860 resultados para Life-limiting conditions


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Background: Nausea can be a debilitating symptom for patients with a life-limiting illness. While addressing reversible components, nonpharmacological strategies and antiemetics are the main therapeutic option. The choice of medication, dose, and route of administration remain highly variable. Objective: The aim of this study was to codify the current clinical approaches and quantify any variation found nationally. Methods: A cross-sectional study utilizing a survey of palliative medicine clinicians examined prescribing preferences for nausea using a clinical vignette. Respondent characteristics, the use of nonpharmacological interventions, first- and second-line antiemetic choices, commencing and maximal dose, and time to review were collected. Results: Responding clinicians were predominantly working in palliative medicine across a range of settings with a 49% response rate (105/213). The main nonpharmacological recommendation was “small, frequent snacks.” Metoclopramide was the predominant first-line agent (69%), followed by haloperidol (26%), while second-line haloperidol was the predominant agent (47%), with wide variation in other nominated agents. Respondents favoring metoclopramide as first-line tended to use haloperidol second-line (65%), but not vice versa. Maximal doses for an individual antiemetic varied up to tenfold. Conclusion: For nausea, a commonly encountered symptom in palliative care, clinicians' favored metoclopramide and haloperidol; however, after these choices, there was large variation in antiemetic selection. While most clinicians recommended modifying meal size and frequency, use of other nonpharmacological therapies was limited.

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Background Haemodialysis (HD) nursing is characterised by frequent, intense interactions with patients over long periods of time resulting in a unique nurse-patient relationship. Due to the life-limiting nature of end-stage renal failure, nurses are likely to have repeated exposures to the death of patients with whom they have formed relationships. Repeated exposure to patient death translates into frequent grief experiences. There is scant literature on the psychological impact of patient death for nurses working in the HD setting. Aims To explore HD nurses experiences of patient death and coping mechanisms used. Methods A sequential mixed method study investigating job satisfaction, stress and burnout found that HD nurses had high levels of stress and burnout. These results were explored in more detail during 8 semi-structured interviews with HD nurses. Interviews were audio-recorded, transcribed verbatim and subjected to thematic analysis. Results Three themes were identified that highlight the stress experienced by nurses when a haemodialysis patient dies. The first theme, “quazi-family” describes the close relationship which forms between nurses and patients. The “complicated grief” theme outlines the impact of death on HD nurses, and the final theme, “remembrance” explains some of the coping mechanisms used in the grieving process. Conclusion Nurses develop individual coping mechanisms to accommodate the grief and loss experienced when a “close” patient dies. The grieving process caused by the death of patient’s needs to be recognised by nurses and nurse managers as causing psychological stress and strain.

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In this paper, we study the Einstein relation for the diffusivity to mobility ratio (DMR) in n-channel inversion layers of non-linear optical materials on the basis of a newly formulated electron dispersion relation by considering their special properties within the frame work of k.p formalism. The results for the n-channel inversion layers of III-V, ternary and quaternary materials form a special case of our generalized analysis. The DMR for n-channel inversion layers of II-VI, IV-VI and stressed materials has been investigated by formulating the respective 2D electron dispersion laws. It has been found, taking n-channel inversion layers of CdGeAs2, Cd(3)AS(2), InAs, InSb, Hg1-xCdxTe, In1-xGaxAsyP1-y lattice matched to InP, CdS, PbTe, PbSnTe, Pb1-xSnxSe and stressed InSb as examples, that the DMR increases with the increasing surface electric field with different numerical values and the nature of the variations are totally band structure dependent. The well-known expression of the DMR for wide gap materials has been obtained as a special case under certain limiting conditions and this compatibility is an indirect test for our generalized formalism. Besides, an experimental method of determining the 2D DMR for n-channel inversion layers having arbitrary dispersion laws has been suggested.

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In dryland agricultural systems of the subtropical, semi-arid region of north-eastern Australia, water is the most limiting resource. Crop productivity depends on the efficient use of rainfall and available water stored in the soil during fallow. Agronomic management practices including a period of fallow, stubble retention, and reduced tillage enhance reserves of soil water. However, access to stored water in these soils may be restricted by the presence of growth-limiting conditions in the rooting zone of the crop. These have been termed as subsoil constraints. Subsoil constraints may include compacted or gravel layers (physical), sodicity, salinity, acidity, nutrient deficiencies, presence of toxic elements (chemical) and low microbial activity (biological). Several of these constraints may occur together in some soils. Farmers have often not been able to obtain the potential yield determined by their prevailing climatic conditions in the marginal rainfall areas of the northern grains region. In the past, the adoption of soil management practices had been largely restricted to the top 100 mm soil layer. Exploitation of the subsoil as a source of water and nutrients has largely been overlooked. The key towards realising potential yields would be to gain better understanding of subsoils and their limitations, then develop options to manage them practically and economically. Due to the complex nature of the causal factors of these constraints, efforts are required for a combination of management approaches rather than individual options, with the aim to combat these constraints for sustainable crop production, managing natural resources and avoiding environmental damage.

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There is an increasing need to understand what makes vegetation at some locations more sensitive to climate change than others. For savanna rangelands, this requires building knowledge of how forage production in different land types will respond to climate change, and identifying how location-specific land type characteristics, climate and land management control the magnitude and direction of its responses to change. Here, a simulation analysis is used to explore how forage production in 14 land types of the north-eastern Australian rangelands responds to three climate change scenarios of +3A degrees C, +17% rainfall; +2A degrees C, -7% rainfall; and +3A degrees C, -46% rainfall. Our results demonstrate that the controls on forage production responses are complex, with functional characteristics of land types interacting to determine the magnitude and direction of change. Forage production may increase by up to 60% or decrease by up to 90% in response to the extreme scenarios of change. The magnitude of these responses is dependent on whether forage production is water or nitrogen (N) limited, and how climate changes influence these limiting conditions. Forage production responds most to changes in temperature and moisture availability in land types that are water-limited, and shows the least amount of change when growth is restricted by N availability. The fertilisation effects of doubled atmospheric CO2 were found to offset declines in forage production under 2A degrees C warming and a 7% reduction in rainfall. However, rising tree densities and declining land condition are shown to reduce potential opportunities from increases in forage production and raise the sensitivity of pastures to climate-induced water stress. Knowledge of these interactions can be applied in engaging with stakeholders to identify adaptation options.

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Relatively few previous studies of individuals receiving a diagnosis of Motor Neurone Disease within the UK health care system have employed qualitative approaches to examine the diagnostic journey from a patient perspective. A qualitative sociological study was undertaken, involving interviews with 42 participants diagnosed with MND, to provide insight into their experiences of undergoing testing and receiving a diagnosis. Adopting a sociological-phenomenological perspective, this article examines key themes that emerged from participant accounts surrounding the lived experience of the diagnostic journey. The key themes that emerged were: The diagnostic quest; living with uncertainty; hearing bad news; communication difficulties; and a reified body of medical interest. In general, doctor-patient communication both at pre and post diagnosis was experienced as highly stressful, distressing and profoundly upsetting. Participants reported such distress as being due to the mode of delivery and communication strategies used by health professionals. We therefore suggest that professional training needs to emphasize the importance to health professionals of fostering greater levels of tact, sensitivity and empathy towards patients diagnosed with devastating, life-limiting illnesses such as MND.

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A simplified yet analytical approach on few ballistic properties of III-V quantum wire transistor has been presented by considering the band non-parabolicity of the electrons in accordance with Kane's energy band model using the Bohr-Sommerfeld's technique. The confinement of the electrons in the vertical and lateral directions are modeled by an infinite triangular and square well potentials respectively, giving rise to a two dimensional electron confinement. It has been shown that the quantum gate capacitance, the drain currents and the channel conductance in such systems are oscillatory functions of the applied gate and drain voltages at the strong inversion regime. The formation of subbands due to the electrical and structural quantization leads to the discreetness in the characteristics of such 1D ballistic transistors. A comparison has also been sought out between the self-consistent solution of the Poisson's-Schrodinger's equations using numerical techniques and analytical results using Bohr-Sommerfeld's method. The results as derived in this paper for all the energy band models gets simplified to the well known results under certain limiting conditions which forms the mathematical compatibility of our generalized theoretical formalism.

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We present a simplified theoretical formulation of the thermoelectric power (TP) under magnetic quantization in quantum wells (QWs) of nonlinear optical materials on the basis of a newly formulated magneto-dispersion law. We consider the anisotropies in the effective electron masses and the spin-orbit constants within the framework of k.p formalism by incorporating the influence of the crystal field splitting. The corresponding results for III-V materials form a special case of our generalized analysis under certain limiting conditions. The TP in QWs of Bismuth, II-VI, IV-VI and stressed materials has been studied by formulating appropriate electron magneto-dispersion laws. We also address the fact that the TP exhibits composite oscillations with a varying quantizing magnetic field in QWs of n-Cd3As2, n-CdGeAs2, n-InSb, p-CdS, stressed InSb, PbTe and Bismuth. This reflects the combined signatures of magnetic and spatial quantizations of the carriers in such structures. The TP also decreases with increasing electron statistics and under the condition of non-degeneracy, all the results as derived in this paper get transformed into the well-known classical equation of TP and thus confirming the compatibility test. We have also suggested an experimental method of determining the elastic constants in such systems with arbitrary carrier energy spectra from the known value of the TP. (C) 2010 Elsevier Ltd. All rights reserved.

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Recently we presented a microscopic expression for dielectric friction on a rotating dipole. This expression has a rather curious structure, involving the contributions of the transverse polarization modes of the solvent and also of the molecular length scale processes. It is shown here that under proper limiting conditions, this expression reduces exactly to the classical continuum model expression of Nee and Zwanzig [J. Chem. Phys. 52, 6353 (1970)]. The derivation requires the use of the asymptotic form of the orientation‐dependent total pair correlation function, the neglect of the contributions of translational modes of the solvent, and also the use of the limit that the size of the solvent molecules goes to zero. Thus, the derivation can be important in understanding the validity of the continuum model and can also help in explaining the results of a recent computer simulation study of dielectric relaxation in a Brownian dipolar lattice.

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The hot deformation behavior of hot isostatically pressed (HIP) NIMONIC AP-1 superalloy is characterized using processing maps in the temperature range 950-degrees-C to 1200-degrees-C and strain rate range 0.001 to 100 s-1. The dynamic materials model has been used for developing the processing maps which show the variation of the efficiency of power dissipation given by [2m/(m +1)] with temperature and strain rate, with m being the strain rate sensitivity of flow stress. The processing map revealed a domain of dynamic recrystallization with a peak efficiency of 40 pct at 1125-degrees-C and 0.3 s-1, and these are the optimum parameters for hot working. The microstructure developed under these conditions is free from prior particle boundary (PPB) defects, cracks, or localized shear bands. At 100 s-1 and 1200-degrees-C, the material exhibits inter-crystalline cracking, while at 0.001 s-1, the material shows wedge cracks at 1200-degrees-C and PPB cracking at 1000-degrees-C. Also at strain rates higher than 10 s-1, adiabatic shear bands occur; the limiting conditions for this flow instability are accurately predicted by a continuum criterion based on the principles of irreversible thermodynamics of large plastic flow.

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We present a simplified theory of carrier backscattering coefficient in a twofold degenerate asymmetric bilayer graphene nanoribbon (BGN) under the application of a low static electric field. We show that for a highly asymmetric BGN(Delta = gamma), the density of states in the lower subband increases more that of the upper, in which Delta and gamma are the gap and the interlayer coupling constant, respectively. We also demonstrate that under the acoustic phonon scattering regime, the formation of two distinct sets of energy subbands signatures a quantized transmission coefficient as a function of ribbon width and provides an extremely low carrier reflection coefficient for a better Landauer conductance even at room temperature. The well-known result for the ballistic condition has been obtained as a special case of the present analysis under certain limiting conditions which forms an indirect validation of our theoretical formalism.

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We present a simplified theoretical formulation of the Fowler-Nordheim field emission (FNFE) under magnetic quantization and also in quantum wires of optoelectronic materials on the basis of a newly formulated electron dispersion law in the presence of strong electric field within the framework of k.p formalism taking InAs, InSb, GaAs, Hg(1-x)Cd(x)Te and In(1-x)Ga(x) As(y)P(1-y) lattice matched to InP as examples. The FNFE exhibits oscillations with inverse quantizing magnetic field and electron concentration due to SdH effect and increases with increasing electric field. For quantum wires the FNFE increases with increasing film thickness due to the existence van-Hove singularity and the magnitude of the quantum jumps are not of same height indicating the signature of the band structure of the material concerned. The appearance of the humps of the respective curves is due to the redistribution of the electrons among the quantized energy levels when the quantum numbers corresponding to the highest occupied level changes from one fixed value to the others. Although the field current varies in various manners with all the variables in all the limiting cases as evident from all the curves, the rates of variations are totally band-structure dependent. Under certain limiting conditions, all the results as derived in this paper get transformed in to well known Fowler-Nordheim formula. (C) 2011 Elsevier Ltd. All rights reserved.

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An attempt is made to study the two dimensional (2D) effective electron mass (EEM) in quantum wells (Qws), inversion layers (ILs) and NIPI superlattices of Kane type semiconductors in the presence of strong external photoexcitation on the basis of a newly formulated electron dispersion laws within the framework of k.p. formalism. It has been found, taking InAs and InSb as examples, that the EEM in Qws, ILs and superlattices increases with increasing concentration, light intensity and wavelength of the incident light waves, respectively and the numerical magnitudes in each case is band structure dependent. The EEM in ILs is quantum number dependent exhibiting quantum jumps for specified values of the surface electric field and in NIPI superlattices; the same is the function of Fermi energy and the subband index characterizing such 2D structures. The appearance of the humps of the respective curves is due to the redistribution of the electrons among the quantized energy levels when the quantum numbers corresponding to the highest occupied level changes from one fixed value to the others. Although the EEM varies in various manners with all the variables as evident from all the curves, the rates of variations totally depend on the specific dispersion relation of the particular 2D structure. Under certain limiting conditions, all the results as derived in this paper get transformed into well known formulas of the EEM and the electron statistics in the absence of external photo-excitation and thus confirming the compatibility test. The results of this paper find three applications in the field of microstructures. (C) 2011 Elsevier Ltd. All rights reserved.

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We address a physically based analytical model of quantum capacitance (C-Q) in a bilayer graphene nanoribbon (BGN) under the application of an external longitudinal static bias. We demonstrate that as the gap (Delta) about the Dirac point increases, a phenomenological population inversion of the carriers in the two sets of subbands occurs. This results in a periodic and composite oscillatory behavior in the C-Q with the channel potential, which also decreases with increase in Delta. We also study the quantum size effects on the C-Q, which signatures heavy spatial oscillations due to the occurrence of van Hove singularities in the total density-of-states function of both the sets of subbands. All the mathematical results as derived in this paper converge to the corresponding well-known solution of graphene under certain limiting conditions and this compatibility is an indirect test of our theoretical formalism. (C) 2012 Elsevier By. All rights reserved.

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Stainless steel of type AISI 316LN - one of the structural materials of fast neutron reactors - must have a long service life under conditions that subject it to different types of wear (galling, adhesion, fretting, and abrasion). Cobalt-based hard facings are generally avoided due to induced radioactivity. Nickel-based hard facings are strongly preferred instead. One alternative to both types of coatings is a hard-alloy coating of CrN. This article examines wear and friction characteristics during the sliding of uncoated steel SS316LN and the same steel with a CrN coating. In addition, a specially designed pin-on-disk tribometer is used to perform tests in a vacuum at temperatures of up to 1000 degrees C in order to study the effect of oxygen on the wear of these materials. The morphology of the wear surface and the structure of the subsurface were studied by scanning electron microscopy. The formation of an adhesion layer and the self-welding of mating parts are seen to take place in the microstructure at temperatures above 500 degrees C. It is also found that steel SS316LN undergoes shear strain during sliding wear. The friction coefficient depends on the oxygen content, load, and temperature, while the wear rate depends on the strain-hardening of the surface of the material being tested.