causes of EDVs in 154 patients with terminal cancer were investigated. The EDVs that started during working hours and ended by home discharge were considered avoidable. During the last 3 months of life, 77% of patients had at least 1 EDV. In total, 309 EDVs were analyzed. The EDVs occurred out of hour in 67%, extended for an average of 3.6 hours, and ended by hospitalization in 52%. The most common chief complaints were pain (46%), dyspnea (13%), and vomiting (12%). The EDVs were considered avoidable in 19% of the visits. The majority of patients with terminal cancer visit the ED before death, mainly because of uncontrolled symptoms. A significant proportion of EDVs at the end of life is potentially avoidable. © The Author(s) 2015.

End-of-life care: Indian perspective

Science.gov (United States)

Sharma, Himanshu; Jagdish, Vankar; Anusha, Prabhakaran; Bharti, Sharma

2013-01-01

According to Hinduism, the main religion of India, the end-of-life (EOL) deals with good and bad death. The WHO definition of palliative care stresses on improving not only the quality of life of patients facing incurable diseases but also their families by providing relief from the pain and suffering that includes the psychosocial and spiritual needs as well. The Indian Society of Palliative Care has been doing a commendable work and appreciable efforts are being done by the Kerala model of delivering the EOL care. The spiritual, ethical issues and ethical challenges raised when the patients are in terminal phase are also reviewed keeping in mind the socio-cultural norms. The Indian Penal Code (IPC) has lacunae, which hamper the physicians from taking proper decision in the EOL care. Some of the sections like IPC 309 are defunct and need to be changed. The Indian Society for Critical Care Medicine has developed a position statement on the patient management of the terminally ill patient in the Intensive Care Unit (ICU) which states that the society should move from the paternalistic model to the share based decision model of the West when deciding the fate of such patients. The literature review on the Indian research on palliative care shows very little emphatic results and the medical under graduates show illiteracy. To strengthen it Medical Council of India has included the palliative care in its curriculum by starting a PG course. Literature review revealed that more research from Indian perspective should be done in this area. This article studies the core issues of developing palliative care in Indian setting keeping in mind the ethical, spiritual and legal issues. PMID:23858271

7 CFR 1469.25 - Contract violations and termination.

Science.gov (United States)

2010-01-01

... termination without delay. (c) If NRCS terminates a contract due to breach of contract, the participant will... terminates a contract due to breach of contract, or the participant voluntarily terminates the contract... 7 Agriculture 10 2010-01-01 2010-01-01 false Contract violations and termination. 1469.25 Section...

Compact Termination for Structural Soft-goods

Science.gov (United States)

Wilkes, Robert, Jr.

2013-01-01

Glass fiber is unique in its ability to withstand atomic oxygen and ultraviolet radiation in-space environments. However, glass fiber is also difficult to terminate by traditional methods without decreasing its strength significantly. Glass fiber products are especially sensitive to bend radius, and do not work very well with traditional 'sewn loop on pin' type connections. As with most composites, getting applied loads from a metallic structure into the webbing without stress concentrations is the key to a successful design. A potted end termination has been shown in some preliminary work to out-perform traditional termination methods. It was proposed to conduct a series of tensile tests on structural webbing or cord to determine the optimum potting geometry, and to then be able to estimate a weight and volume savings over traditional sewn-overa- pin connections. During the course of the investigation into potted end terminations for glass fiber webbing, a new and innovative connection was developed that has lower weight, reduced fabrication time, and superior thermal tolerance over the metallic end terminations that were to be optimized in the original proposal. This end termination essentially transitions the flexible glass fiber webbing into a rigid fiberglass termination, which can be bolted/fastened with traditional methods

9 CFR 3.40 - Terminal facilities.

Science.gov (United States)

2010-01-01

... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Terminal facilities. 3.40 Section 3.40... Pigs and Hamsters Transportation Standards § 3.40 Terminal facilities. No person subject to the Animal... animal holding areas of a terminal facility where shipments of live guinea pigs or hamsters are...

9 CFR 3.65 - Terminal facilities.

Science.gov (United States)

2010-01-01

... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Terminal facilities. 3.65 Section 3.65... Transportation Standards § 3.65 Terminal facilities. No person subject to the Animal Welfare regulations shall commingle shipments of live rabbits with inanimate cargo. All animal holding areas of a terminal facility...

Hamilton Park Care Facility, Balrothery, Balbriggan, Co. Dublin.

LENUS (Irish Health Repository)

Galvin, Miriam

2018-01-27

Amyotrophic lateral sclerosis (ALS), also known as motor neuron disease (MND), is a debilitating terminal condition. Informal caregivers are key figures in ALS care provision. The physical, psychological and emotional impact of providing care in the home requires appropriate assistance and support. The objective of this analysis is to explore the needs of informal ALS caregivers across the caregiving course.

Battery system including batteries that have a plurality of positive terminals and a plurality of negative terminals

Science.gov (United States)

Dougherty, Thomas J; Symanski, James S; Kuempers, Joerg A; Miles, Ronald C; Hansen, Scott A; Smith, Nels R; Taghikhani, Majid; Mrotek, Edward N; Andrew, Michael G

2014-01-21

A lithium battery for use in a vehicle includes a container, a plurality of positive terminals extending from a first end of the lithium battery, and a plurality of negative terminals extending from a second end of the lithium battery. The plurality of positive terminals are provided in a first configuration and the plurality of negative terminals are provided in a second configuration, the first configuration differing from the second configuration. A battery system for use in a vehicle may include a plurality of electrically connected lithium cells or batteries.

Termination of plastic-clad fiber

International Nuclear Information System (INIS)

Nance, W.R.

1982-03-01

Optical waveguides are ideal in a nuclear weapon environment because of their resistance to electromagnetic interference. Of the fibers on today's market, plastic-clad silica (PCS) is the most radiation resistant and therfore the best choice. Because terminating PCS is complex, this paper attemps to address the major problems associated with these terminations including selecting the proper connector and optimizing the terminating procedures. The sources of losses in the connectors are summarized and typical loss values are given for four connectors which were tested

Effect of Ge surface termination on oxidation behavior

Science.gov (United States)

Lee, Younghwan; Park, Kibyung; Cho, Yong Soo; Lim, Sangwoo

2008-09-01

Sulfur-termination was formed on the Ge(1 0 0) surface using (NH 4) 2S solution. Formation of Ge-S and the oxidation of the S-terminated Ge surface were monitored with multiple internal reflection Fourier transform infrared spectroscopy and X-ray photoelectron spectroscopy. In the 0.5, 5, or 20% (NH 4) 2S solution, H-termination on the Ge(1 0 0) surface was substituted with S-termination in 1 min. When the S-terminated Ge(1 0 0) surface was exposed in air ambient, the oxidation was retarded for about 3600 min. The preservation time of the oxide layer up to one monolayer of S-terminated Ge(1 0 0) surface was about 120 times longer than for the H-terminated Ge(1 0 0) surface. However, the oxidation of S-terminated Ge(1 0 0) surface drastically increased after the threshold time. There was no significant difference in threshold time between S-terminations formed in 0.5, 5, and 20% (NH 4) 2S solutions. With the surface oxidation, desorption of S on the Ge surface was observed. The desorption behavior of sulfur on the S-terminated Ge(1 0 0) surface was independent of the concentration of the (NH 4) 2S solution that forms S-termination. Non-ideal S-termination on Ge surfaces may be related to drastic oxidation of the Ge surface. Finally, with the desulfurization on the S-terminated Ge(1 0 0) surface, oxide growth is accelerated.

Caring for terminal AIDS patients: The experiences of caregivers in ...

African Journals Online (AJOL)

13 unstructured interviews, which were audio-taped, were conducted with caregivers working full-time in a formal institution caring for patients who are dying from AIDS. The transcribed interviews were analysed using Tesch's method of descriptive analysis (in Creswell 1994:115). One central theme emerged, namely that in ...

Mechanisms of DNA replication termination.

Science.gov (United States)

Dewar, James M; Walter, Johannes C

2017-08-01

Genome duplication is carried out by pairs of replication forks that assemble at origins of replication and then move in opposite directions. DNA replication ends when converging replication forks meet. During this process, which is known as replication termination, DNA synthesis is completed, the replication machinery is disassembled and daughter molecules are resolved. In this Review, we outline the steps that are likely to be common to replication termination in most organisms, namely, fork convergence, synthesis completion, replisome disassembly and decatenation. We briefly review the mechanism of termination in the bacterium Escherichia coli and in simian virus 40 (SV40) and also focus on recent advances in eukaryotic replication termination. In particular, we discuss the recently discovered E3 ubiquitin ligases that control replisome disassembly in yeast and higher eukaryotes, and how their activity is regulated to avoid genome instability.

Minimum airflow reset of single-duct VAV terminal boxes

Science.gov (United States)

Cho, Young-Hum

Single duct Variable Air Volume (VAV) systems are currently the most widely used type of HVAC system in the United States. When installing such a system, it is critical to determine the minimum airflow set point of the terminal box, as an optimally selected set point will improve the level of thermal comfort and indoor air quality (IAQ) while at the same time lower overall energy costs. In principle, this minimum rate should be calculated according to the minimum ventilation requirement based on ASHRAE standard 62.1 and maximum heating load of the zone. Several factors must be carefully considered when calculating this minimum rate. Terminal boxes with conventional control sequences may result in occupant discomfort and energy waste. If the minimum rate of airflow is set too high, the AHUs will consume excess fan power, and the terminal boxes may cause significant simultaneous room heating and cooling. At the same time, a rate that is too low will result in poor air circulation and indoor air quality in the air-conditioned space. Currently, many scholars are investigating how to change the algorithm of the advanced VAV terminal box controller without retrofitting. Some of these controllers have been found to effectively improve thermal comfort, indoor air quality, and energy efficiency. However, minimum airflow set points have not yet been identified, nor has controller performance been verified in confirmed studies. In this study, control algorithms were developed that automatically identify and reset terminal box minimum airflow set points, thereby improving indoor air quality and thermal comfort levels, and reducing the overall rate of energy consumption. A theoretical analysis of the optimal minimum airflow and discharge air temperature was performed to identify the potential energy benefits of resetting the terminal box minimum airflow set points. Applicable control algorithms for calculating the ideal values for the minimum airflow reset were developed and

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.

What is a "good enough" termination?

Science.gov (United States)

Gabbard, Glen O

2009-06-01

In Freud's technique papers, he failed to develop a systematic approach to termination. Much of the existing literature is based on psychoanalytic mythologies about the way patients are expected to end analysis. The models described in the literature are often starkly at odds with what one sees in clinical practice. A wish for idealized versions of termination underlies much of what has been written, and we need to shift to a conceptual model involving "good enough" termination. A number of different endings to psychoanalysis may, in the long run, lead to productive outcomes; these models are examined, as are various approaches to the dilemmas presented at the time of termination.

Trauma and termination.

Science.gov (United States)

Ferraro, F

1995-02-01

The author suggests a particular reading of the thesis put forward by Freud in 'Analysis terminable and interminable' that an effective and more definitive conclusion may be expected in analyses of cases with traumatic aetiology. This reading shifts the emphasis from the patient's history to the possibility of its crystallising in focal nuclei emerging within the analytic relationship under the pressure of the termination. The revival of separation anxieties which cannot be worked through, and their crystallisation in precipitating traumatic events, may give rise to decisive psychic work allowing the analysis to be brought to a conclusion. Two case histories are presented to show how the end of the analysis assumes the form of a new trauma, which reactivates in the present, traumatic anxieties from the patient's own infantile history. In the first case a premature birth and in the second a miscarriage, originally experienced as isolated automatic events without time or history, are relived in the terminal phase as vicissitudes of the transference, so that new meaning can be assigned to them and they can be withdrawn from the somatic cycle of repetition. The powerful tendency to act out and the intense countertransference pressure on the analyst are discussed in the light of the specificities of this phase, which is crucial to the success of the analysis. This leads to a re-examination, in the concluding notes, of some theoretical questions inherent in the problem of the termination and, in particular, to a discussion of the ambiguous concept of a natural ending.

N-Terminal Domains in Two-Domain Proteins Are Biased to Be Shorter and Predicted to Fold Faster Than Their C-Terminal Counterparts

Directory of Open Access Journals (Sweden)

Etai Jacob

2013-04-01

Full Text Available Computational analysis of proteomes in all kingdoms of life reveals a strong tendency for N-terminal domains in two-domain proteins to have shorter sequences than their neighboring C-terminal domains. Given that folding rates are affected by chain length, we asked whether the tendency for N-terminal domains to be shorter than their neighboring C-terminal domains reflects selection for faster-folding N-terminal domains. Calculations of absolute contact order, another predictor of folding rate, provide additional evidence that N-terminal domains tend to fold faster than their neighboring C-terminal domains. A possible explanation for this bias, which is more pronounced in prokaryotes than in eukaryotes, is that faster folding of N-terminal domains reduces the risk for protein aggregation during folding by preventing formation of nonnative interdomain interactions. This explanation is supported by our finding that two-domain proteins with a shorter N-terminal domain are much more abundant than those with a shorter C-terminal domain.

Efficiency analysis of container ports and terminals

OpenAIRE

Liu, Q.

2010-01-01

In the past two decades the steady growth of seaborne trade has resulted in the increase of container ships, container ports and their terminals. The structure of the shipping market is, moreover, continuously evolving. On the carrier side, shipping companies form consortia and alliances; on the port side, global terminal operators and dedicated container terminals are emerging. The aim of this research is to evaluate the efficiency of container ports and terminals and to study...

Strategic technology alliance termination : an empirical investigation

NARCIS (Netherlands)

Sadowski, B.M.; Duysters, G.M.

2008-01-01

There is growing consensus that overall alliance termination rates are high. However, despite this track record of termination and despite unsurpassed growth rates of strategic technology alliances, little is known about the reasons for their termination. Typically strategic alliances have been

Terminal addition in a cellular world.

Science.gov (United States)

Torday, J S; Miller, William B

2018-07-01

Recent advances in our understanding of evolutionary development permit a reframed appraisal of Terminal Addition as a continuous historical process of cellular-environmental complementarity. Within this frame of reference, evolutionary terminal additions can be identified as environmental induction of episodic adjustments to cell-cell signaling patterns that yield the cellular-molecular pathways that lead to differing developmental forms. Phenotypes derive, thereby, through cellular mutualistic/competitive niche constructions in reciprocating responsiveness to environmental stresses and epigenetic impacts. In such terms, Terminal Addition flows according to a logic of cellular needs confronting environmental challenges over space-time. A reconciliation of evolutionary development and Terminal Addition can be achieved through a combined focus on cell-cell signaling, molecular phylogenies and a broader understanding of epigenetic phenomena among eukaryotic organisms. When understood in this manner, Terminal Addition has an important role in evolutionary development, and chronic disease might be considered as a form of 'reverse evolution' of the self-same processes. Copyright © 2017. Published by Elsevier Ltd.

Position Statement: Palliative Care for Children.

Science.gov (United States)

Death Studies, 1993

1993-01-01

Notes that International Work Group on Death, Dying, and Bereavement recognizes wide variation of attitudes, beliefs, and behaviors pertaining to childhood death, dying, and bereavement. Statement identifies set of assumptions which can serve as guidelines, across cultures, in care of children with terminal illness and their families. (Author/NB)

Concept Layout Model of Transportation Terminals

OpenAIRE

Yao, Li-ya; Sun, Li-shan; Wang, Wu-hong; Xiong, Hui

2012-01-01

Transportation terminal is the key node in transport systems. Efficient terminals can improve operation of passenger transportation networks, adjust the layout of public transportation networks, provide a passenger guidance system, and regulate the development of commercial forms, as well as optimize the assembly and distribution of modern logistic modes, among others. This study aims to clarify the relationship between the function and the structure of transportation terminals and establish ...

Pro–A-Type Natriuretic Peptide, Proadrenomedullin, and N-Terminal Pro–B-Type Natriuretic Peptide Used in a Multimarker Strategy in Primary Health Care in Risk Assessment of Patients With Symptoms of Heart Failure

DEFF Research Database (Denmark)

Alehagen, Urban; Dahlström, Ulf; Rehfeld, Jens F

2013-01-01

Use of new biomarkers in the handling of heart failure patients has been advocated in the literature, but most often in hospital-based populations. Therefore, we wanted to evaluate whether plasma measurement of N-terminal pro-B-type natriuretic peptide (NT-proBNP), midregional pro-A-type...... natriuretic peptide (MR-proANP), and midregional proadrenomedullin (MR-proADM), individually or combined, gives prognostic information regarding cardiovascular and all-cause mortality that could motivate use in elderly patients presenting with symptoms suggestive of heart failure in primary health care....

14 CFR 272.12 - Termination.

Science.gov (United States)

2010-01-01

... Aeronautics and Space OFFICE OF THE SECRETARY, DEPARTMENT OF TRANSPORTATION (AVIATION PROCEEDINGS) ECONOMIC REGULATIONS ESSENTIAL AIR SERVICE TO THE FREELY ASSOCIATED STATES § 272.12 Termination. These provisions shall terminate on October 1, 1998, unless the program of essential air service to the Federated States of...

Industrial sterilization of medical supplies. Turkey. Terminal report. Project findings and recommendations. Report prepared for the Government of Turkey

International Nuclear Information System (INIS)

1995-08-01

The document contains the terminal report on the implementation of the project IAEA/UNDP-TUR/88/040 'Industrial Sterilization of Medical Supplies' (1988-1995). The objective of the project was to set up a Radiation Sterilization Centre in Ankara for health care products indigenously manufactured

Abandonment of terminally ill patients in the Byzantine era. An ancient tradition?

Science.gov (United States)

Lascaratos, J; Poulakou-Rebelakou, E; Marketos, S

1999-06-01

Our research on the texts of the Byzantine historians and chroniclers revealed an apparently curious phenomenon, namely, the abandonment of terminally ill emperors by their physicians when the latter realised that they could not offer any further treatment. This attitude tallies with the mentality of the ancient Greek physicians, who even in Hippocratic times thought the treatment and care of the terminally ill to be a challenge to nature and hubris to the gods. Nevertheless, it is a very curious attitude in the light of the concepts of the Christian Byzantine physicians who, according to the doctrines of the Christian religion, should have been imbued with the spirit of philanthropy and love for their fellowmen. The meticulous analysis of three examples of abandonment of Byzantine emperors, and especially that of Alexius I Comnenus, by their physicians reveals that this custom, following ancient pagan ethics, in those times took on a ritualised form without any significant or real content.

End-of-life decisions in perinatal care. A view from health-care providers

Directory of Open Access Journals (Sweden)

Patricia Grether

2015-11-01

Full Text Available Objective. To examine the opinions of a perinatal health team regarding decisions related to late termination of pregnancy and severely ill newborns. Materials and Methods. An anonymous questionnaire was administered to physicians, social workers, and nurses in perinatal care. Differences were evaluated using the chi square and Student’s t tests. Results. When considering severely ill fetuses and newborns, 82% and 93% of participants, respectively, opted for providing palliative care, whereas 18% considered feticide as an alter- native. Those who opted for palliative care aimed to diminish suffering and those who opted for intensive care intended to protect life or sanctity of life. There was poor knowledge about the laws that regulate these decisions. Conclusions. Although there is no consensus on what decisions should be taken with severely ill fetuses or neonates, most participants considered palliative care as the first option, but feticide or induced neonatal death was not ruled out.

Terminal structure

Science.gov (United States)

Schmidt, Frank [Langenhagen, DE; Allais, Arnaud [Hannover, DE; Mirebeau, Pierre [Villebon sur Yvette, FR; Ganhungu, Francois [Vieux-Reng, FR; Lallouet, Nicolas [Saint Martin Boulogne, FR

2009-10-20

A terminal structure (2) for a superconducting cable (1) is described. It consists of a conductor (2a) and an insulator (2b) that surrounds the conductor (2a), wherein the superconducting cable (1) has a core with a superconducting conductor (5) and a layer of insulation that surrounds the conductor (5), and wherein the core is arranged in such a way that it can move longitudinally in a cryostat. The conductor (2a) of the terminal structure (2) is electrically connected with the superconducting conductor (5) or with a normal conductor (6) that is connected with the superconducting conductor (5) by means of a tubular part (7) made of an electrically conductive material, wherein the superconducting conductor (5) or the normal conductor (6) can slide in the part (7) in the direction of the superconductor.

Terminally ill cancer patients' wish to hasten death.

Science.gov (United States)

Kelly, B; Burnett, P; Pelusi, D; Badger, S; Varghese, F; Robertson, M

2002-07-01

This exploratory study investigated factors associated with the wish to hasten death among a sample of terminally ill cancer patients. Semi-structured interviews conducted on a total of 72 hospice and home palliative care patients were subjected to qualitative analysis using QSR-NUDIST. The main themes to emerge suggested that patients with a high wish to hasten death had greater concerns with physical symptoms and psychological suffering, perceived themselves to be more of a burden to others, and experienced higher levels of demoralization, while also reporting less confidence in symptom control, fewer social supports, less satisfaction with life experiences and fewer religious beliefs when compared with patients who had a moderate or no wish to hasten death. The implications of these findings will be discussed.

43 CFR 29.13 - Termination.

Science.gov (United States)

2010-10-01

... Termination. Upon termination of operations of the Pipeline, the full disposition of all claims, and the... shall request that Congress provide for final disposition of the Fund. If Congress at any time establishes a comprehensive oil pollution liability fund which supersedes or repeals the Fund, the Fund assets...

7 CFR 983.89 - Termination.

Science.gov (United States)

2010-01-01

..., ARIZONA, AND NEW MEXICO Miscellaneous Provisions § 983.89 Termination. (a) The Secretary may at any time..., That such majority has, during such representative period, produced for market more than fifty percent of the volume of such pistachios produced for market, but such termination shall be announced at...

[Nurses' perception, experience and knowledge of palliative care in intensive care units].

Science.gov (United States)

Piedrafita-Susín, A B; Yoldi-Arzoz, E; Sánchez-Fernández, M; Zuazua-Ros, E; Vázquez-Calatayud, M

2015-01-01

Adequate provision of palliative care by nursing in intensive care units is essential to facilitate a "good death" to critically ill patients. To determine the perceptions, experiences and knowledge of intensive care nurses in caring for terminal patients. A literature review was conducted on the bases of Pubmed, Cinahl and PsicINFO data using as search terms: cuidados paliativos, UCI, percepciones, experiencias, conocimientos y enfermería and their alternatives in English (palliative care, ICU, perceptions, experiences, knowledge and nursing), and combined with AND and OR Boolean. Also, 3 journals in intensive care were reviewed. Twenty seven articles for review were selected, most of them qualitative studies (n=16). After analysis of the literature it has been identified that even though nurses perceive the need to respect the dignity of the patient, to provide care aimed to comfort and to encourage the inclusion of the family in patient care, there is a lack of knowledge of the end of life care in intensive care units' nurses. This review reveals that to achieve quality care at the end of life, is necessary to encourage the training of nurses in palliative care and foster their emotional support, to conduct an effective multidisciplinary work and the inclusion of nurses in decision making. Copyright © 2014 Elsevier España, S.L.U. y SEEIUC. All rights reserved.

49 CFR 450.15 - Termination of delegation.

Science.gov (United States)

2010-10-01

... 49 Transportation 6 2010-10-01 2010-10-01 false Termination of delegation. 450.15 Section 450.15... SECURITY SAFETY APPROVAL OF CARGO CONTAINERS GENERAL Procedure for Delegation to Approval Authorities § 450.15 Termination of delegation. (a) An Approval Authority may voluntarily terminate its delegation by...

Scandium Terminal Imido Chemistry.

Science.gov (United States)

Lu, Erli; Chu, Jiaxiang; Chen, Yaofeng

2018-02-20

Research into transition metal complexes bearing multiply bonded main-group ligands has developed into a thriving and fruitful field over the past half century. These complexes, featuring terminal M═E/M≡E (M = transition metal; E = main-group element) multiple bonds, exhibit unique structural properties as well as rich reactivity, which render them attractive targets for inorganic/organometallic chemists as well as indispensable tools for organic/catalytic chemists. This fact has been highlighted by their widespread applications in organic synthesis, for example, as olefin metathesis catalysts. In the ongoing renaissance of transition metal-ligand multiple-bonding chemistry, there have been reports of M═E/M≡E interactions for the majority of the metallic elements of the periodic table, even some actinide metals. In stark contrast, the largest subgroup of the periodic table, rare-earth metals (Ln = Sc, Y, and lanthanides), have been excluded from this upsurge. Indeed, the synthesis of terminal Ln═E/Ln≡E multiple-bonding species lagged behind that of the transition metal and actinide congeners for decades. Although these species had been pursued since the discovery of a rare-earth metal bridging imide in 1991, such a terminal (nonpincer/bridging hapticities) Ln═E/Ln≡E bond species was not obtained until 2010. The scarcity is mainly attributed to the energy mismatch between the frontier orbitals of the metal and the ligand atoms. This renders the putative terminal Ln═E/Ln≡E bonds extremely reactive, thus resulting in the formation of aggregates and/or reaction with the ligand/environment, quenching the multiple-bond character. In 2010, the stalemate was broken by the isolation and structural characterization of the first rare-earth metal terminal imide-a scandium terminal imide-by our group. The double-bond character of the Sc═N bond was unequivocally confirmed by single-crystal X-ray diffraction. Theoretical investigations revealed the presence

Terminating America's wars : the Gulf War and Kosovo

OpenAIRE

Musser, William G.

2002-01-01

Approved for public release; distribution is unlimited This thesis asks two questions: 1) What factors have contributed to the termination of recent United States wars? and 2) How can elements of national power be applied successfully to terminate the future wars of the United States? To answer these questions, this thesis offers a model of war termination and applies it to cases of war termination, in the Gulf War and in Kosovo. These case studies indicate that termination of future wars ...

10 CFR 600.244 - Termination for convenience.

Science.gov (United States)

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Termination for convenience. 600.244 Section 600.244 Energy DEPARTMENT OF ENERGY (CONTINUED) ASSISTANCE REGULATIONS FINANCIAL ASSISTANCE RULES Uniform... Requirements § 600.244 Termination for convenience. Except as provided in § 600.443 awards may be terminated in...

44 CFR 13.44 - Termination for convenience.

Science.gov (United States)

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Termination for convenience. 13.44 Section 13.44 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY... § 13.44 Termination for convenience. Except as provided in § 13.43 awards may be terminated in whole or...

15 CFR 930.115 - Termination of mediation.

Science.gov (United States)

2010-01-01

... 15 Commerce and Foreign Trade 3 2010-01-01 2010-01-01 false Termination of mediation. 930.115... MANAGEMENT FEDERAL CONSISTENCY WITH APPROVED COASTAL MANAGEMENT PROGRAMS Secretarial Mediation § 930.115 Termination of mediation. Mediation shall terminate: (a) At any time the Federal and State agencies agree to a...

23 CFR 635.125 - Termination of contract.

Science.gov (United States)

2010-04-01

... CONSTRUCTION AND MAINTENANCE Contract Procedures § 635.125 Termination of contract. (a) All contracts exceeding... 23 Highways 1 2010-04-01 2010-04-01 false Termination of contract. 635.125 Section 635.125... the termination will be effected and the basis for settlement. In addition, such contracts shall...

SIRKULASI TERMINAL PENUMPANG KAPAL LAUT

Directory of Open Access Journals (Sweden)

Etsa Purnama Sari

2014-01-01

Full Text Available Wilayah Indonesia yang terdiri dari pulau dan perairan menjadikan angkutan laut menjadi salah satu sarana transportasi yang cukup efektif di negara ini. Daya angkut yang besar dan beragam serta biaya yang lebih murah dengan jarak jangkauan yang luas, membuat sarana ini banyak diminati oleh masyarakat sekaligus juga merupakan pendukung utama perkembangan kehidupan sosial budaya dan roda perekonomian. Untuk mendukung proses transportasi laut ini perlu sarana berupa pelabuhan. Pelabuhan dalam melakukan pelayanan terhadap kapal memiliki beberapa fasilitas pokok dan penunjang yang wajib dimiliki. Salah satunya adalah terminal penumpang kapal laut dengan berbagai kegiatan di dalamnya untuk kedatangan maupun keberangkatan. Masalah ketidaknyamanan dalam berkegiatan, jauhnya akses sirkulasi antara satu kegiatan dengan kegiatan kegiatan embarkasi dan debarkasi yang tidak teratur, pembagian jalur sirkulasi penumpang dan pengantar penumpang yang tidak jelas seringkali muncul akibat sirkulasi yang tidak direncanakan dengan baik pada terminal penumpang kapal laut. Bahkan tidak jarang dapat menimbulkan adanya calo tiket hingga adanya penumpang tanpa tiket yang dapat masuk ke dalam kapal hingga kapal berlayar. Perencanaan sebuah sirkulasi yang tepat pada terminal penumpang kapal laut memerlukan kajian terhadap unsur-unsur sirkulasi seperti pencapaian, pola sirkulasi, jalur sirkulasi, serta bentuk ruang sirkulasi. Kajian unsur-unsur ini selanjutnya diselidiki melalui penelusuran masalah dengan analisis deskriptif melalui penggambaran objek penelitian yang terdapat pada Terminal Penumpang Pelabuhan International Yokohama, Terminal Penumpang Pelabuhan Kobe dan Terminal Penumpang Pelabuhan Osanbashi Hall   As one of the largest archipelago country, sea transportation acts as one of the most effective means of transportation in Indonesia. Large and diverse carrying capacity, lower cost with wide range of distances, are factors which making sea

Modifiable factors associated with caregiver burden among family caregivers of terminally ill Korean cancer patients.

Science.gov (United States)

Yoon, Seok-Joon; Kim, Jong-Sung; Jung, Jin-Gyu; Kim, Sung-Soo; Kim, Samyong

2014-05-01

Higher caregiver burden is associated with poor quality of life among family caregivers. However, in Korea, very few studies have examined factors associated with caregiver burden. The present study investigated factors associated with caregiver burden among family caregivers of terminally ill Korean cancer patients, particularly modifiable factors as a potential target of intervention strategies. A cross-sectional study using self-administered questionnaires was performed. Sixty-four family caregivers of terminally ill cancer patients who were admitted to the hospice-palliative care unit of a university hospital in South Korea were included. To identify caregiver burden, the Caregiver Reaction Assessment scale (CRA) was used in this study. Time spent in providing care per day, number of visits per week from other family members, family functioning, and a positive subscale, self-esteem, of the CRA were deemed as modifiable factors. Other sociodemographic, caregiving characteristics of the subjects were non-modifiable factors. Longer time spent providing care per day, fewer weekly visits from other family members, poor family functioning, and low self-esteem were considered as modifiable factors associated with caregiver burden. Low monthly income and the spouse being the family caregiver were non-modifiable factors. Our study has practical significance in that it identifies modifiable factors that can be used to devise intervention strategies. Developing and applying such intervention strategies for alleviating the factors associated with high caregiver burden could be important for improving the quality of life of both patients and their families.

The Practice of Hospital Intranet Terminal Access Control Solution

Institute of Scientific and Technical Information of China (English)

QI Shi-tao; TANG Li-ming

2016-01-01

Along with the increasingly urgent management needs of intranet terminals in hospital, and large scaled deployment of terminal management system, terminal access control has become one of the standard functions of terminal management. This paper mainly aims at some simple research for the system construction of hospital intranet terminal access control.

48 CFR 22.1023 - Termination for default.

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Termination for default... Amended 22.1023 Termination for default. As provided by the Act, any contractor failure to comply with the requirements of the contract clauses related to the Act may be grounds for termination for default (see...

49 CFR 18.44 - Termination for convenience.

Science.gov (United States)

2010-10-01

... 49 Transportation 1 2010-10-01 2010-10-01 false Termination for convenience. 18.44 Section 18.44 Transportation Office of the Secretary of Transportation UNIFORM ADMINISTRATIVE REQUIREMENTS FOR GRANTS AND... Enforcement § 18.44 Termination for convenience. Except as provided in § 18.43 awards may be terminated in...

36 CFR 1207.44 - Termination for convenience.

Science.gov (United States)

2010-07-01

... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false Termination for convenience. 1207.44 Section 1207.44 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS... Termination for convenience. Except as provided in § 1207.43 awards may be terminated in whole or in part only...

45 CFR 1157.44 - Termination for convenience.

Science.gov (United States)

2010-10-01

... 45 Public Welfare 3 2010-10-01 2010-10-01 false Termination for convenience. 1157.44 Section 1157.44 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL FOUNDATION ON THE ARTS... Enforcement § 1157.44 Termination for convenience. Except as provided in § 1157.43 awards may be terminated in...

45 CFR 602.44 - Termination for convenience.

Science.gov (United States)

2010-10-01

... 45 Public Welfare 3 2010-10-01 2010-10-01 false Termination for convenience. 602.44 Section 602.44 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE FOUNDATION UNIFORM... Requirements § 602.44 Termination for convenience. Except as provided in § 602.43 awards may be terminated in...

Parents' Voices Supporting Music Therapy within Pediatric Palliative Care

OpenAIRE

Kathryn Lindenfelser

2005-01-01

It has been my experience that parents are willing and open to express their voices to promote and advocate for music therapy services for their terminally ill children. By listening to parents' voices when providing care for terminally ill children, much can be done to ease the suffering of children and families at the end of life (Widger & Wilkins, 2004). My music therapy masters research at the University of Melbourne with Dr. Katrina McFerran will investigate bereaved parents' experie...

Truth Telling as an Element of Culturally Competent Care at End of Life.

Science.gov (United States)

Rising, Margaret L

2017-01-01

Nondisclosure of terminal prognosis in the context of intercultural interactions can cause moral distress among health care providers guided exclusively by informed consent. However, cultural humility can show that revealing and withholding prognostic information are two equally valid paths to the goal of protecting the patient from harm. Assumptions and history giving rise to the preference for truth telling in the United States(US) are examined. Principles of biomedical ethics are described within the context of US, Chinese, and Latin American cultures. The process of cultural competence in the delivery of health care services is explained and introduces the concept of cultural humility. By focusing more on biases and assumptions brought forth from the dominant culture, health care providers may experience less moral distress and convey increased caring in the context of intercultural interactions and nondisclosure of prognosis of a terminal illness. © The Author(s) 2015.

System program for MICRO-CAMAC terminal system

International Nuclear Information System (INIS)

Sasajima, Yoji; Yamada, Takayuki; Yagi, Hideyuki; Ishiguro, Misako

1979-08-01

A JAERI on-line network system was developed and exists for on-line data processing of nuclear instrumentation. As terminal systems for the network system, the one with a Micro -8 micro-computer is used. By modifying the control program for Micro-8 terminal system, a system program has been developed for a MICRO-CAMAC terminal system, which is controlled by a micro-computer framed within the CAMAC Crate Controller. In this report are described software specifications of the MICRO -CAMAC terminal system and its operation method. (author)

29 CFR 97.44 - Termination for convenience.

Science.gov (United States)

2010-07-01

... 29 Labor 1 2010-07-01 2010-07-01 true Termination for convenience. 97.44 Section 97.44 Labor Office of the Secretary of Labor UNIFORM ADMINISTRATIVE REQUIREMENTS FOR GRANTS AND COOPERATIVE... § 97.44 Termination for convenience. Except as provided in § 97.43 awards may be terminated in whole or...

43 CFR 12.84 - Termination for convenience.

Science.gov (United States)

2010-10-01

... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Termination for convenience. 12.84 Section 12.84 Public Lands: Interior Office of the Secretary of the Interior ADMINISTRATIVE AND AUDIT... Termination for convenience. Except as provided in § 12.83 awards may be terminated in whole or in part only...

7 CFR 3016.44 - Termination for convenience.

Science.gov (United States)

2010-01-01

... 7 Agriculture 15 2010-01-01 2010-01-01 false Termination for convenience. 3016.44 Section 3016.44 Agriculture Regulations of the Department of Agriculture (Continued) OFFICE OF THE CHIEF FINANCIAL OFFICER... Termination for convenience. Except as provided in § 3016.43 awards may be terminated in whole or in part only...

Spatial Evaluation Approach in the Planning Process of Transport Logistic Terminals

Directory of Open Access Journals (Sweden)

Mitja Pavliha

2006-09-01

Full Text Available The "state-of-the-art" of the present global European situationis in desperate need for a new approach to development ofurban and rural environment with an interdisciplinary approach,when introducing the elements of transport infrastructureand transport infrastructure landscape into space and environment.In order to reach a decision regarding the location of a certaintransport logistic terminal some constraints (technical andtechnological as well as financial should be considered. Aspart of the process trying to respond to these constraints, associatedprimarily with the traffic conditions at the appointed networklocations, a careful evaluation in respect to cargo flowsand infrastructure connections as well as spatial planningshould be performed.M01phological indicators, which directly and indirectly affectthe structure and the form of the transport infrastructure elements- transport logistic terminals, are extracted and presentedin the paper. At this point, the paper concludes that thelaying down and the evaluation of transport infrastructure elementsare based on two categories of morphological elements:Constructed morphological elements (all constntctionsand their elements, andNatural morphological elements (topography, climate, vegetation,etc..The presented spatial methodology deals with the interactionsbetween the constructed and natural morphological elements- the quality and the characteristics of the design areadded to both groups.Findings and projections acquired on the basis of a spatialevaluation and transport logistic analysis constitute, togetherwith financial-economic assumptions, the basis for elaboratinga business plan - a significant element in the decision-makingprocess regarding the development of a transport logistic terminal.

Family Caregivers’ Social Representations of Death in a Palliative Care Context

OpenAIRE

Sabrina Lessard; Bernard-Simon Leclerc; Suzanne Mongeau

2016-01-01

The objective of this study was to consider the social representations of death of family caregivers in a palliative care context. The authors focused on the analysis of 23 interviews with family caregivers who cared for a terminally ill person at home and/or in a specialized palliative care unit, in Québec, Canada. The finding showed that family caregivers had different images that specifically represented death: (a) ...

24 CFR 85.44 - Termination for convenience.

Science.gov (United States)

2010-04-01

... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Termination for convenience. 85.44 Section 85.44 Housing and Urban Development Office of the Secretary, Department of Housing and Urban... § 85.44 Termination for convenience. Except as provided in § 85.43 awards may be terminated in whole or...

The cost of home-based terminal care for people with AIDS in South ...

African Journals Online (AJOL)

Even with this level of HBC input, patients still incurred hospital costs of R2 522 and primary care clinic costs of R1 154 per patient per year. HBC costs are increased in rural areas where a vehicle is required for staff transport. HBC shows considerable potential to deal cost-effectively with growing palliative care needs in the ...

Selection of Air Terminal Device

DEFF Research Database (Denmark)

Nielsen, Peter V.

This paper discusses the selection of the air terminal device for the experiments and numerical prediction in the International Energy Agency Annex 20 work: Air Flow Pattern within Buildings,......This paper discusses the selection of the air terminal device for the experiments and numerical prediction in the International Energy Agency Annex 20 work: Air Flow Pattern within Buildings,...

Functionalization of hydroxyl terminated polybutadiene with ...

Indian Academy of Sciences (India)

CBDT), has been covalently attached at the terminal carbon atoms of the hydroxyl terminated polybutadiene (HTPB) backbone. The modification of HTPB backbone by CBDT molecule does not affect the unique physico-chemical properties such ...

Physicians' opinions on palliative care and euthanasia in the Netherlands.

Science.gov (United States)

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

2006-10-01

In recent decades significant developments in end-of-life care have taken place in The Netherlands. There has been more attention for palliative care and alongside the practice of euthanasia has been regulated. The aim of this paper is to describe the opinions of physicians with regard to the relationship between palliative care and euthanasia, and determinants of these opinions. Cross-sectional. Representative samples of physicians (n = 410), relatives of patients who died after euthanasia and physician-assisted suicide (EAS; n = 87), and members of the Euthanasia Review Committees (ERCs; n = 35). Structured interviews with physicians and relatives of patients, and a written questionnaire for the members of the ERCs. Approximately half of the physicians disagreed and one third agreed with statements describing the quality of palliative care in The Netherlands as suboptimal and describing the expertise of physicians with regard to palliative care as insufficient. Almost two thirds of the physicians disagreed with the suggestion that adequate treatment of pain and terminal care make euthanasia redundant. Having a religious belief, being a nursing home physician or a clinical specialist, never having performed euthanasia, and not wanting to perform euthanasia were related to the belief that adequate treatment of pain and terminal care could make euthanasia redundant. The study results indicate that most physicians in The Netherlands are not convinced that palliative care can always alleviate all suffering at the end of life and believe that euthanasia could be appropriate in some cases.

The relationship between dignity status and quality of life in iranian terminally ill patients with cancer

Directory of Open Access Journals (Sweden)

Abbas Hosseini

2017-01-01

Full Text Available Background: Palliative care is an approach that has been used to care for terminally ill patients. The current study was performed to assess the association between the status of patient dignity and quality of life (QOL in Iranian terminally ill patients with cancer. Materials and Methods: This descriptive correlational study was conducted on 210 end-stage cancer patients (102 men and 108 women who were referred to Seyed Al-Shohada Hospital, Isfahan, Iran, in 2015. To assess dignity status, we used the Patient Dignity Inventory. The Persian version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire was used for QOL assessment. Results: There was a significant negative association between total dignity status and QOL scales. In addition, significant negative relationship was observed between dignity-related domains (loss of worth sense: r = −0.50, P< 0.001; anxiety and uncertainty: r = −0.51, P< 0.001; symptom distress: r = −0.62, P< 0.001; and loss of autonomy: r = −0.61, P< 0.001 and functional scale and some subscales of the QOL scale. In contrast, a significant positive relationship was found between dignity-related domains, and total symptom scale and fatigue. No significant relationship was observed between different items of dignity and global health status/QOL scale. Conclusions: High dignity status in terminally ill patients was associated with higher QOL in terms of functional intactness and lower symptom distress. Further studies are necessary to shed light to our findings.

Structure of the afferent terminals in terminal ganglion of a cricket and persistent homology.

Directory of Open Access Journals (Sweden)

Jacob Brown

Full Text Available We use topological data analysis to investigate the three dimensional spatial structure of the locus of afferent neuron terminals in crickets Acheta domesticus. Each afferent neuron innervates a filiform hair positioned on a cercus: a protruding appendage at the rear of the animal. The hairs transduce air motion to the neuron signal that is used by a cricket to respond to the environment. We stratify the hairs (and the corresponding afferent terminals into classes depending on hair length, along with position. Our analysis uncovers significant structure in the relative position of these terminal classes and suggests the functional relevance of this structure. Our method is very robust to the presence of significant experimental and developmental noise. It can be used to analyze a wide range of other point cloud data sets.

Accuracy Analysis of Lunar Lander Terminal Guidance Algorithm

Directory of Open Access Journals (Sweden)

E. K. Li

2017-01-01

Full Text Available This article studies a proposed analytical algorithm of the terminal guidance for the lunar lander. The analytical solution, which forms the basis of the algorithm, was obtained for a constant acceleration trajectory and thrust vector orientation programs that are essentially linear with time. The main feature of the proposed algorithm is a completely analytical solution to provide the lander terminal guidance to the desired spot in 3D space when landing on the atmosphereless body with no numerical procedures. To reach 6 terminal conditions (components of position and velocity vectors at the final time are used 6 guidance law parameters, namely time-to-go, desired value of braking deceleration, initial values of pitch and yaw angles and rates of their change. In accordance with the principle of flexible trajectories, this algorithm assumes the implementation of a regularly updated control program that ensures reaching terminal conditions from the current state that corresponds to the control program update time. The guidance law parameters, which ensure that terminal conditions are reached, are generated as a function of the current phase coordinates of a lander. The article examines an accuracy and reliability of the proposed analytical algorithm that provides the terminal guidance of the lander in 3D space through mathematical modeling of the lander guidance from the circumlunar pre-landing orbit to the desired spot near the lunar surface. A desired terminal position of the lunar lander is specified by the selenographic latitude, longitude and altitude above the lunar surface. The impact of variations in orbital parameters on the terminal guidance accuracy has been studied. By varying the five initial orbit parameters (obliquity, ascending node longitude, argument of periapsis, periapsis height, apoapsis height when the terminal spot is fixed the statistic characteristics of the terminal guidance algorithm error according to the terminal

Operational Optimization in Port Container Terminals

DEFF Research Database (Denmark)

As a result of the significant increase in worldwide containerized transportation the development of efficient handling systems in marine terminals has become very important for port competitiveness. In order to optimize the productivity the total handling time for containers in the terminal must...... be minimized. An overview of the different operational problems in port container terminals is presented and an aggregated model and solution approach is shown. Next, there will be focused on the yard storage problem and a mathematical formulation and solution proposals will be presented....

Performance Evaluation and Modelling of Container Terminals

Science.gov (United States)

Venkatasubbaiah, K.; Rao, K. Narayana; Rao, M. Malleswara; Challa, Suresh

2018-02-01

The present paper evaluates and analyzes the performance of 28 container terminals of south East Asia through data envelopment analysis (DEA), principal component analysis (PCA) and hybrid method of DEA-PCA. DEA technique is utilized to identify efficient decision making unit (DMU)s and to rank DMUs in a peer appraisal mode. PCA is a multivariate statistical method to evaluate the performance of container terminals. In hybrid method, DEA is integrated with PCA to arrive the ranking of container terminals. Based on the composite ranking, performance modelling and optimization of container terminals is carried out through response surface methodology (RSM).

An N-terminal region of a Myb-like protein is involved in its intracellular localization and activation of a gibberellin-inducible proteinase gene in germinated rice seeds.

Science.gov (United States)

Sutoh, Keita; Washio, Kenji; Imai, Ryozo; Wada, Masamitsu; Nakai, Tomonori; Yamauchi, Daisuke

2015-01-01

The expression of the gene for a proteinase (Rep1) is upregulated by gibberellins. The CAACTC regulatory element (CARE) of the Rep1 promoter is involved in the gibberellin response. We isolated a cDNA for a CARE-binding protein containing a Myb domain in its carboxyl-terminal region and designated the gene Carboxyl-terminal Myb1 (CTMyb1). This gene encodes two polypeptides of two distinctive lengths, CTMyb1L and CTMyb1S, which include or exclude 213 N-terminal amino acid residues, respectively. CTMyb1S transactivated the Rep1 promoter in the presence of OsGAMyb, but not CTMyb1L. We observed an interaction between CTMyb1S and the rice prolamin box-binding factor (RPBF). A bimolecular fluorescence complex analysis detected the CTMyb1S and RPBF complex in the nucleus, but not the CTMyb1L and RPBF complex. The results suggest that the arrangement of the transfactors is involved in gibberellin-inducible expression of Rep1.

Terminal Ballistics

CERN Document Server

Rosenberg, Zvi

2012-01-01

This book covers the important issues of terminal ballistics in a comprehensive way combining experimental data, numerical simulations and analytical modeling. The first chapter reviews the experimental equipment which are used for ballistic tests and the diagnostics for material characterization under impulsive loading conditions. The second chapter covers essential features of the codes which are used for terminal ballistics such as the Euler vs. Lagrange schemes and meshing techniques, as well as the most popular material models. The third chapter, devoted to the penetration mechanics of rigid penetrators, brings the update of modeling in this field. The fourth chapter deals with plate perforation and the fifth chapter deals with the penetration mechanics of shaped charge jets and eroding long rods. The last two chapters discuss several techniques for the disruption and defeating of the main threats in armor design. Throughout the book the authors demonstrate the advantages of numerical simulations in unde...

Epimerization-free C-terminal peptide activation, elongation and cyclization

NARCIS (Netherlands)

Popović, S.

2015-01-01

C-terminal peptide activation and cyclization reactions are generally accompanied with epimerization (partial loss of C‐terminal stereointegrity). Therefore, the focus of this thesis was to develop epimerization-free methods for C-terminal peptide activation to enable C-terminal peptide elongation

Effects and safety of mechanical bathing as a complementary therapy for terminal stage cancer patients from the physiological and psychological perspective: a pilot study.

Science.gov (United States)

Fujimoto, Sawako; Iwawaki, Yoko; Takishita, Yukie; Yamamoto, Yoko; Murota, Masako; Yoshioka, Saori; Hayano, Azusa; Hosokawa, Toyoshi; Yamanaka, Ryuya

2017-11-01

In palliative care hospitals in Japan, mechanical bathing is conducted to maintain cleanliness. However, the physiological and psychological influence of mechanical bathing on patients has not been sufficiently studied. The objective of this study was to assess, using physiological and psychological indices, the effects of mechanical bathing care for patients in the terminal stage of cancer. Mechanical bathing was performed using a Marine Court SB7000 in a supine or semi-seated position. The heart rate variability analysis method was used to measure autonomic nervous system function. The patients' state of anxiety was assessed using the State-Trait Anxiety Inventory (STAI), a psychological index, and patients' verbal responses were also collected after mechanical bathing. Twenty-four patients were enrolled in this study. Their sympathetic and parasympathetic nervous activity did not differ before and after bathing. A significant difference was found between pre- and post-bathing anxiety, as evaluated by STAI (P mechanical bathing according to STAI evaluation and their verbal responses. The findings suggest that the method of bathing used in this study is safe and pain-relieving for terminal stage cancer patients. It is thus possible to provide safe and comfortable care for terminal stage cancer patients using mechanical baths. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Digital autonomous terminal access communications

Science.gov (United States)

Novacki, S.

1987-01-01

A significant problem for the Bus Monitor Unit is to identify the source of a given transmission. This problem arises from the fact that the label which identifies the source of the transmission as it is put into the bus is intercepted by the Digital Autonomous Terminal Access Communications (DATAC) terminal and removed from the transmission. Thus, a given subsystem will see only data associated with a label and never the identifying label itself. The Bus Monitor must identify the source of the transmission so as to be able to provide some type of error identification/location in the event that some problem with the data transmission occurs. Steps taken to alleviate this problem by modifications to the DATAC terminal are discussed.

The essence of spirituality of terminally ill patients.

Science.gov (United States)

Chao, Co-Shi Chantal; Chen, Ching-Huey; Yen, Miaofen

2002-12-01

The purpose of this hermeneutic study was to investigate the essence of spirituality of terminally ill patients. In-depth unstructured interviews were used as the method for data collection. In the six-month period of data collection, the researcher was in the role of a hospice palliative care consultant who directly took care of the subject patients in a hospice ward of a teaching hospital. The six subjects were selected purposively according to various demographic backgrounds. Interview transcripts provided the data for analysis. The results were composed of four constitutive patterns and ten themes. The first constitutive pattern was "Communion with Self" which included three themes: (1) Self-identity--spirituality is the discovery of the authentic self. (2) Wholeness--a human being is full of contradictions but still in wholeness. (3) Inner peace--spirituality is negotiating conflicts for self-reconciliation. The second constitutive pattern was "Communion with others" which included two themes: (1) Love--spirituality is a caring relationship but not an over-attachment to others. (2) Reconciliation--spirituality is to forgive and to be forgiven. The third constitutive pattern was "Communion with Nature" which included two themes: (1) Inspiration from the nature--spirituality is the resonance of the marvelous beauty of nature. (2) Creativity--spirituality is conceiving imaginatively. The fourth constitutive pattern was "Communion with Higher Being" which included three themes: (1) Faithfulness--spirituality is keeping the trust dependably. (2) Hope--spirituality is claiming possibilities. (3) Gratitude--spirituality is giving thanks and embracing grace. The scientific rigor of this qualitative research as well as the strength and limitations of the study are reported. Implications for hospice palliative care and future research are recommended.

Windows Terminal Servers Orchestration

Science.gov (United States)

Bukowiec, Sebastian; Gaspar, Ricardo; Smith, Tim

2017-10-01

Windows Terminal Servers provide application gateways for various parts of the CERN accelerator complex, used by hundreds of CERN users every day. The combination of new tools such as Puppet, HAProxy and Microsoft System Center suite enable automation of provisioning workflows to provide a terminal server infrastructure that can scale up and down in an automated manner. The orchestration does not only reduce the time and effort necessary to deploy new instances, but also facilitates operations such as patching, analysis and recreation of compromised nodes as well as catering for workload peaks.

Coal terminal directory

Energy Technology Data Exchange (ETDEWEB)

NONE

2008-06-15

The directory gives a comprehensive listing of the world's coal terminals, in a total of 50 countries including information on throughput, facilities, storage capacity, and vessel size limitation.

STUDY OF FACTORS RELATED TO STRESS AMONG WOMEN UNDERGOING TERMINATION OF PREGNANCY (TOP IN A COLLECTIVIST CULTURE

Directory of Open Access Journals (Sweden)

Priyanka H

2016-01-01

Full Text Available BACKGROUND India is a country where people are dependent on each other for psychological support. Traditional Indian culture follows a collectivist pattern where the woman cares more about her family and society than herself. An unmarried woman who is pregnant poses a problem for both herself and her baby here, where traditional values are held high and pregnancy without marriage is almost always a taboo. AIMS To find the impact of Termination of Pregnancy (TOP on the anxiety and depression levels among pregnant women, correlation with period of gestation and the impact of perceived social support on anxiety and depression levels of these women. SETTING One hundred women who attended the outpatient department of ESICMC- PGIMSR, Bengaluru, India, requesting for Termination of Pregnancy, between August 2011 and December 2014 were studied. DESIGN A Prospective Observational study. METHODS AND MATERIAL Hospital Anxiety and Depression Scale (HADS and Multidimensional Scale of Perceived Social Support (Zimet, 1988 were measured both pre-TOP and Hospital Anxiety and Depression Scale (HADS was measured post TOP in women fulfilling the Inclusion and Exclusion criteria. STATISTICAL ANALYSIS Averages and proportions were calculated for the study and appropriate statistical tests like Wilcoxon Signed Ranks Test and Spearman’s Correlation Coefficient were done using MiniTab version 16. RESULTS 1 There is a reduction of depression and anxiety after Termination of pregnancy (p <0.05 more so among unmarried women with an unwanted pregnancy. 2 The higher the period of gestation, the higher the levels of HADS anxiety levels were observed (p value of <0.05. 3 The lower the social support scores, the higher the levels of HADS anxiety and depression (p value of <0.05. CONCLUSIONS There is a need for larger number of abortion care providers in India with increased contraception awareness and education regarding the need for Termination of Pregnancy in medical

NPOESS Field Terminal Updates

Science.gov (United States)

Heckmann, G.; Route, G.

2009-12-01

The National Oceanic and Atmospheric Administration (NOAA), Department of Defense (DoD), and National Aeronautics and Space Administration (NASA) are jointly acquiring the next-generation weather and environmental satellite system; the National Polar-orbiting Operational Environmental Satellite System (NPOESS). NPOESS replaces the current Polar-orbiting Operational Environmental Satellites (POES) managed by NOAA and the Defense Meteorological Satellite Program (DMSP) managed by the DoD. The NPOESS satellites carry a suite of sensors that collect meteorological, oceanographic, climatological, and solar-geophysical observations of the earth, atmosphere, and space. The ground data processing segment for NPOESS is the Interface Data Processing Segment (IDPS), developed by Raytheon Intelligence and Information Systems. The IDPS processes NPOESS satellite data to provide environmental data products (aka, Environmental Data Records or EDRs) to NOAA and DoD processing centers operated by the United States government. The IDPS will process EDRs beginning with the NPOESS Preparatory Project (NPP) and continuing through the lifetime of the NPOESS system. IDPS also provides the software and requirements for the Field Terminal Segment (FTS). NPOESS provides support to deployed field terminals by providing mission data in the Low Rate and High Rate downlinks (LRD/HRD), mission support data needed to generate EDRs and decryption keys needed to decrypt mission data during Selective data Encryption (SDE). Mission support data consists of globally relevant data, geographically constrained data, and two line element sets. NPOESS provides these mission support data via the Internet accessible Mission Support Data Server and HRD/LRD downlinks. This presentation will illustrate and describe the NPOESS capabilities in support of Field Terminal users. This discussion will include the mission support data available to Field Terminal users, content of the direct broadcast HRD and LRD

Size-change termination and transition invariants

DEFF Research Database (Denmark)

Heizmann, Matthias; Jones, Neil; Podelski, Andreas

2010-01-01

Two directions of recent work on program termination use the concepts of size-change termination resp. transition invariants. The difference in the setting has as consequence the inherent incomparability of the analysis and verification methods that result from this work. Yet, in order...

48 CFR 32.109 - Termination financing.

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Termination financing. 32... CONTRACTING REQUIREMENTS CONTRACT FINANCING Non-Commercial Item Purchase Financing 32.109 Termination financing. To encourage contractors to invest their own funds in performance despite the susceptibility of...

III-V/Si Tandem Cells Utilizing Interdigitated Back Contact Si Cells and Varying Terminal Configurations: Preprint

Energy Technology Data Exchange (ETDEWEB)

Schnabel, Manuel; Klein, Talysa R.; Jain, Nikhil; Essig, Stephanie; Schulte-Huxel, Henning; Warren, Emily; van Hest, Maikel F. A. M.; Geisz, John; Stradins, Paul; Tamboli, Adele; Rienacker, Michael; Merkle, Agnes; Schmidt, Jan; Brendel, Rolf; Peibst, Robby

2017-07-11

Solar cells made from bulk crystalline silicon (c-Si) dominate the market, but laboratory efficiencies have stagnated because the current record efficiency of 26.3% is already very close to the theoretical limit of 29.4% for a single-junction c-Si cell. In order to substantially boost the efficiency of Si solar cells we have been developing stacked III-V/Si tandem cells, recently attaining efficiencies above 32% in four-terminal configuration. In this contribution, we use state-of-the-art III-V cells coupled with equivalent circuit simulations to compare four-terminal (4T) to three- and two-terminal (3T, 2T) operation. Equivalent circuit simulations are used to show that tandem cells can be operated just as efficiently using three terminals as with four terminals. However, care must be taken not to overestimate 3T efficiency, as the two circuits used to extract current interact, and a method is described to accurately determine this efficiency. Experimentally, a 4T GaInP/Si tandem cell utilizing an interdigitated back contact cell is shown, exhibiting a 4T efficiency of 31.5% and a 2T efficiency of 28.1%. In 3T configuration, it is used to verify the finding from simulation that 3T efficiency is overestimated when interactions between the two circuits are neglected. Considering these, a 3T efficiency approaching the 4T efficiency is found, showing that 3T operation is efficient, and an outlook on fully integrated high-efficiency 3T and 2T tandem cells is given.

12 CFR 611.1223 - Plan of termination-contents.

Science.gov (United States)

2010-01-01

...; (4) The anticipated benefits and potential disadvantages of the termination; (5) The right of certain.... Summarize the plan of termination. (3) Benefits and disadvantages. Provide an enumerated statement of the anticipated benefits and potential disadvantages of the termination. (4) Recommendation. Explain the board's...

Palliative sedation in end-of-life care and survival: a systematic review.

Science.gov (United States)

Maltoni, Marco; Scarpi, Emanuela; Rosati, Marta; Derni, Stefania; Fabbri, Laura; Martini, Francesca; Amadori, Dino; Nanni, Oriana

2012-04-20

Palliative sedation is a clinical procedure aimed at relieving refractory symptoms in patients with advanced cancer. It has been suggested that sedative drugs may shorten life, but few studies exist comparing the survival of sedated and nonsedated patients. We present a systematic review of literature on the clinical practice of palliative sedation to assess the effect, if any, on survival. A systematic review of literature published between January 1980 and December 2010 was performed using MEDLINE and EMBASE databases. Search terms included palliative sedation, terminal sedation, refractory symptoms, cancer, neoplasm, palliative care, terminally ill, end-of-life care, and survival. A manual search of the bibliographies of electronically identified articles was also performed. Eleven published articles were identified describing 1,807 consecutive patients in 10 retrospective or prospective nonrandomized studies, 621 (34.4%) of whom were sedated. One case-control study was excluded from prevalence analysis. The most frequent reason for sedation was delirium in the terminal stages of illness (median, 57.1%; range, 13.8% to 91.3%). Benzodiazepines were the most common drug category prescribed. Comparing survival of sedated and nonsedated patients, the sedation approach was not shown to be associated with worse survival. Even if there is no direct evidence from randomized clinical trials, palliative sedation, when appropriately indicated and correctly used to relieve unbearable suffering, does not seem to have any detrimental effect on survival of patients with terminal cancer. In this setting, palliative sedation is a medical intervention that must be considered as part of a continuum of palliative care.

Multi-terminal memtransistors from polycrystalline monolayer molybdenum disulfide

Science.gov (United States)

Sangwan, Vinod K.; Lee, Hong-Sub; Bergeron, Hadallia; Balla, Itamar; Beck, Megan E.; Chen, Kan-Sheng; Hersam, Mark C.

2018-02-01

Memristors are two-terminal passive circuit elements that have been developed for use in non-volatile resistive random-access memory and may also be useful in neuromorphic computing. Memristors have higher endurance and faster read/write times than flash memory and can provide multi-bit data storage. However, although two-terminal memristors have demonstrated capacity for basic neural functions, synapses in the human brain outnumber neurons by more than a thousandfold, which implies that multi-terminal memristors are needed to perform complex functions such as heterosynaptic plasticity. Previous attempts to move beyond two-terminal memristors, such as the three-terminal Widrow-Hoff memristor and field-effect transistors with nanoionic gates or floating gates, did not achieve memristive switching in the transistor. Here we report the experimental realization of a multi-terminal hybrid memristor and transistor (that is, a memtransistor) using polycrystalline monolayer molybdenum disulfide (MoS2) in a scalable fabrication process. The two-dimensional MoS2 memtransistors show gate tunability in individual resistance states by four orders of magnitude, as well as large switching ratios, high cycling endurance and long-term retention of states. In addition to conventional neural learning behaviour of long-term potentiation/depression, six-terminal MoS2 memtransistors have gate-tunable heterosynaptic functionality, which is not achievable using two-terminal memristors. For example, the conductance between a pair of floating electrodes (pre- and post-synaptic neurons) is varied by a factor of about ten by applying voltage pulses to modulatory terminals. In situ scanning probe microscopy, cryogenic charge transport measurements and device modelling reveal that the bias-induced motion of MoS2 defects drives resistive switching by dynamically varying Schottky barrier heights. Overall, the seamless integration of a memristor and transistor into one multi-terminal device could

Prenatal diagnosis of hypoplastic left heart syndrome: impact of counseling patterns on parental perceptions and decisions regarding termination of pregnancy.

Science.gov (United States)

Hilton-Kamm, Debra; Chang, Ruey-Kang; Sklansky, Mark

2012-12-01

An online survey for parents of children with congenital heart disease (CHD) was developed to study parents' experiences at the time of diagnosis. The survey was distributed to online support groups. A total of 841 responses from parents of children with CHD were received during a 4-week period. The current study examined those respondents (211 [25 %]) who reported their child's diagnosis as hypoplastic left heart syndrome (HLHS). Among these, 138 (65 %) reported receiving the diagnosis prenatally. 32 % of those receiving a prenatal diagnosis reported that after they declined to terminate the pregnancy, termination was mentioned again by their physicians. Parents who had termination mentioned again after their initial decline reported significantly lower optimism regarding their child's life expectancy than those who did not have it mentioned again (66 vs. 94 %, p survival" (34 vs. 13 %, p = 0.01); and were more likely to change pediatric cardiologists (PCs) (43 vs. 12 %, p parents, when termination of pregnancy was mentioned after the parents declined it, or if the parents felt pressure to terminate, the parents perceived a lower chance of survival, felt less optimistic about their child's life expectancy, and were more likely to choose another PC for long-term follow-up care. Our study could not determine whether repeated discussions of the possibility for termination of pregnancy independently impacts parental optimism regarding prognosis or whether those who counsel with repeated discussions of termination tend to have more guarded notions of the prognosis of children with HLHS. Further study is warranted to identify the implications of counseling patterns on parental perceptions and decisions regarding termination of pregnancy.

Comprehensive study of gate-terminated and source-terminated field-plate 0.13 µm NMOS transistors

International Nuclear Information System (INIS)

Chiu, Hsien-Chin; Lin, Shao-Wei; Cheng, Chia-Shih; Wei, Chien-Cheng

2008-01-01

This study systematically investigated microwave noise, power and linearity characteristics of field-plate (FP) 0.13 µm CMOS transistors in which the field-plate metal is connected to the gate terminal and the source terminal. The gate-terminated FP NMOS (FP-G NMOS) provided the best noise figure (NF) at 6 GHz compared with standard devices and the source-terminated FP device (FP-S NMOS) as the lowest gate resistance (R g ) was obtained by this structure. By adopting the field-plate metal in NMOS, both FP-S and FP-G devices achieved higher current density at high gate bias voltages. Moreover, these two devices also had higher efficiency under high drain-to-source voltages at the high input power swing. The third-order inter-modulation product (IM3) is −39.4 dBm for FP-S NMOS at P in of −20 dBm; the corresponding values for FP-G and standard devices are −34.9 dBm and −37.3 dBm, respectively. Experimental results indicate that the FP-G architecture is suitable for low noise applications and FP-S is suitable for high power and high linearity operation

Terminal-Dependent Statistical Inference for the FBSDEs Models

Directory of Open Access Journals (Sweden)

Yunquan Song

2014-01-01

Full Text Available The original stochastic differential equations (OSDEs and forward-backward stochastic differential equations (FBSDEs are often used to model complex dynamic process that arise in financial, ecological, and many other areas. The main difference between OSDEs and FBSDEs is that the latter is designed to depend on a terminal condition, which is a key factor in some financial and ecological circumstances. It is interesting but challenging to estimate FBSDE parameters from noisy data and the terminal condition. However, to the best of our knowledge, the terminal-dependent statistical inference for such a model has not been explored in the existing literature. We proposed a nonparametric terminal control variables estimation method to address this problem. The reason why we use the terminal control variables is that the newly proposed inference procedures inherit the terminal-dependent characteristic. Through this new proposed method, the estimators of the functional coefficients of the FBSDEs model are obtained. The asymptotic properties of the estimators are also discussed. Simulation studies show that the proposed method gives satisfying estimates for the FBSDE parameters from noisy data and the terminal condition. A simulation is performed to test the feasibility of our method.

9 CFR 3.117 - Terminal facilities.

Science.gov (United States)

2010-01-01

... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Terminal facilities. 3.117 Section 3... Marine Mammals Transportation Standards § 3.117 Terminal facilities. Carriers and intermediate handlers... facility of any carrier or intermediate handler where marine mammal shipments are maintained must be...

Bargaining in Mergers and Termination Fees

NARCIS (Netherlands)

Weitzel, U.; Rosenkranz, S.

We model takeovers as a bargaining process and explain termination fees for, both, the target and the acquirer, subject to parties’ bargaining power and outside options. In equilibrium, termination fees are offered by firms with outside options in exchange for a greater share of merger synergies.

48 CFR 52.249-6 - Termination (Cost-Reimbursement).

Science.gov (United States)

2010-10-01

...-Reimbursement). 52.249-6 Section 52.249-6 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION....249-6 Termination (Cost-Reimbursement). As prescribed in 49.503(a)(1), insert the following clause: Termination (Cost-Reimbursement) (MAY 2004) (a) The Government may terminate performance of work under this...

Family members' views on the benefits of harp music vigils for terminally-ill or dying loved ones.

Science.gov (United States)

Ganzini, Linda; Rakoski, Alexa; Cohn, Sharilyn; Mularski, Richard A

2015-02-01

Music-thanatology is a palliative modality that uses harp and voice to provide bedside vigils, particularly for terminally ill or actively dying. We sought to determine the benefits of music vigils for terminally ill patients. Survey of 55 family members, whose terminally ill loved one experienced a music vigil during hospitalization, regarding effects on the patient's breathing, relaxation, comfort, pain and ability to sleep. Written comments on negative and positive results of the vigils were coded using content analysis. Family members perceived that the vigils resulted in modest improvement in the patients' breathing, relaxation, comfort, and ability to sleep, with fewer positive effects on pain, and almost no negative effects. Open ended comments focused on the positive benefit in increasing calm, relaxation, comfort. Comments on the positive effects for the family were almost as common as comments on the positive results for the patient. The use of music-vigils in palliative care should be investigated more extensively as our study supports that this intervention has benefits, almost no risk, minimal cost, and may improve patient-family experience of the dying process.

Randomised preference trial of medical versus surgical termination of pregnancy less than 14 weeks' gestation (TOPS).

Science.gov (United States)

Robson, S C; Kelly, T; Howel, D; Deverill, M; Hewison, J; Lie, M L S; Stamp, E; Armstrong, N; May, C R

2009-11-01

To determine the acceptability, efficacy and costs of medical termination of pregnancy (MTOP) compared with surgical termination of pregnancy (STOP) at less than 14 weeks' gestation, and to understand women's decision-making processes and experiences when accessing the termination service. A partially randomised preference trial and economic evaluation with follow-up at 2 weeks and 3 months. The Royal Victoria Infirmary, Newcastle upon Tyne, UK. Women accepted for termination of pregnancy (TOP) under the relevant Acts of Parliament with pregnancies day of abortion. A further group of women attending contraception and sexual health clinics participated in a discrete choice experiment (DCE). STOP: all women > or = 6 weeks' and pay (WTP); distress, using the Impact of Event Scale (IES); anxiety and depression; satisfaction with care; experience of care; frequency and extent of symptoms including self-assessment of pain; clinical effectiveness; and complications. A DCE was used to identify attributes that shape women's preferences for abortion services. The trial recruited 1877 women, 349 in the randomised arms and 1528 in the preference arms. Of those in the preference arms, 54% chose MTOP. At 2 weeks after the procedure more women having STOP would choose the same method again in the future. Acceptability of MTOP declined with increasing gestational age. The difference in acceptability between STOP and MTOP persisted at 3 months. At 2 weeks after TOP, women in the preference arms were prepared to pay more to have their preferred option. There was no difference in anxiety or depression scores in women having MTOP or STOP. However, women randomised to MTOP had higher scores on subscales of the IES at both 2 weeks and 3 months. There was no difference in IES scores between MTOP and STOP in the preference arm. Women were more likely to be satisfied overall and with technical and interpersonal aspects of care if they had STOP rather than MTOP. Experience of care scores

[Truth telling and advance care planning at the end of life].

Science.gov (United States)

Hu, Wen-Yu; Yang, Chia-Ling

2009-02-01

One of the core values in terminal care the respect of patient 'autonomy'. This essay begins with a discussion of medical ethics principles and the Natural Death Act in Taiwan and then summarizes two medical ethical dilemmas, truth telling and advance care planning (ACP), faced in the development of hospice and palliative care in Taiwan. The terminal truth telling process incorporates the four basic principles of Assessment and preparation, Communication with family, Truth-telling process, and Support and follow up (the so-called "ACTs"). Many experts suggest practicing ACP by abiding by the following five steps: (1) presenting and illustrating topics; (2) facilitating a structured discussion; (3) completing documents with advanced directives (ADs); (4) reviewing and updating ADs; and (5) applying ADs in clinical circumstances. Finally, the myths and challenges in truth telling and ADs include the influence of healthcare system procedures and priorities, inadequate communication skills, and the psychological barriers of medical staffs. Good communication skills are critical to truth telling and ACP. Significant discussion about ACP should help engender mutual trust between patients and the medical staffs who take the time to establish such relationships. Promoting patient autonomy by providing the opportunity of a good death is an important goal of truth telling and ACP in which patients have opportunities to choose their terminal treatment.

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.

Living and dying with dignity in Chinese society: perspectives of older palliative care patients in Hong Kong.

Science.gov (United States)

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

2013-07-01

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

Health care providers' attitudes towards termination of pregnancy: A qualitative study in South Africa

Directory of Open Access Journals (Sweden)

Orner Phyllis

2009-08-01

Full Text Available Abstract Background Despite changes to the abortion legislation in South Africa in 1996, barriers to women accessing abortion services still exist including provider opposition to abortions and a shortage of trained and willing abortion care providers. The dearth of abortion providers undermines the availability of safe, legal abortion, and has serious implications for women's access to abortion services and health service planning. In South Africa, little is known about the personal and professional attitudes of individuals who are currently working in abortion service provision. Exploring the factors which determine health care providers' involvement or disengagement in abortion services may facilitate improvement in the planning and provision of future services. Methods Qualitative research methods were used to collect data. Thirty four in-depth interviews and one focus group discussion were conducted during 2006 and 2007 with health care providers who were involved in a range of abortion provision in the Western Cape Province, South Africa. Data were analysed using a thematic analysis approach. Results Complex patterns of service delivery were prevalent throughout many of the health care facilities, and fragmented levels of service provision operated in order to accommodate health care providers' willingness to be involved in different aspects of abortion provision. Related to this was the need expressed by many providers for dedicated, stand-alone abortion clinics thereby creating a more supportive environment for both clients and providers. Almost all providers were concerned about the numerous difficulties women faced in seeking an abortion and their general quality of care. An overriding concern was poor pre and post abortion counselling including contraceptive counselling and provision. Conclusion This is the first known qualitative study undertaken in South Africa exploring providers' attitudes towards abortion and adds to the body of

42 CFR 422.510 - Termination of contract by CMS.

Science.gov (United States)

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Termination of contract by CMS. 422.510 Section 422... Advantage Organizations § 422.510 Termination of contract by CMS. (a) Termination by CMS. CMS may at any time terminate a contract if CMS determines that the MA organization meets any of the following: (1...

Optical control system for high-voltage terminals

International Nuclear Information System (INIS)

Bicek, J.J.

1978-01-01

An optical control system for the control of devices in the terminal of an electrostatic accelerator includes a laser that is modulated by a series of preselected codes produced by an encoder. A photodiode receiver is placed in the laser beam at the high-voltage terminal of an electrostatic accelerator. A decoder connected to the photodiode decodes the signals to provide control impulses for a plurality of devices at the high voltage of the terminal

7 CFR 1465.25 - Contract violations and termination.

Science.gov (United States)

2010-01-01

.... (2) If NRCS terminates a contract due to breach of contract, or the participant voluntarily... 7 Agriculture 10 2010-01-01 2010-01-01 false Contract violations and termination. 1465.25 Section... ASSISTANCE Contracts § 1465.25 Contract violations and termination. (a) If NRCS determines that a participant...

29 CFR 408.7 - Terminal trusteeship financial report.

Science.gov (United States)

2010-07-01

... 29 Labor 2 2010-07-01 2010-07-01 false Terminal trusteeship financial report. 408.7 Section 408.7...-MANAGEMENT STANDARDS LABOR ORGANIZATION TRUSTEESHIP REPORTS § 408.7 Terminal trusteeship financial report... a terminal financial report, and one copy, with the Office of Labor-Management Standards, on Form LM...

[Terminal phase hydration, pain and delirium

DEFF Research Database (Denmark)

Heick, A.

2009-01-01

Hydration of the terminal patient may relieve confusion and complaints of "dry mouth". But it may worsen oedema of the brain, lungs, and extremities, worsen terminal rattling and cause a need for frequent changing of diapers. The decision of whether and how to treat a dying patient with fluids...

28 CFR 2.43 - Early termination.

Science.gov (United States)

2010-07-01

... terminated because there is a likelihood that the parolee will engage in conduct violating any criminal law... shall review the status of the parolee to determine the need for continued supervision. The Commission shall also conduct a status review whenever the supervision officer recommends early termination of the...

42 CFR 423.509 - Termination of contract by CMS.

Science.gov (United States)

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Termination of contract by CMS. 423.509 Section 423... Contracts with Part D plan sponsors § 423.509 Termination of contract by CMS. (a) Termination by CMS. CMS may at any time terminate a contract if CMS determines that the Part D plan sponsor meets any of the...

Physiotherapy in the care of the dying.

Science.gov (United States)

Davies, B

1980-01-01

This paper examines the role of the physiotherapist in the care of patients whose conditions have reached the point at which intensive active treatment is no longer appropriate and is, therefore, replaced by palliative care directed toward the comfort and support of the patients and their families. The principles of physiotherapy in the delivery of palliative care (modified treatment aims, team approach, and acceptance of death), the possible contexts--both physical and psychological--of effective palliative care, and the attitudinal characteristics of physiotherapists best suited to the implementation of effective palliative care are discussed. The results of a survey of Canadian undergraduate training in physiotherapeutic palliative care, and the present level and method of instruction in this area, are included. The article demonstrates how the physiotherapist can play a central role in the multidisciplinary approach to terminal patient care by assisting patients to make the most of their decreasing potentials, by encouraging them to set short-term goals, and by relieving them of their discomfort.

48 CFR 252.237-7007 - Termination for default.

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Termination for default... of Provisions And Clauses 252.237-7007 Termination for default. As prescribed in 237.7003(b), use the following clause: Termination for Default (DEC 1991) (a) This clause supplements and is in addition to the...

41 CFR 105-71.144 - Termination for convenience.

Science.gov (United States)

2010-07-01

... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Termination for convenience. 105-71.144 Section 105-71.144 Public Contracts and Property Management Federal Property... Termination for convenience. Except as provided in § 105-71.143 awards may be terminated in whole or in part...

Capacity Analysis of Ro-Ro Terminals by Using Simulation Modeling Method

Directory of Open Access Journals (Sweden)

Emin Deniz Özkan

2016-09-01

Full Text Available In Ro-Ro terminals, terminal capacity is more needed than other types of marine terminals since Ro-Ro cargoes cannot be stacked. In this sense, the variables affecting capacity of a Ro-Ro terminal can be listed as follows; number of vehicles arrived to a terminal, distance between terminals, ship capacity, terminal gates, customs control units, terminal traffic and local traffic, security check, bunkering services etc. In this study, a model generated intended for making capacity analysis in Ro-Ro terminals by using simulation modeling method. Effect of three variables to terminal capacity was investigated while generating the scenarios; ‘number of trucks arriving to terminals’, ‘distance between terminals’ and ‘Ro-Ro ship capacity’. The results show that the variable which affect terminal capacity mostly is ‘number of trucks arriving to terminals’. As a consequence of this situation, it is thought that a Ro-Ro terminal operator must prioritize the demand factor and make an effective demand forecasting in determination of the terminal area.

Treatment of nausea and vomiting in terminally ill cancer patients.

Science.gov (United States)

Glare, Paul A; Dunwoodie, David; Clark, Katherine; Ward, Alicia; Yates, Patsy; Ryan, Sharon; Hardy, Janet R

2008-01-01

Nausea and vomiting is a common and distressing symptom complex in patients with far-advanced cancer, affecting up to 60% of individuals at some stage of their illness. The current approach to the palliative care of patients with nausea and vomiting is based on identifying the cause, understanding its pathophysiology and knowing the pharmacology of the drugs available for its amelioration. The following six main syndromes are identified: gastric stasis, biochemical, raised intracranial pressure, vestibular, mechanical bowel obstruction and ileus. A careful history, focused physical examination and appropriate investigations are needed to elucidate the syndrome and its cause, so that therapy is rational. Drugs are the mainstay of treatment in terminal cancer, and the main classes of antiemetic agents are prokinetics, dopamine antagonists, antihistamines, anticholinergics and serotonin antagonists. Dexamethasone and octreotide are also used, especially in bowel obstruction. Non-drug measures are important in relieving the associated distress. Patients should be able to die comfortably, without tubes. Despite decades of practice affirming this approach, the evidence base is weak and well designed studies are urgently needed.

Minimum Efficient Scale (MES) and preferred scale of container terminals

OpenAIRE

Kaselimi, Evangelia N.; Notteboom, Theo E.; Pallis, Athanasios A.; Farrell, Sheila

2011-01-01

Abstract: The decision on the scale of a port terminal affects the terminals managerial, operational and competitive position in all the phases of its life. It also affects competition structures in the port in which the terminal is operating, and has a potential impact on other terminals. Port authorities and terminal operators need to know the scale of the terminal when engaging in concession agreements. In economic theory the scale of a plant/firm is typically defined in relation to the Mi...

[Terminal phase hydration, pain and delirium

DEFF Research Database (Denmark)

Heick, A.

2009-01-01

Hydration of the terminal patient may relieve confusion and complaints of "dry mouth". But it may worsen oedema of the brain, lungs, and extremities, worsen terminal rattling and cause a need for frequent changing of diapers. The decision of whether and how to treat a dying patient with fluids sh...

42 CFR 421.205 - Termination by the Secretary.

Science.gov (United States)

2010-10-01

... for termination. The Secretary may terminate a contract with a carrier at any time if he or she... performed its function in a manner inconsistent with the effective and efficient administration of the... intent to terminate the contract, the carrier may request a hearing within 20 days after the date on the...

The "Palliative Care Quality of Life Instrument (PQLI" in terminal cancer patients

Directory of Open Access Journals (Sweden)

Kouvaris John

2004-02-01

Full Text Available Abstract Background This paper describes the development of a new quality of life instrument in advanced cancer patients receiving palliative care. Methods The Palliative Care Quality of Life Instrument incorporates six multi-item and one single-item scale. The questionnaire was completed at baseline and one-week after. The final sample consisted of 120 patients. Results The average time required to complete the questionnaire, in both time points, was approximately 8 minutes. All multi-item scales met the minimal standards for reliability (Cronbach's alpha coefficient ≥.70 either before or during palliative treatment. Test-retest reliability in terms of Spearman-rho coefficient was also satisfactory (p Conclusion The PQLI is a reliable and valid measure for the assessment of quality of life in patients with advanced stage cancer.

Pharmacokinetic considerations and recommendations in palliative care, with focus on morphine, midazolam and haloperidol.

Science.gov (United States)

Franken, L G; de Winter, B C M; van Esch, H J; van Zuylen, L; Baar, F P M; Tibboel, D; Mathôt, R A A; van Gelder, T; Koch, B C P

2016-06-01

A variety of medications are used for symptom control in palliative care, such as morphine, midazolam and haloperidol. The pharmacokinetics of these drugs may be altered in these patients as a result of physiological changes that occur at the end stage of life. This review gives an overview of how the pharmacokinetics in terminally ill patients may differ from the average population and discusses the effect of terminal illness on each of the four pharmacokinetic processes absorption, distribution, metabolism, and elimination. Specific considerations are also given for three commonly prescribed drugs in palliative care: morphine, midazolam and haloperidol). The pharmacokinetics of drugs in terminally ill patients can be complex and limited evidence exists on guided drug use in this population. To improve the quality of life of these patients, more knowledge and more pharmacokinetic/pharmacodynamics studies in terminally ill patients are needed to develop individualised dosing guidelines. Until then knowledge of pharmacokinetics and the physiological changes that occur in the final days of life can provide a base for dosing adjustments that will improve the quality of life of terminally ill patients. As the interaction of drugs with the physiology of dying is complex, pharmacological treatment is probably best assessed in a multi-disciplinary setting and the advice of a pharmacist, or clinical pharmacologist, is highly recommended.

The role of radiotherapy in hospice care

International Nuclear Information System (INIS)

Nishimura, Tetsuo; Sugiyama, Akira; Shimizu, Teppei; Ichinohe, Kenji; Teshima, Takeshi; Kaneko, Masao; Hara, Yoshio; Chihara, Satoshi.

1989-01-01

The aim of palliative radiotherapy for the terminally ill is to improve the quality of the remaining span of life. From November 1982 to September 1987, 69 patients in the Seirei Hospice have been treated with such radiotherapy, and symptomatic relief was obtained in 64% of these patients. Radiotherapy also proved useful in achieving an improvement in their performance status. While the aim of hospice care is not directed towards treatment of the underlying disease, the use of radiotherapy is considered to have an important role in hospice care. (author)

Coach terminal as important element of transport infrastructure

Directory of Open Access Journals (Sweden)

V. Gromule

2007-10-01

Full Text Available The determination of the coach terminal as passenger logistics hub is described. The factors responsible for successful functioning of this hub are discussed. The location of the coach terminal is one of the important factors. The present coach terminal is located in the heart of the city where land availability is critical. The simulation model of the terminal was developed to complement the design and construction of a new one. The used simulation package VISSIM has visual reference to assist in explaining the complexity of transport node’s job and analysis of possible congestions. During the development of the modelling the critical bottlenecks are identified and decisions are taken to reduce the risk of their occurrence, the solution being immediately incorporated into the final design of the coach terminal under development.

Modular approach for satellite communication ground terminals

Science.gov (United States)

Gould, G. R.

1984-01-01

The trend in satellite communications is toward completely digital, time division multiple access (TDMA) systems with uplink and downlink data rates dictated by the type of service offered. Trunking terminals will operate in the 550 MBPS (megabit per second) region uplink and downlink, whereas customer premise service (CPS) terminals will operate in the 25 to 10 MBPS region uplink and in the 200 MBPS region downlink. Additional criteria for the ground terminals will be to maintain clock sychronization with the system and burst time integrity to within a matter of nanoseconds, to process required order-fire information, to provide adaptive data scrambing, and to compensate for variations in the user input output data rates, and for changes in range in the satellite communications links resulting from satellite perturbations in orbit. To achieve the required adaptability of a ground terminal to the above mentioned variables, programmable building blocks can be developed that will meet all of these requirements. To maintain system synchronization, i.e., all bursted data arriving at the satellite within assigned TDMA windows, ground terminal transmit data rates and burst timing must be maintained within tight tolerances. With a programmable synchronizer as the heart of the terminal timing generation, variable data rates and burst timing tolerances are achievable. In essence, the unit inputs microprocessor generated timing words and outputs discrete timing pulses.

Depressão e ansiedade nos cuidadores de mulheres em fase terminal de câncer de mama e ginecológico Depression and anxiety in caregivers of terminally-ill breast and gynecological cancer patients

Directory of Open Access Journals (Sweden)

Vera Lucia Rezende

2005-12-01

patients with terminal breast or gynecological cancer. METHODS: for this cross-sectional study, 133 informal caretakers of terminally-ill breast and gynecologic cancer patients were included. Patients were hospitalized for palliative care in the Oncology Clinic of the "Centro de Atenção Integral à Saúde da Mulher (Campinas, Brasil from August 2002 to May 2004. Seventy-one of the patients had breast cancer and 62 had gynecological malignancies. Hospital Anxiety and Depression Scale (HAD was applied to these informal caretakers, in order to detect anxiety and depression, and they were also interviewed to provide additional information regarding their age, gender, religion, relation to patient, current occupation, if they cared for other people, whether their routine had changed and whether other people helped them to care for the patient. Logistic regression was used to calculate the odds ratio (OR and its confidence interval (CI, used to assess the relationship between the diagnoses of anxiety and depression among the informal caretakers. For multiple analyses, the stepwise criterion for variable selection was used. RESULTS: 43% percent of the patients identified their daughters as their main caretaker, and 24%, their husbands. Most of the caretakers were over 35 years old (63%, 68% were female, 59% were unemployed, 47% cared for another person and 84% referred that his/her routine had changed because of caring. Anxiety was detected in 99 caretakers (74.4% and depression in 71 (53.4%. Anxiety and depression were strongly correlated (odds ratio 5.6; 95% confidence interval 2.2 to 15.9. Bivariate analysis disclosed that the patients' husbands were less affected by depression, but multivariate analysis revealed that only the fact of being male was related to a lower prevalence of anxiety. CONCLUSION: caring for terminally-ill cancer patients led to high prevalence of anxiety and depression. Only men and the patients' husbands were found to have a lower prevalence of

Productivity simulation model for optimization of maritime container terminals

Directory of Open Access Journals (Sweden)

Elen TWRDY

2009-01-01

Full Text Available This article describes a proposed productivity simulation model enabling container terminal operators to find optimization possibilities. A research of more than forty terminals has been done, in order to provide a helping tool for maritime container terminals. By applying an adequate simulation model, it is possible to measure and increase the productivity in all subsystem of the maritime container terminal. Management of a maritime container terminal includes a vast number of different financial and operational decisions. Financial decisions are often in a direct connection with investments in infrastructure and handling equipment. Such investments are very expensive. Therefore, they must give back the invested money as soon as possible. On the other hand, some terminals are limited by the physical extension and are forced to increase annual throughput only with sophisticated equipment on the berth side and on the yard as well. Considering all these important facts in container and shipping industry, the proposed simulation model gives a helping tool for checking the productivity and its time variation and monitoring competitiveness of a certain maritime terminal with terminals from the same group.

29 CFR 408.8 - Terminal trusteeship information report.

Science.gov (United States)

2010-07-01

... information report. There shall be filed at the same time that the terminal trusteeship financial report is filed a terminal trusteeship information report on Form LM-16. If in answer to Item 6 of Form LM-16... 29 Labor 2 2010-07-01 2010-07-01 false Terminal trusteeship information report. 408.8 Section 408...

47 CFR 25.134 - Licensing provisions of Very Small Aperture Terminal (VSAT) and C-band Small Aperture Terminal...

Science.gov (United States)

2010-10-01

... 47 Telecommunication 2 2010-10-01 2010-10-01 false Licensing provisions of Very Small Aperture Terminal (VSAT) and C-band Small Aperture Terminal (CSAT) networks. 25.134 Section 25.134 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES SATELLITE COMMUNICATIONS...

The shift to early palliative care: a typology of illness journeys and the role of nursing.

Science.gov (United States)

Wittenberg-Lyles, Elaine; Goldsmith, Joy; Ragan, Sandra

2011-06-01

For the current study, clinical observations of communication between patients, families, and clinicians during chronic, serious, or terminal illness in a cancer care trajectory were examined for patterns and trends. Five communication characteristics were concluded, which informed a typology of illness journeys experienced by patients with cancer and their families. The isolated journey characterizes an illness path in which communication about terminal prognosis and end-of-life care options are not present; communication is restricted by a curative-only approach to diagnosis as well as the structure of medical care. The rescued journey signifies a transition between curative care (hospital narrative) to noncurative care (hospice narrative), challenging patients and their families with an awareness of dying. The rescued journey allows communication about prognosis and care options, establishes productive experiences through open awareness, and affords patients and families opportunities to experience end-of-life care preferences. Finally, palliative care prior to hospice provides patients and families with an illness journey more readily characterized by open awareness and community, which facilitates a comforted journey. Nurses play a pivotal role in communicating about disease progression and plans of care. The typology presented can inform a structured communication curriculum for nurses and assist in the implementation of early palliative care.

Fractional surface termination of diamond by electrochemical oxidation.

Science.gov (United States)

Hoffmann, René; Obloh, Harald; Tokuda, Norio; Yang, Nianjun; Nebel, Christoph E

2012-01-10

The crystalline form of sp(3)-hybridized carbon, diamond, offers various electrolyte-stable surface terminations. The H-termination-selective attachment of nitrophenyl diazonium, imaged by AFM, shows that electrochemical oxidation can control the fractional hydrogen/oxygen surface termination of diamond on the nanometer scale. This is of particular interest for all applications relying on interfacial electrochemistry, especially for biointerfaces.

KAJIAN SANITASI TERMINAL DI PROVINSI DAERAH ISTIMEWA YOGYAKARTA TAHUN 2016

Directory of Open Access Journals (Sweden)

Dani Febriyanto

2017-04-01

Full Text Available Sanitasi adalah suatu usaha untuk mengawasi beberapa faktor lingkungan fisik yang berpenga-ruh pada manusia terutama terhadap hal-hal yang mempunyai efek merusak perkembangan fi-sik, kesehatan, dan kelangsungan hidup. Berdasarkan uji pendahuluan yang dilakukan pada 2-4 April 2016, diketahui bahwa terdapat beberapa sarana atau fasilitas terminal bus yang tidak se-suai dengan persyaratan. Hal tersebut memiliki dampak yang buruk bagi lingkungan dan kese-hatan manusia di tempat umum tersebut. Tujuan penelitian ini adalah untuk mengetahui gambar-an kondisi sanitasi terminal bus di Provinsi D. I. Yogyakarta, dengan melakukan penelitian survei dengan analisis deskriptif. Dari 16 populasi terminal yang ada, yang dijadikan sampel penelitian adalah Terminal Wates, Terminal Jombor, Terminal Giwangan, dan Terminal Dhaksinarga yang diambil dengan metoda area probability sampling. Ada lima variabel yang diamati dengan mela-kukan inspeksi sanitasi, yaitu: penyehatan lingkungan luar, penyehatan ruang dan bangunan, fa-silitas sanitasi, kenyamanan dan keselamatan, serta higiene makanan dan minuman. Hasil dan kesimpulan penelitian ini adalah kondisi sanitasi terminal bus di Provinsi D. I. Yogyakarta masih kurang baik, karena hanya Terminal Giwangan yang berkategori laik sehat dengan prosentase 89 %.

Family's difficulty scale in end-of-life home care: a new measure of the family's difficulties in caring for patients with cancer at the end of life at home from bereaved family's perspective.

Science.gov (United States)

Ishii, Yoko; Miyashita, Mitsunori; Sato, Kazuki; Ozawa, Taketoshi

2012-02-01

The aim of this study was to develop a tool to measure the family's difficulties in caring for cancer patients at the end of life at home: Family's Difficulty Scale in end-of-life home care (FDS). The draft of the FDS was derived from a pilot interview survey and literature reviews. The questionnaires were sent to 395 bereaved family caregivers whose family members were patients with terminal cancer receiving home service. We obtained 306 responses (response rate, 81%). Factor analysis resulted in 29 items and 8 factors: Burden of Care, Concerns about Home Care Doctor, Balance of Work and Care, Patient's Pain and Condition, Concerns about Visiting Nurse, Concerns about Home Care Service, Relationship between Family Caregivers and their Families, and Funeral Preparations. The cumulative rate of contribution was 71.8%. Cronbach coefficient α for the FDS was 0.73-0.75; the intraclass correlation coefficient in the test-retest examination was 0.75-0.85. Evidence for construct validity was confirmed by convergent and divergent validity. Concurrent validity was confirmed by significant correlations between identified factors and concurrent measures. The validity and reliability of this new instrument were confirmed. This scale should help home care providers to assess and focus on family difficulties and provide individualized care for the family who cares for a patient with terminal cancer at home.

Distress, Stress and Solidarity in Palliative Care.

Science.gov (United States)

deMontigny, Johanne

1993-01-01

Notes that role of psychologist on palliative care unit is to be there for terminally ill, their friends, and their families, both during the dying and the bereavement and for the caregiver team. Focuses on work of decoding ordinary words which for many patients hide painful past. Stresses necessity to remain open to unexpected. (Author/NB)

JCO criticality accident termination operation

OpenAIRE

金盛 正至

2010-01-01

In 2001, we summarized the circumstances surrounding termination of the JCO criticality accident based on testimony in the Mito District Court on December 17, 2001. JCO was the company for uranium fuels production in Japan. That document was assembled based on actual testimony in the belief that a description of the work involved in termination of the accident would be useful in some way for preventing nuclear disasters in the future. This year is the tenth year of the JCO criticality acciden...

Training simulator for operations at LNG terminals

International Nuclear Information System (INIS)

Tsuta, T.; Yamamoto, K.; Tetsuka, S.; Koyama, K.

1997-01-01

The Tokyo Gas LNG terminals are among the major energy centers of the Tokyo area, supplying 8 million customers with city gas, and also supplying fuel for thermal power generation at the neighboring thermal power plant operated by the Tokyo Electric Power Company. For this reason, in the event of an emergency at the terminal operators have to be able to respond quickly and accurately to restore operations and prevent secondary damage. Modern LNG terminals are highly reliable and are equipped with backup systems, and occurrences of major trouble are now almost nil. Operators therefore have to be trained to respond to emergencies using simulators, in order to heighten their emergency response capabilities. Tokyo Gas Co., Ltd. has long been aware of the need for simulators and has used them in training, but a new large-scale, real-time simulator has now developed in response to new training needs, applying previously accumulated expertise to create a model of an entire LNG terminal incorporating new features. The development of this new simulator has made possible training for emergencies affecting an entire terminal, and this has been very effective in raising the standards of operators. (au)

Home-based palliative care: challenges in the care of technology-dependent children.

Science.gov (United States)

Floriani, Ciro A

2010-01-01

To conceptualize palliative care and its indications in Pediatrics; to describe the difficulties involved in the delivery of such care at home for technology-dependent children; and to analyze, from a bioethical perspective, the moral dilemmas of palliative care assistance. A literature review of palliative care for technology-dependent children and a bioethical analysis of moral dilemmas. There are several obstacles to palliative care for technology-dependent children: structural difficulties at home; social isolation of both children and families; health professionals' sense of disbelief regarding this type of care; an excessive number of medical devices at home; uncertainty of a terminal prognosis; physical, emotional, social, material, and financial burden for parents and family; changes in family dynamics to adjust to these children; paternalistic relationship between professionals and family; changes in family roles, with shifts in the caregiver role. It is essential to outline an agenda based on the premise that the medical apparatus for technology-dependent children will change the landscape of the home, and such a change might become a problem to be faced by all those living together. Based on this assumption, actions performed in a setting other than a health care facility might exert an actual protective effect on children and family, offering support in their several needs and developing a model of care delivery that includes interventions in the different levels of burden on these vulnerated and unprotected individuals.

Micro-terminator: 'Hasta la vista, lncRNA!'.

Science.gov (United States)

Diederichs, Sven

2015-04-01

Transcriptional termination is an important yet incompletely understood aspect of gene expression. Proudfoot, Jopling and colleagues now identify a new Microprocessor-mediated mechanism of transcriptional termination, which acts specifically on long noncoding transcripts that serve as microRNA precursors.

Predictable uncertainty about terminal operations in the sea

Directory of Open Access Journals (Sweden)

S. Hess

2010-06-01

Full Text Available This paper considers a problem of planning short term operations in a bulk terminal faced by port management when making tactical decisions. Ship loading and discharging, cargo stocking, the maintenance and service of facility equipment are regular operations of a bulk terminal which is a subsystem of a sea port the conduct of which is subject to difficult-to-predict or unforeseen influences. The problem that port management encounters in day to day operations looks into making the best possible plan with the scheduled duration of operations/states and transition instants, considering various internal and external factors influencing terminal performance. A state and transition model is used for deriving effective solutions to obtaining the state order and state transition time of a bulk terminal with an objective of minimizing operational costs. The behaviour of the terminal is tested applying the stochastic and deterministic method.

Addressing the emotional barriers to access to reproductive care.

Science.gov (United States)

Rich, Camilla W; Domar, Alice D

2016-05-01

Health care professionals make the medical care of infertility patients a priority, with the goal of achieving a singleton pregnancy for each. Patients who never seek out care, who do not return for treatment after the diagnostic workup, or who drop out of treatment are rarely noticed. Yet this is the outcome for the majority of patients, and the primary reason after financial for treatment termination is the emotional aspect. Attending to the psychological needs of our patients must become a higher priority, to provide all patients true access to care. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

[Ethics in intensive care and euthanasia : With respect to inactivating defibrillators at the end of life in terminally ill patients].

Science.gov (United States)

Trappe, H-J

2017-04-01

In critically ill patients, intensive care medical procedures allow diseases to be cured or controlled that were considered incurable many years ago. For patients with terminal heart failure or heart disease with other severe comorbidities (cancer, stroke), the questions whether the deactivation of defibrillators is appropriate or must be regarded as active euthanasia may arise. Notable cases from the author's hospital are analyzed. The literature on the topic euthanasia and basic literature regarding defibrillator therapy are discussed. It is undisputed that patients as part of their self-determination have the right to renounce treatment. Active euthanasia and the thereby deliberate induction of death is prohibited by law in Germany and will be prosecuted. Passive euthanasia is the omission or reduction of possibly life-prolonging treatment measures. Passive euthanasia requires the patient's consent and is legally and ethically permissible. Indirect euthanasia takes into account acceleration of death as a side effect of a medication. Unpunishable assisted suicide ("assisted suicide") is the mere assistance of self-controlled and self-determined death. Assisted suicide is fundamentally not a criminal offense in Germany. Deactivation of a defibrillator is a treatment discontinuation, which is only permitted in accordance with the wishes of the patient. It is not a question of passive or active euthanasia. Involvement of a local ethics committee and/or legal consultation is certainly useful and sometimes also allows previously unrecognized questions to be answered.

Unfinished Business in Families of Terminally Ill With Cancer Patients.

Science.gov (United States)

Yamashita, Ryoko; Arao, Harue; Takao, Ayumi; Masutani, Eiko; Morita, Tatsuya; Shima, Yasuo; Kizawa, Yoshiyuki; Tsuneto, Satoru; Aoyama, Maho; Miyashita, Mitsunori

2017-12-01

Unfinished business often causes psychological issues after bereavement. Providing care for families of terminally ill patients with cancer to prevent unfinished business is important. To clarify the prevalence and types of unfinished business in families of end-of-life patients with cancer admitted to palliative care units (PCUs), explore depression and grief associated with unfinished business, and explore the factors affecting unfinished business. We conducted a cross-sectional, anonymous, self-report questionnaire survey with 967 bereaved families of patients with cancer admitted to PCUs. The questionnaire assessed the presence or the absence of unfinished business, content of unfinished business, depression, grief, process of preparedness, condition of the family and patient, and the degree of involvement of health care professionals. Questionnaires were sent to 967 families, and 73.0% responded. In total, 26.0% of families had some unfinished business, with improvement of the patient-family relationship being a common type of unfinished business. Families with unfinished business had significantly higher depression and grief scores after bereavement compared with those without. Factors that influenced the presence or the absence of unfinished business were preparedness for the patient's death (P = 0.001), discussion between the patient and family about the disease trajectory and way to spend daily life (P business. Health care professionals should coordinate the appropriate timing for what the family wishes to do, with consideration of family dynamics, including the family's preparedness, communication pattern, and relationships. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

The Risk of Termination Shock From Solar Geoengineering

Science.gov (United States)

Parker, Andy; Irvine, Peter J.

2018-03-01

If solar geoengineering were to be deployed so as to mask a high level of global warming, and then stopped suddenly, there would be a rapid and damaging rise in temperatures. This effect is often referred to as termination shock, and it is an influential concept. Based on studies of its potential impacts, commentators often cite termination shock as one of the greatest risks of solar geoengineering. However, there has been little consideration of the likelihood of termination shock, so that conclusions about its risk are premature. This paper explores the physical characteristics of termination shock, then uses simple scenario analysis to plot out the pathways by which different driver events (such as terrorist attacks, natural disasters, or political action) could lead to termination. It then considers where timely policies could intervene to avert termination shock. We conclude that some relatively simple policies could protect a solar geoengineering system against most of the plausible drivers. If backup deployment hardware were maintained and if solar geoengineering were implemented by agreement among just a few powerful countries, then the system should be resilient against all but the most extreme catastrophes. If this analysis is correct, then termination shock should be much less likely, and therefore much less of a risk, than has previously been assumed. Much more sophisticated scenario analysis—going beyond simulations purely of worst-case scenarios—will be needed to allow for more insightful policy conclusions.

48 CFR 49.601 - Notice of termination for convenience.

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Notice of termination for convenience. 49.601 Section 49.601 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION... termination for convenience. (See 49.402-3(g) for notice of termination for default.) ...

28 CFR 66.44 - Termination for convenience.

Science.gov (United States)

2010-07-01

... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Termination for convenience. 66.44 Section 66.44 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) UNIFORM ADMINISTRATIVE... Reports, Records, Retention, and Enforcement § 66.44 Termination for convenience. Except as provided in...

Termination of Dynamic Contracts in an Equilibrium Labor Market Model

OpenAIRE

Wang, Cheng

2005-01-01

I construct an equilibrium model of the labor market where workers and firms enter into dyamic contracts that can potentially last forever, but are subject to optimal terminations. Upon a termination, the firm hires a new worker, and the worker who is terminated receives a termination compensation from the firm and is then free to go back to the labor market to seek new employment opportunities and enter into new dynamic contracts. The model permits only two types of equilibrium terminations ...

Assessing Port Governance, Devolution and Terminal Performance in Nigeria

Directory of Open Access Journals (Sweden)

D. E. Onwuegbuchunam

2018-02-01

Full Text Available Concerns about performance and efficiency in port terminals led many national governments to embark on port reforms. The Federal government of Nigeria, for example, adopted the Landlord port model which brought about concessioning of port terminals to private operators. Despite high investments in terminal facilities by the private terminal operators, there are still complaints about level of service offered to port users. This paper applied key performance indicator metrics and parameters of queuing model in assessing performance of Nigeria’s concessioned port terminals. Data for the study were obtained from terminal level records of cargo and ship handling activities for years 2000 to 2015. Major findings indicate that cargo and vessel throughputs improved after the reforms in the six ports examined. However, much variability was observed in trends in ships’ turnround times across all ports after the concession policy implementation. Additional results from the queuing model analysis suggest that the high ships turnround times observed in some ports are associated to delays in ship operation at the berths. The paper recommends that policy interventions be focused on ship operations at the berths as a step in improving service level in the port terminals.