Omvårdnad vid livets slut: LCP i jämförelse med ordinarie palliativ vård samt sjuksköterskors och läkares erfarenhet av LCP

Syftet med denna studie var att se om en strukturerad vårdform vid livets slut såsom Liverpool Care Pathway for the dying, LCP, har någon inverkan på omvårdnaden av de palliativa patienterna jämfört med ordinarie palliativ vård samt att beskriva vårdpersonalens upplevelser av LCP. Studien genomfördes som en systematisk litteraturstudie där underlag inhämtades genom sökning av veteskapliga artiklar i databaser samt att artiklar söktes manuellt på Högskolan Dalarnas bibliotek. Artiklar har även sökts från referenser på andra artiklar direkt på titeln och vid sökningarna användes sökorden både enskilt och i kombination varvid 10 artiklar valdes ut till resultatet. Resultatet visade att efter införandet av LCP förbättrades dokumentationen, patienterna hade inte onödiga livsförlängande behandlingar. Symtomen i form av smärta, oro/ångest och slemproduktion var mindre, samt att kommunikationen mellan vårdpersonal, närstående och patient förbättrades. Sjuksköterskorna upplevde att tiden för dokumentation förkortades och mer tid kunde läggas på patienterna, sjuksköterskor ansåg också att den gamla rutinmässiga behandlingen och omvårdnaden förbättrades. LCP dokumenten gjorde även att anhöriga kunde följa omvårdnaden vilket gjorde dem tryggare i vad som skedde med deras närstående och vad som hände i vården runt denne.

Vilka skillnader upplever vårdpersonal och närstående mellan den vanliga palliativa vården och en vård med styrda vårdplaner? : En systematisk litteraturstudie

Syftet med föreliggande studie var att ta reda på vårdpersonal och närståendes upplevelser vad gäller vanlig palliativ vård och strukturerade vårdplaner så som LCP/ICP. Studien genomfördes som en systematisk litteraturstudie där underlaget inhämtades genom att med specifika sökord söka i Högskolan Dalarnas databas ELIN@ efter vetenskapliga artiklar. En artikel har även sökts från en annan referenslista där artikelnamnet använts som sökord. Vid sökningarna har sökorden använts var för sig och i kombination med varandra varvid 13 stycken artiklar valdes ut till resultatet. Resultatet visade att det fanns brister i den ordinarie palliativa vården vad det gäller kommunikation, symtomlindring och anhörigvård. Tidsbrist och stress var också utmärkande i den ordinarie palliativa vården. Vad gäller patienter som vårdats under LCP/ICP så upplevde närstående och vårdpersonal att både kommunikation och symtomkontroll var avsevärt bättre än i den ordinarie palliativa vården. Tiden för det goda samtalet fanns i betydligt större utsträckning vid vård under LCP/ICP. En orsak var att sjuksköterskan istället för att lägga ner tid på dokumentationen hade möjlighet att vara där för patienten och dess närstående. De närstående hade också möjlighet att vara delaktiga i vården på grund av att de hade tillgång till dokumentationen kring patienten.

Automatic estimation of crowd density using texture

This paper considers the role of automatic estimation of crowd density and its importance for the automatic monitoring of areas where crowds are expected to be present. A new technique is proposed which is able to estimate densities ranging from very low to very high concentration of people, which is a difficult problem because in a crowd only parts of people's body appear. The new technique is based on the differences of texture patterns of the images of crowds. Images of low density crowds tend to present coarse textures, while images of dense crowds tend to present fine textures. The image pixels are classified in different texture classes and statistics of such classes are used to estimate the number of people. The texture classification and the estimation of people density are carried out by means of self organising neural networks. Results obtained respectively to the estimation of the number of people in a specific area of Liverpool Street Railway Station in London (UK) are presented. (C) 1998 Elsevier B.V. Ltd. All rights reserved.

On the efficacy of texture analysis for crowd monitoring

The goal of this work is to assess the efficacy of texture measures for estimating levels of crowd densities ill images. This estimation is crucial for the problem of crowd monitoring. and control. The assessment is carried out oil a set of nearly 300 real images captured from Liverpool Street Train Station. London, UK using texture measures extracted from the images through the following four different methods: gray level dependence matrices, straight lille segments. Fourier analysis. and fractal dimensions. The estimations of dowel densities are given in terms of the classification of the input images ill five classes of densities (very low, low. moderate. high and very high). Three types of classifiers are used: neural (implemented according to the Kohonen model). Bayesian. and an approach based on fitting functions. The results obtained by these three classifiers. using the four texture measures. allowed the conclusion that, for the problem of crowd density estimation. texture analysis is very effective.

Estimation of crowd density using image processing

Human beings perceive images through their properties, like colour, shape, size, and texture. Texture is a fertile source of information about the physical environment. Images of low density crowds tend to present coarse textures, while images of dense crowds tend to present fine textures. This paper describes a new technique for automatic estimation of crowd density, which is a part of the problem of automatic crowd monitoring, using texture information based on grey-level transition probabilities on digitised images. Crowd density feature vectors are extracted from such images and used by a self organising neural network which is responsible for the crowd density estimation. Results obtained respectively to the estimation of the number of people in a specific area of Liverpool Street Railway Station in London (UK) are presented.

Estimating crowd density with Minkowski fractal dimension

The estimation of the number of people in an area under surveillance is very important for the problem of crowd monitoring. When an area reaches an occupation level greater than the projected one, people's safety can be in danger. This paper describes a new technique for crowd density estimation based on Minkowski fractal dimension. Fractal dimension has been widely used to characterize data texture in a large number of physical and biological sciences. The results of our experiments show that fractal dimension can also be used to characterize levels of people congestion in images of crowds. The proposed technique is compared with a statistical and a spectral technique, in a test study of nearly 300 images of a specific area of the Liverpool Street Railway Station, London, UK. Results obtained in this test study are presented.

Nova espécie do gênero Galissus Dupont (Coleoptera, Cerambycidae) e chave para identificação das espécies

Galissus nigrescens sp. nov. é descrita da Costa Rica (Veragua Rainforest Reserve, Brisas de Veragua, Liverpool, Limón) e é fornecida chave para identificação das espécies.

Human toxocariasis: diagnosis, worldwide seroprevalences and clinical expression of the systemic and ocular forms.

Although human toxocariasis ranks among the most common zoonotic infections worldwide, it remains relatively unknown to the public. The causal agents are the nematode parasites Toxocara canis and T. cati, whose definitive hosts are dogs and cats, respectively. When embryonated eggs are accidentally ingested by humans, larvae hatch in the small intestine, penetrate the intestinal wall and migrate, via the bloodstream, to the liver, lungs, muscles, eye and central nervous system. Although most human infections are asymptomatic, two well-defined clinical syndromes are classically recognised: visceral larva migrans (a systemic disease caused by larval migration through major organs) and ocular larva migrans (a disease limited to the eyes and optic nerves). Two less-severe syndromes have recently been described, one mainly in children (covert toxocariasis) and the other mainly in adults (common toxocariasis). Here, the current laboratory diagnosis, epidemiology and main clinical features of both the systemic and ocular forms of human toxocariasis are reviewed. New developments in serological diagnosis are described, the available seroprevalence data are analysed, and the results of relevant clinical studies that have been published over the last decade are explored, to provide an updated overview of this neglected but highly prevalent human infection.

Immune pathomechanism of drug hypersensitivity reactions

Drug hypersensitivity research has progressed enormously in recent years, and a greater understanding of mechanisms has contributed to improved drug safety. Progress has been made in genetics, enabling personalized medicine for certain drugs, and in understanding drug interactions with the immune system. In a recent meeting in Rome, the clinical, chemical, pharmacologic, immunologic, and genetic aspects of drug hypersensitivity were discussed, and certain aspects are briefly summarized here. Small chemicals, including drugs, can induce immune reactions by binding as a hapten to a carrier protein. Park (Liverpool, England) demonstrated (1) that drug haptens bind to protein in patients in a highly restricted manner and (2) that irreversibly modified carrier proteins are able to stimulate CD4(+) and CD8(+) T cells from hypersensitive patients. Drug haptens might also stimulate cells of the innate immune system, in particular dendritic cells, and thus give rise to a complex and complete immune reaction. Many drugs do not have hapten-like characteristics but might gain them on metabolism (so-called prohaptens). The group of Naisbitt found that the stimulation of dendritic cells and T cells can occur as a consequence of the transformation of a prohapten to a hapten in antigen-presenting cells and as such explain the immune-stimulatory capacity of prohaptens. The striking association between HLA-B alleles and the development of certain drug reactions was discussed in detail. Mallal (Perth, Australia) elegantly described a highly restricted HLA-B∗5701-specific T-cell response in abacavir-hypersensitive patients and healthy volunteers expressing HLA-B∗5701 but not closely related alleles. Expression of HLA-B∗1502 is a marker known to be necessary but not sufficient to predict carbamazepine-induced Stevens-Johnson syndrome/toxic epidermal necrolysis in Han Chinese. The group of Chen and Hong (Taiwan) described the possible "missing link" because they showed that the presence of certain T-cell receptor (TCR) clonotypes was necessary to elicit T-cell responses to carbamazepine. The role of TCRs in drug binding was also emphasized by Pichler (Bern, Switzerland). Following up on their "pharmacological interactions of drugs with immune receptors" concept (p-i concept), namely that drugs can bind directly to TCRs, MHC molecules, or both and thereby stimulate T cells, they looked for drug-binding sites for the drug sulfamethoxazole in drug-specific TCRs: modeling revealed up to 7 binding sites on the CDR3 and CDR2 regions of TCR Vα and Vβ. Among many other presentations, the important role of regulatory T cells in drug hypersensitivity was addressed.

Robin Huws Jones (United Kingdom), President 1976- 1980

Robin Huws Jones, President of the International Association of Schools of Social Work from 1976 to 1980, lived a life of challenge and change. Born in Wales in 1909, he often remarked that learning to speak Welsh at age two was such a challenge that he didn’t bother to learn English until he was six. The death of his mother when he was three led to the first of many changes in a life that was not easy in the formative years. Robin remained in the care of his father while his sister became the ward of two aunts. With his father, a draper’sassistant, he left Wales to live in a crowded boarding house in Liverpool.

The use of mechanisms and modes of toxic action in integrated testing strategies: the report and recommendations of a workshop held as part of the European Union OSIRIS Integrated Project

This report on The Potential of Mode of Action (MoA) Information Derived from Non-testing and Screening Methodologies to Support Informed Hazard Assessment, resulted from a workshop organised within OSIRIS (Optimised Strategies for Risk Assessment of Industrial Chemicals through Integration of Non-test and Test Information), a project partly funded by the EU Commission within the Sixth Framework Programme. The workshop was held in Liverpool, UK, on 30 October 2008, with 35 attendees. The goal of the OSIRIS project is to develop integrated testing strategies (ITS) fit for use in the REACH system, that would enable a significant increase in the use of non-testing information for regulatory decision making, and thus minimise the need for animal testing. One way to improve the evaluation of chemicals may be through categorisation by way of mechanisms or modes of toxic action. Defining such groups can enhance read-across possibilities and priority settings for certain toxic modes or chemical structures responsible for these toxic modes. Overall, this may result in a reduction of in vivo testing on organisms, through combining available data on mode of action and a focus on the potentially most-toxic groups. In this report, the possibilities of a mechanistic approach to assist in and guide ITS are explored, and the differences between human health and environmental areas are summarised.