Too ill to will? deathbed wills: assessing testamentary capacity near the end of life

Assessing testamentary capacity in the terminal phase of an illness or at a person's deathbed is fraught with challenges for both doctors and lawyers. Numerous issues need to be considered when assessing capacity for a will. These issues are exacerbated when such an assessment needs to be undertaken at the bedside of a dying patient. The nature and severity of the illness, effects on cognition of the terminal illness, effects of medication, urgency, psychological and emotional factors, interactions with carers, family and lawyers, and a range of other issues confound and complicate the assessment of capacity. What is the doctor's role in properly assessing capacity in this context and how does this role intersect with the legal issues? Doctors will play an increasing role in assessing testamentary capacity in this setting. The ageing of society, more effective treatment of acute illness and, often, the prolongation of dying are only some of the factors leading to this increasing need. However, despite its importance and increasing prevalence, the literature addressing this challenging practical area is scarce and offers limited guidance. This paper examines these challenges and discusses some practical approaches.

Acute renal failure in critically ill patients : With special reference to prediction of outcome

Acute renal failure (ARF) is a clinical syndrome characterized by rapidly decreasing glomerular filtration rate, which results in disturbances in electrolyte- and acid-base homeostasis, derangement of extracellular fluid volume, and retention of nitrogenous waste products, and is often associated with decreased urine output. ARF affects about 5-25% of patients admitted to intensive care units (ICUs), and is linked to high mortality and morbidity rates. In this thesis outcome of critically ill patients with ARF and factors related to outcome were evaluated. A total of 1662 patients from two ICUs and one acute dialysis unit in Helsinki University Hospital were included. In study I the prevalence of ARF was calculated and classified according to two ARF-specific scoring methods, the RIFLE classification and the classification created by Bellomo et al. (2001). Study II evaluated monocyte human histocompatibility leukocyte antigen-DR (HLA-DR) expression and plasma levels of one proinflammatory (interleukin (IL) 6) and two anti-inflammatory (IL-8 and IL-10) cytokines in predicting survival of critically ill ARF patients. Study III investigated serum cystatin C as a marker of renal function in ARF and its power in predicting survival of critically ill ARF patients. Study IV evaluated the effect of intermittent hemodiafiltration (HDF) on myoglobin elimination from plasma in severe rhabdomyolysis. Study V assessed long-term survival and health-related quality of life (HRQoL) in ARF patients. Neither of the ARF-specific scoring methods presented good discriminative power regarding hospital mortality. The maximum RIFLE score for the first three days in the ICU was an independent predictor of hospital mortality. As a marker of renal dysfunction, serum cystatin C failed to show benefit compared with plasma creatinine in detecting ARF or predicting patient survival. Neither cystatin C nor plasma concentrations of IL-6, IL-8, and IL-10, nor monocyte HLA-DR expression were clinically useful in predicting mortality in ARF patients. HDF may be used to clear myoglobin from plasma in rhabdomyolysis, especially if the alkalization of diuresis does not succeed. The long-term survival of patients with ARF was found to be poor. The HRQoL of those who survive is lower than that of the age- and gender-matched general population.

Essential nursing care of the critically ill patient

This chapter is about essential nursing care. Because it is often referred to as basic nursing, nurses may not always perceive it as deserving of priority. Yet, how well patients are cared for has a direct effect on their sense of wellbeing and their recovery. ‘Interventional patient hygiene’ is a systematic, evidence-based approach to nursing actions designed to improve patient outcomes using a framework of hygiene, catheter care, skin care, mobility and oral care.1 This chapter focuses on the physical care, infection control, preventative therapies and transport of critically ill patients. The first two areas are closely linked: poor-quality physical care increases the risk of infection. The final areas are essential features of critical care nursing.

The good, the bad and the ugly of bone-anchored prostheses: Guideline to assess true clinical outcomes

The aim of this study is to share the key elements of an evaluation framework to determine the true clinical outcomes of bone-anchored prostheses. Scientists, clinicians and policy makers are encouraged to implement their own evaluations relying on the proposed framework using a single database to facilitate reflective practice and, eventually, robust prospective studies.

The Rocky Road of Social Sustainability : The Impact of Integrated Biodiversity Conservation and Development on the Local Realities in Ranomafana National Park, Madagascar

The objective of this study is to examine the social impacts of the integrated conservation and development project (ICDP) aimed at biodiversity conservation and local socio-economic development in the Ranomafana National Park (RNP), Madagascar. Furthermore, the study explores social sustainability and justice of the ICDP in Ranomafana. This ethnographically informed impact study uses of various field methods. The research material used consists of observation, interviews (key-person and focus group), school children's writings, official statistics and project documents. Fieldwork was conducted in three phases in 2001, 2002 and 2004 in twelve villages around the park, as well as in neighbouring areas of Ranomafana. However, four of those twelve villages were chosen for closer study. This study consists of five independent articles and a concluding chapter. Social impacts were studied through reproductive health indicators as well as a life security approach. Equity and distribution of benefits and drawbacks of ICDP were analysed and the actors related to the conservation in Ranomafana were identified. The children and adolescents' environmental views were also examined. The reproductive health indicators studied showed a poor state of reproductive health in the park area. Moreover, the existing social capital in the villages seemed to be fragmented due to economic difficulties that were partly caused by the conservation regulations. The ICDP in Ranomafana did not pay attention to the heterogeneity of the affected communities even though the local beneficiaries of the ICDP varied according to their ethnicity, living place, wealth, social position and gender. In addition, various conservation actors (local people in various groups, local authorities, tourist business owners, conservation NGOs and scientists) contest their interests over the forest, conservation and its related activities. This study corroborates the same type of evidence and conclusions discussed in other similar cases elsewhere: so called social conservation programmes still cannot meet the needs of the people living near the protected areas; on the contrary, they even have a reverse impact on the people's lives. A fundamental misunderstood assumption in the conservation process in Ranomafana was to consider the local people as a problem for biodiversity conservation. Major reasons for the failure of the ICDP in Ranomafana include a lack of local institutions that would have been able to communicate as equals with the conservation NGOs as well as to transfer the tradition of the authoritarian governance in conservation management together with the over-appreciation of scientific biodiversity, and lack of will to understand the local people's rights to use the forest for their livelihoods.

Impact of riparian land use on stream insects of Kudremukh National Park, Karnataka state, India

The impact of riparian land use on the stream insect communities was studied at Kudremukh National Park located within Western Ghats, a tropical biodiversity hotspot in India. The diversity and community composition of stream insects varied across streams with different riparian land use types. The rarefied family and generic richness was highest in streams with natural semi evergreen forests as riparian vegetation. However, when the streams had human habitations and areca nut plantations as riparian land use type, the rarefied richness was higher than that of streams with natural evergreen forests and grasslands. The streams with scrub lands and iron ore mining as the riparian land use had the lowest rarefied richness. Within a landscape, the streams with the natural riparian vegetation had similar community composition. However, streams with natural grasslands as the riparian vegetation, had low diversity and the community composition was similar to those of paddy fields. We discuss how stream insect assemblages differ due to varied riparian land use patterns, reflecting fundamental alterations in the functioning of stream ecosystems. This understanding is vital to conserve, manage and restore tropical riverine ecosystems.

A Strategy for Conserving the Biodiversity of the Uttara Kannada District in South India

Taking the various values ascribed to biodiversity as its point of departure rather many years ago, the present study aims at deriving a conservation strategy for Uttara Kannada. This hilly district, with the highest proportion of its area under forests in South India, is divided into five ecological zones: coastal, northern evergreen, southern evergreen, moist deciduous, and dry deciduous. The heavily-populated coastal zone includes mangrove forests and estuarine wetlands. The evergreen forests are particularly rich in the diversity of plant species which they support - including wild relatives of a number of cultivated plants. They also serve a vital function in watershed conservation. The moist deciduous forests are rich in bird species; both moist and dry deciduous forests include a number of freshwater ponds and lakes that support a high diversity of aquatic birds.Reviewing the overall distribution of biodiversity, we identify specific localities - including estuaries, evergreen forests, and moist deciduous forests - which should be set aside as Nature reserves. These larger reserves must be complemented by a network of traditionally-protected sacred groves and sacred trees that are distributed throughout the district and that protect today, for instance, the finest surviving stand of dipterocarp trees.We also spell out the necessary policy-changes in overall development strategy that should stem the ongoing decimation of biodiversity. These include (1) revitalizing community-based systems of sustainable management of village forests and protection of sacred groves and trees; (2) reorienting the usage-pattern of reserve forests from production of a limited variety of timber and softwood species for industrial consumers, to production of a larger diversity of non-wood forest produce of commercial value to support the rural economy; (3) utilizing marginal lands under private ownership for generating industrial wood supplies; and (4) provision of incentives for in situ maintenance of land-races of cultivated plants - especially evergreen, fruit-yielding trees - by the local people.It is proposed that this broad framework be now taken to the local communities, and that an action-plan be developed on the basis of inputs provided - and initiatives taken - by them.

Phenology of tree species of tropical moist forest of Uttara Kannada district, Karnataka, India

Phenological observations on tree species in tropical moist forest of Uttara Kannada district (13ℴ55′ to 15ℴ31′ N lat; 74ℴ9′ to 75ℴ10′ E long) during the years 1983–1985 revealed that there exists a strong seasonality for leaf flush, leaf drop and reproduction. Young leaves were produced in the pre-monsoon dry period with a peak in February, followed by the expansion of leaves which was completed in March. Abscission of leaves occurred in the post-monsoon winter period with a peak in December. There were two peaks for flowering (December and March), while fruit ripening had a single peak in May–June, preceding the monsoon rainfall. The duration of maturation of leaves was the shortest, while that of full ripening of fruits was the longest. Mature flowers of evergreen species lasted longer than those of deciduous species; in contrast the phenophase of ripe fruits of deciduous species was longer than that of evergreen species.

Recovery of copper from vanadiferrous magnetite ore of Masanikere area, Shimoga district

Studies have been carried out to recover copper from vanadiferrous magnetite ores by a novel reaction with lime in the presence of water vapour. The ore, mixed with different proportions of lime, has been roasted in the presence of steam. The roasted product is either directly leached with dilute mineral acids or subjected to magnetic separation and then leached. The effect of various parameters such as amount of lime added, temperature and duration of roasting and time of leaching on the recovery of copper has been investigated. The results indicate that over 90% copper could be recovered under optimum conditions of roasting and leaching.

Decentralized Sustainable Energy Planning of Tumkur District, India

Present work shows the feasibility of decentralized energy options for the Tumkur district in India. Decentralized energy planning (DEP) involves scaling down energy planning to subnational or regional scales. The important aspect of the energy planning at decentralized level would be to prepare an area-based DEP to meet energy needs and development of alternate energy sources at least-cost to the economy and environment. The geographical coverage and scale reflects the level at which the analysis takes place, which is an important factor in determining the structure of models. In the present work, DEP modeling under different scenarios has been carried out for Tumkur district of India for the year 2020. DEP model is suitably scaled for obtaining the optimal mix of energy resources and technologies using a computer-based goal programming technique. The rural areas of the Tumkur district have different energy needs. Results show that electricity needs can be met by biomass gasifier technology, using biomass feedstock produced by allocating only 12% of the wasteland in the district at 8 t/ha/yr of biomass productivity. Surplus electricity can be produced by adopting the option of biomass power generation from energy plantations. The surplus electricity generated can be supplied to the grid. The sustainable development scenario is a least cost scenario apart from promoting self-reliance, local employment, and environmental benefits. (C) 2010 American Institute of Chemical Engineers Environ Prog, 30: 248-258, 2011

A comparative analysis of regeneration in natural forests and joint forest management plantations in Uttara Kannada district, Western Ghats

Five villages undertaking joint forest management (JFM) were chosen in Uttara Kannada district, Karnataka for assessing regeneration in plantations and nearby natural forests of the village. Species number, stem density, diversity index, similarity in species composition in less disturbed and disturbed forests and plantations in the village were compared. Stem density was low in all the disturbed forests; however, the species number was low in disturbed forests of three villages and high in two villages. Plantations showed lower diversity values compared to the adjacent natural forests. Regeneration in all less disturbed forests was better compared to the disturbed counterparts. Villages were ranked based on number of landless families, per, capita forest available and number of cut stems. Assessment of village forests using ranks indicates that parameters such as per capita availability, cut stems in the forests may determine the success of JFM.

The Asian elephants Elephas maximus of Cat Tien National Park, Vietnam: status and conservation of a vanishing population

This study updates the status and conservation of the Endangered Asian elephant Elephas maximus in Cat Tien National Park, Vietnam. Line transect indirect surveys, block surveys for elephant signs, village surveys of elephant-human conflict incidents, guard-post surveys for records of sightings, and surveys of elephant food plants were undertaken during the dry and wet seasons of 2001. A minimum of 11 elephants and a maximum of 15-17 elephants was estimated for c. 500 km2 of the Park and its vicinity. The elephants are largely confined to the southern boundary of the Park and make extensive use of the adjoining La Nga State Forest Enterprises. During the dry season the elephants depend on at least 26 species of wild and cultivated plants, chiefly the fruits of cashew. Most of the villages surveyed reported some elephant-human conflict. Two adult male elephants seem to cover a large area to raid crops, whereas the family groups restrict themselves to a few villages; overall, the conflict is not serious. Since 2001 there have been no reports of any deaths or births of elephants in the Park. We make recommendations for habitat protection and management, increasing the viability of the small population, reducing elephant-human conflicts, and improving the chances of survival of the declining elephants of this Park. The Government has now approved an Action Plan for Urgent Conservation Areas in Vietnam that calls for the establishment of three elephant conservation areas in the country, including Cat Tien National Park.