End-of-Life Decisions and Advanced Old Age

Article

The subversion of the good life (enlightened rebelliousness for the 21st century: a critical perspective on the work of Bolívar Echeverría)

El debate sobre el modelo civilizatorio de la modernidad de Occidente, consu economía concentradora y excluyente, y su matriz económico energética petrolera y extractivista no sustentable, ha reavivado en los escenarios políticos y académicos de la salud la discusión de la propuesta del buen vivir inscrita en las nuevas constituciones de Bolivia y Ecuador. Ante la crisis social, sanitaria y ambiental producida por la imposición de una economía de la muerte, y la consiguiente multiplicación de modos de vivir malsanos, se discuten aquí las tesis de Bolívar Echeverría sobre la base material de la vida y la cultura, como una herramienta para evaluar históricamente los desempeños de los gobiernos de las izquierdas realmente existentes, y trabajar un modelo de transición histórica y el indispensable remozamiento de la conciencia crítica desde una visión radicalmente renovadora, pero que mire la realidad sin dogmatismo, sin estridencias míticas y con un sentido de profunda autocrítica.

The bubbles or the boiling pot? An ecosystemic approach to culture, environment and quality of life

For the diagnosis and prognosis of the problems of quality of life, a multidisciplinary ecosystemic approach encompasses four dimensions of being-in-the-world, as donors and recipients: intimate, interactive, social and biophysical. Social, cultural and environmental vulnerabilities are understood and dealt with, in different circumstances of space and time, as the conjugated effect of all dimensions of being-in-the-world, as they induce the events (deficits and assets), cope with consequences (desired or undesired) and contribute for change. Instead of fragmented and reduced representations of reality, diagnosis and prognosis of cultural, educational, environmental and health problems considers the connections (assets) and ruptures (deficits) between the different dimensions, providing a planning model to develop and evaluate research, teaching programmes, public policies and field projects. The methodology is participatory, experiential and reflexive; heuristic-hermeneutic processes unveil cultural and epistemic paradigms that orient subject-object relationships; giving people the opportunity to reflect on their own realities, engage in new experiences and find new ways to live better in a better world. The proposal is a creative model for thought and practice, providing many opportunities for discussion, debate and development of holistic projects integrating different scientific domains (social sciences, psychology, education, philosophy, etc.).

Playing to Create New Ways of Playing: A Child with Prader-Willi Syndrome

This investigation evaluates the possibility of constructing new ways of playing for a child with Prader-Willi syndrome, by means of occupational therapy. It is a qualitative study which makes use of the case study methodology, whose starting point is the clinical intervention as data collect field. It also presents a short revision of the literature to subside discussions and reflections. It was observed that through the playing experience the occupational therapist led the child to know his own limitations and possibilities, by making him discover new ways of doing activities. Observing the therapist and learning with her, the patient experienced different situations throughout the therapeutic relationship, what enabled him to experiment them in his everyday life. Finally, this study aims at showing the clinical reasoning of an occupational therapist with a view to demonstrate Brazilian therapeutical conduct.

How to grow the peanut : and 105 ways of preparing it for human consumption /

Cover title.

Music in everyday living and learning; ways of integrating music with other experiences, a report.

Mode of access: Internet.

Mirror neurons in the tree of life, development and evolution of sensorimotor matching responses

Mirror neurons in the tree of life rappresenta lo sviluppo e l' evoluzione del sistema dei neuroni specchio nei primati umani, non - umani e di alcune specie di uccelli, utilizzando metodi cooptati dalla filosofia della biologia e la biologia teorica, per integrare dati relativi al sistema nervoso e al comportamento delle specie in esame.

The measurement properties of the menorrhagia multi-attribute quality-of-life scale:a psychometric analysis

Menorrhagia, or heavy menstrual bleeding (HMB), is a common gynaecological condition. As the aim of treatment is to improve women's wellbeing and quality of life (QoL), it is necessary to have effective ways to measure this. This study investigated the reliability and validity of the menorrhagia multi-attribute scale (MMAS), a menorrhagia-specific QoL instrument. Participants (n = 431) completed the MMAS and a battery of other tests as part of the baseline assessment of the ECLIPSE (Effectiveness and Cost-effectiveness of Levonorgestrel-containing Intrauterine system in Primary care against Standard trEatment for menorrhagia) trial. Analyses of their responses suggest that the MMAS has good measurement properties and is therefore an appropriate condition-specific instrument to measure the outcome of treatment for HMB. © 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.

A comparative study of life history and gene flow in darters (Pisces: Percidae)

Gene flow, or the exchange of genes between populations, is important because it determines the evolutionary trajectory of a species, including the relative influences of genetic drift and natural selection in the process of population differentiation. Gene flow differs among species because of variation in dispersal capability and abundances across taxa, and historical forces related to geological or lineage history. Both history and ecology influence gene flow in potentially complicated ways, and accounting for their effects remains an important problem in evolutionary biology. This research is a comparative study of gene flow and life-history in a monophyletic group of stream fishes, the darters. As a first step in disentangling historical and ecological effects, I reconstructed the phylogenetic relationships of the study species from nucleotide sequences in the mtDNA control region. I then used this phylogeny and regional glaciation history to infer historical effects on life-history evolution and gene flow in 15 species of darters. Gene flow was estimated indirectly, using information from 20 resolvable and polymorphic allozyme loci. When I accounted for historical effects, comparisons across taxa revealed that gene flow rates were closely associated with differences in clutch sizes and reproductive investment patterns. I hypothesized that differences in larval dispersal among taxa explained this relationship. Results from a field study of larval drift were consistent with this hypothesis. Finally, I asked whether there was an interaction between species' ecology and genetic differentiation across biogeographically distinct regions. Information from allozymes and mtDNA sequences revealed that life history plays an important role in the magnitude of species divergence across biogeographic boundaries. These results suggested an important association between life histories and rates of speciation following an allopatric isolation event. This research, along with other studies from the literature, further illustrates the enormous potential of North American freshwater fishes as a system for studying speciation processes. ^

Harmonization of Life Cycle Climate Performance and Its Improvements for Heat Pump Applications

Life Cycle Climate Performance (LCCP) is an evaluation method by which heating, ventilation, air conditioning and refrigeration systems can be evaluated for their global warming impact over the course of their complete life cycle. LCCP is more inclusive than previous metrics such as Total Equivalent Warming Impact. It is calculated as the sum of direct and indirect emissions generated over the lifetime of the system “from cradle to grave”. Direct emissions include all effects from the release of refrigerants into the atmosphere during the lifetime of the system. This includes annual leakage and losses during the disposal of the unit. The indirect emissions include emissions from the energy consumption during manufacturing process, lifetime operation, and disposal of the system. This thesis proposes a standardized approach to the use of LCCP and traceable data sources for all aspects of the calculation. An equation is proposed that unifies the efforts of previous researchers. Data sources are recommended for average values for all LCCP inputs. A residential heat pump sample problem is presented illustrating the methodology. The heat pump is evaluated at five U.S. locations in different climate zones. An excel tool was developed for residential heat pumps using the proposed method. The primary factor in the LCCP calculation is the energy consumption of the system. The effects of advanced vapor compression cycles are then investigated for heat pump applications. Advanced cycle options attempt to reduce the energy consumption in various ways. There are three categories of advanced cycle options: subcooling cycles, expansion loss recovery cycles and multi-stage cycles. The cycles selected for research are the suction line heat exchanger cycle, the expander cycle, the ejector cycle, and the vapor injection cycle. The cycles are modeled using Engineering Equation Solver and the results are applied to the LCCP methodology. The expander cycle, ejector cycle and vapor injection cycle are effective in reducing LCCP of a residential heat pump by 5.6%, 8.2% and 10.5%, respectively in Phoenix, AZ. The advanced cycles are evaluated with the use of low GWP refrigerants and are capable of reducing the LCCP of a residential heat by 13.7%, 16.3% and 18.6% using a refrigerant with a GWP of 10. To meet the U.S. Department of Energy’s goal of reducing residential energy use by 40% by 2025 with a proportional reduction in all other categories of residential energy consumption, a reduction in the energy consumption of a residential heat pump of 34.8% with a refrigerant GWP of 10 for Phoenix, AZ is necessary. A combination of advanced cycle, control options and low GWP refrigerants are necessary to meet this goal.

The Scored Patient-Generated Subjective Global Assessment (PG-SGA) and its Association with Quality of Life in Ambulatory Patients Receiving Radiotherapy

OBJECTIVE: To evaluate the scored Patient-generated Subjective Global Assessment (PG-SGA) tool as an outcome measure in clinical nutrition practice and determine its association with quality of life (QoL). DESIGN: A prospective 4 week study assessing the nutritional status and QoL of ambulatory patients receiving radiation therapy to the head, neck, rectal or abdominal area. SETTING: Australian radiation oncology facilities. SUBJECTS: Sixty cancer patients aged 24-85 y. INTERVENTION: Scored PG-SGA questionnaire, subjective global assessment (SGA), QoL (EORTC QLQ-C30 version 3). RESULTS: According to SGA, 65.0% (39) of subjects were well-nourished, 28.3% (17) moderately or suspected of being malnourished and 6.7% (4) severely malnourished. PG-SGA score and global QoL were correlated (r=-0.66, P<0.001) at baseline. There was a decrease in nutritional status according to PG-SGA score (P<0.001) and SGA (P<0.001); and a decrease in global QoL (P<0.001) after 4 weeks of radiotherapy. There was a linear trend for change in PG-SGA score (P<0.001) and change in global QoL (P=0.003) between those patients who improved (5%) maintained (56.7%) or deteriorated (33.3%) in nutritional status according to SGA. There was a correlation between change in PG-SGA score and change in QoL after 4 weeks of radiotherapy (r=-0.55, P<0.001). Regression analysis determined that 26% of the variation of change in QoL was explained by change in PG-SGA (P=0.001). CONCLUSION: The scored PG-SGA is a nutrition assessment tool that identifies malnutrition in ambulatory oncology patients receiving radiotherapy and can be used to predict the magnitude of change in QoL.

The impact of perceived stage of cancer on carers’ anxiety and depression during the patients’ final year of life

Objective: This paper explores the effects of perceived stage of cancer (PSOC) on carers' anxiety and depression during the patients' final year. Methods: A consecutive sample of patients and carers (N=98) were surveyed at regular intervals regarding PSOC, and anxiety and depression using the Hospital Anxiety and Depression Scale. Means were compared by gender using the Mann-Whitney U-test. The chi-square was used to analyse categorical data. Agreement between carers' and patients' PSOC was estimated using kappa statistics. Correlations between carers' PSOC and their anxiety and depression were calculated using the Spearman's rank correlation. Results: Over time, an increasing proportion of carers reported that the cancer was advanced, culminating at 43% near death. Agreement regarding PSOC was fair (kappa=0.29-0.34) until near death (kappa=0.21). Carers' anxiety increased over the year; depression increased in the final 6 months. Females were more anxious (p=0.049, 6 months; p=0.009, 3 months) than males, and more depressed until 1 month to death. The proportion of carers reporting moderate-severe anxiety almost doubled over the year to 27%, with more females in this category at 6 months (p=0.05). Carers with moderate-severe depression increased from 6 to 15% over the year. Increased PSOC was weakly correlated with increased anxiety and depression. Conclusions: Carers' anxiety exceeded depression in severity during advanced cancer. Females generally experienced greater anxiety and depression. Carers were more realistic than patients regarding the ultimate outcome, which was reflected in their declining mental health, particularly near the end.