900 resultados para End-Of-Life Management
Resumo:
This paper evaluates the implications of Osama bin Ladin’s death for the future of al-Qaeda’s global jihad. It critically examines the debate as to the make-up of the group and identifies bin Ladin’s primary role as chief ideologue advocating a defensive jihad to liberate the umma. The rationale and appeal of bin Ladin’s message and Muslims’ reaction to both his statements and al-Qaeda’s increasing use of sectarian violence are assessed in the context of Pan-Islam as political ideology. The paper concludes that while the ideal of Islamic unity and the sentiment of Muslim solidarity are unlikely to vanish, al-Qaeda’s violent jihad has not only failed to achieve these goals but has worked against it, thereby confining it to the political margins.
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The diversification of life involved enormous increases in size and complexity. The evolutionary transitions from prokaryotes to unicellular eukaryotes to metazoans were accompanied by major innovations inmetabolicdesign.Hereweshowthat thescalingsofmetabolic rate, population growth rate, and production efficiency with body size have changed across the evolutionary transitions.Metabolic rate scales with body mass superlinearly in prokaryotes, linearly in protists, and sublinearly inmetazoans, so Kleiber’s 3/4 power scaling law does not apply universally across organisms. The scaling ofmaximum population growth rate shifts from positive in prokaryotes to negative in protists and metazoans, and the efficiency of production declines across these groups.Major changes inmetabolic processes duringtheearlyevolutionof life overcameexistingconstraints, exploited new opportunities, and imposed new constraints. The 3.5 billion year history of life on earth was characterized by
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The aim of this article was to determine which aspects of Huntington's disease (HD) are most important with regard to the health-related quality of life (HrQOL) of patients with this neurodegenerative disease. Seventy patients with HD participated in the study. Assessment comprised the Unified Huntington's Disease Rating Scale (UHDRS) motor, cognitive and functional capacity sections, and the Beck Depression inventory. Mental and physical HrQOL were assessed using summary scores of the SF-36. Multiple regression analyses showed that functional capacity and depressive mood were significantly associated with HrQOL, in that greater impairments in HrQOL were associated with higher levels of depressive mood and lower functional capacity. Motor symptoms and cognitive function were not found to be as closely linked with HrQOL. Therefore, it can be concluded that, depressive mood and greater functional incapacity are key factors in HrQOL for people with HD, and further longitudinal investigation will be useful to determine their utility as specific targets in intervention studies aimed at improving patient HrQOL, or whether other mediating variables. As these two factors had a similar association with the mental and physical summary scores of the SF-36, this generic HrQOL measure did not adequately capture and distinguish the true mental and physical health-related HrQOL in HD.
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Hocaoglu MB, Gaffan EA, Ho AK. The Huntington's disease health-related quality of life questionnaire: a disease-specific measure of health-related quality of life. Huntington's disease (HD) is a genetic neurodegenerative disorder characterized by motor, cognitive and psychiatric disturbances, and yet there is no disease-specific patient-reported health-related quality of life outcome measure for patients. Our aim was to develop and validate such an instrument, i.e. the Huntington's Disease health-related Quality of Life questionnaire (HDQoL), to capture the true impact of living with this disease. Semi-structured interviews were conducted with the full spectrum of people living with HD, to form a pool of items, which were then examined in a larger sample prior to data-driven item reduction. We provide the statistical basis for the extraction of three different sets of scales from the HDQoL, and present validation and psychometric data on these scales using a sample of 152 participants living with HD. These new patient-derived scales provide promising patient-reported outcome measures for HD.
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Huntington’s disease (HD) is a fatal, neurodegenerative disease for which there is no known cure. Proxy evaluation is relevant for HD as its manifestation might limit the ability of persons to report their health-related quality of life (HrQoL). This study explored patient–proxy ratings of HrQoL of persons at different stages of HD, and examined factors that may affect proxy ratings. A total of 105 patient–proxy pairs completed the Huntington’s disease health-related quality of life questionnaire (HDQoL) and other established HrQoL measures (EQ-5D and SF-12v2). Proxy–patient agreement was assessed in terms of absolute level (mean ratings) and intraclass correlation. Proxies’ ratings were at a similar level to patients’ self-ratings on an overall Summary Score and on most of the six Specific Scales of the HDQoL. On the Specific Hopes and Worries Scale, proxies on average rated HrQoL as better than patients’ self-ratings, while on both the Specific Cognitive Scale and Specific Physical and Functional Scale proxies tended to rate HrQoL more poorly than patients themselves. The patient’s disease stage and mental wellbeing (SF-12 Mental Component scale) were the two factors that primarily affected proxy assessment. Proxy scores were strongly correlated with patients’ self-ratings of HrQoL, on the Summary Scale and all Specific Scales. The patient–proxy correlation was lower for patients at moderate stages of HD compared to patients at early and advanced stages. The proxy report version of the HDQoL is a useful complementary tool to self-assessment, and a promising alternative when individual patients with advanced HD are unable to self-report.
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The construction industry has become a truly global network of interconnected stakeholders making demands which require the involvement of skilled workforces from all over the world. Construction Management Strategies sets the foundations for understanding and managing construction’s inherent complexity and uniqueness. It establishes clear definitions of commonly accepted terms like built environment, construction, civil engineering, etc. which are often given confusing and conflicting interpretations. It cuts through the plethora of overlapping role titles currently used in the construction sector that make it difficult to establish how projects are actually managed.
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An automatic method for recognizing natively disordered regions from amino acid sequence is described and benchmarked against predictors that were assessed at the latest critical assessment of techniques for protein structure prediction (CASP) experiment. The method attains a Wilcoxon score of 90.0, which represents a statistically significant improvement on the methods evaluated on the same targets at CASP. The classifier, DISOPRED2, was used to estimate the frequency of native disorder in several representative genomes from the three kingdoms of life. Putative, long (>30 residue) disordered segments are found to occur in 2.0% of archaean, 4.2% of eubacterial and 33.0% of eukaryotic proteins. The function of proteins with long predicted regions of disorder was investigated using the gene ontology annotations supplied with the Saccharomyces genome database. The analysis of the yeast proteome suggests that proteins containing disorder are often located in the cell nucleus and are involved in the regulation of transcription and cell signalling. The results also indicate that native disorder is associated with the molecular functions of kinase activity and nucleic acid binding.
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This article examines the ways in which political organisations of the far left and far right responded to punk-informed youth culture in Britain during the late 1970s. It examines how both tried to understand punk within their own ideological framework, particularly in relation to the perceived socio-economic and political crises of the late 1970s, before then endeavouring to appropriate—or use—punk for their own ends. Ultimately, however, the article suggests that while punk may indeed be seen as a cultural response to the breakdown of what some have described as the post-war ‘consensus’ in the 1970s, the far left and far right's focus on cultural expression cut across the basic foundations on which they had been built. Consequently, neither left nor right proved able to provide an effective political conduit through which the disaffections expressed by punk could be channelled.
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The time evolution of the circulation change at the end of the Baiu season is investigated using ERA40 data. An end-day is defined for each of the 23 years based on the 850 hPa θe value at 40˚Nin the 130-140˚E sector exceeding 330 K. Daily time series of variables are composited with respect to this day. These composite time-series exhibit a clearer and more rapid change in the precipitation and the large-scale circulation over the whole East Asia region than those performed using calendar days. The precipitation change includes the abrupt end of the Baiu rain, the northward shift of tropical convection perhaps starting a few days before this, and the start of the heavier rain at higher latitudes. The northward migration of lower tropospheric warm, moist tropical air, a general feature of the seasonal march in the region, is fast over the continent and slow over the ocean. By mid to late July the cooler air over the Sea of Japan is surrounded on 3 sides by the tropical air. It is suggestive that the large-scale stage has been set for a jump to the post-Baiu state, i.e., for the end of the Baiu season. Two likely triggers for the actual change emerge from the analysis. The first is the northward movement of tropical convection into the Philippine region. The second is an equivalent barotropic Rossby wave-train, that over a 10-day period develops downstream across Eurasia. It appears likely that in most years one or both mechanisms can be important in triggering the actual end of the Baiu season.
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Urban domestic cat (Felis catus) populations can attain exceedingly high densities and are not limited by natural prey availability. This has generated concerns that they may negatively affect prey populations, leading to calls for management. We enlisted cat-owners to record prey returned home to estimate patterns of predation by free-roaming pets in different localities within the town of Reading, UK and questionnaire surveys were used to quantify attitudes to different possible management strategies. Prey return rates were highly variable: only 20% of cats returned ≥4 dead prey annually. Consequently, approximately 65% of owners received no prey in a given season, but this declined to 22% after eight seasons. The estimated mean predation rate was 18.3 prey cat−1 year−1 but this varied markedly both spatially and temporally: per capita predation rates declined with increasing cat density. Comparisons with estimates of the density of six common bird prey species indicated that cats killed numbers equivalent to adult density on c. 39% of occasions. Population modeling studies suggest that such predation rates could significantly reduce the size of local bird populations for common urban species. Conversely, most urban residents did not consider cat predation to be a significant problem. Collar-mounted anti-predation devices were the only management action acceptable to the majority of urban residents (65%), but were less acceptable to cat-owners because of perceived risks to their pets; only 24% of cats were fitted with such devices. Overall, cat predation did appear to be of sufficient magnitude to affect some prey populations, although further investigation of some key aspects of cat predation is warranted. Management of the predation behavior of urban cat populations in the UK is likely to be challenging and achieving this would require considerable engagement with cat owners.