Initiating advance care planning on end-of-life issues in dementia: Ambiguity among UK and Dutch physicians

Background
In dementia, advance care planning (ACP) of end-of-life issues may start as early as possible in view of the patient’s decreasing ability to participate in decision making. We aimed to assess whether practicing physicians in the Netherlands and the United Kingdom who provide most of the end-of-life care, differ in finding that ACP in dementia should start at diagnosis.

Methods
In a cross-sectional study, we surveyed 188 Dutch elderly care physicians who are on the staff of nursing homes and 133 general practitioners from Northern Ireland. We compared difference by country in the outcome (perception of ACP timing), rated on a 1–5 agreement scale. Regression analyses examined whether a country difference can be explained by contrasts in demographics, presence, exposure and role perceptions.

Results
There was wide variability in agreement with the initiation of ACP at dementia diagnosis, in particular in the UK but also in the Netherlands (60.8% agreed, 25.3% disagreed and 14.0% neither agreed, nor disagreed). Large differences in physician characteristics (Dutch physicians being more present, exposed and adopting a stronger role perception) hardly explained the modest country difference. The perception that the physician should take the initiative was independently associated with agreeing with ACP at diagnosis.

Conclusions
There is considerable ambiguity about initiating ACP in dementia at diagnosis among physicians practicing in two different European health care systems and caring for different patient populations. ACP strategies should accommodate not only variations in readiness to engage in ACP early among patient and families, but also among physicians.

The estimation and improvement of the selectivity in crustacean and fish trawls

Tese de dout., Ciências e Tecnologias das Pescas, Faculdade de Ciências do Mar e do Ambiente, Univ. do Algarve, 2003

Fast and accurate multi-scale keypoints based on end-stopped cells

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Last End Point / Pinckney Island PSG - R036/R037

The South Carolina Department of Natural Resources provides maps to recreational and state shellfish grounds, available to the public for recreational harvesting or to commercial harvest. This map shows the location of Last End Point / Pinckney Island PSG - R036/R0378 Recreational Shellfish Ground in Beaufort County.

Adaptive digital receivers for analog front-end mismatch correction

Phase and gain mismatches between the I and Q analog signal processing paths of a quadrature receiver are responsible for the generation of image signals which limit the dynamic range of a practical receiver. In this paper we analyse the effects these mismatches and propose a low-complexity blind adaptive algorithm to minimize this problem. The proposed solution is based on two, 2-tap adaptive filters, arranged in Adaptive Noise Canceller (ANC) set-up. The algorithm lends itself to efficient real-time implementation with minimal increase in modulator complexity.

Adaptive compensation of analog front-end I/Q mismatches in digital receivers

I and Q Channel phase and gain misniatches are of great concern in communications receiver design. In this paper we analyse the effects of I and Q channel mismatches and propose a low-complexity blind adaptive algorithm to minimize this problem. The proposed solution consists of two, 2-tap adaptive filters, arranged in Adaptive Noise Canceller (ANC) set-up, with the output of one cross-fed to the input of the other. The system works as a de-correlator eliminating I and Q mismatch errors.

Towards the End of Life: an In-depth Exploration of the Role of Admiral Nursing in Dementia Care (Innovative Practice)

There are approximately 150 Admiral Nurses in the UK who work alongside other health and social care professionals to support people with dementia and their family carers. However, the stigma of the disease and the lack of recognition that dementia is a life limiting illness have led to neglect in addressing the end of life challenges. The small in-depth study reported here aimed to add to an extremely limited formal evidence base for the effectiveness of this approach and to develop a greater understanding of the range of knowledge and skills required of them in ensuring they are better able to support families in the later stages of the illness. Findings focus on the experiences of family carers, the impact of performing the Admiral Nurse role and the use of qualitative measures in this setting.

Dual-tracking multi-constellation GNSS front-end for high-performance receiver applications

This paper presents the design and implementation of a dual–tracking Radio Frequency (RF) front–end for a multi–constellation Global Navigation Satellite Systems (GNSS) receiver. The RF frond–end is based on the direct RF conversion architecture, which employs sub–Nyquist sampling (also known as subsampling) at RF. The dual–tracking RF front–end is composed of a few RF components that are duplicated to form the two RF channels. Employing a dual–channel Analogue–to–Digital Converter (ADC) enables synchronisation of the RF channels and minimises the errors resulting from the differences in the satellite clocks and the propagation delay between the two RF channels. The digitised GNSS signals are processed by two separate acquisition and tracking engines that are driven by the front–end’s master clock. This setup provides two synchronised receivers that are integrated onto one piece of hardware. The hardware is intended to be used for research applications such as multipath mitigation, scintillation assessment, and advanced satellite clock and spatial frame transformation modelling.

The influence of multimorbidity on hospital, intensive care, and emergency department use at the end of life for patients with chronic conditions

Thesis (Master's)--University of Washington, 2016-03

At the end of the day: Macmillan's account of the Cuban missile crisis

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