Supporting family caregivers with palliative symptom management: A qualitative analysis of the provision of an emergency medication kit in the home setting

Purpose The purpose of this qualitative analysis was to examine the experiences of family caregivers supporting a dying person in the home setting. In particular, it explores caregivers’ perceptions of receiving palliative care at home when supplied with an emergency medication kit (EMK). Results Most family caregivers described preexisting medication management strategies that were unable to provide timely intervention in symptoms. The EMK was largely viewed as an effective strategy in providing timely symptom control and preventing readmission to inpatient care. Caregivers reported varying levels of confidence in the administration of medication. Conclusion The provision of an EMK is an effective strategy for improving symptom control and preventing inpatient admissions of home-dwelling palliative care patients.

The use of emergency medication kits in community palliative care: An exploratory survey of views of current practice in Australian home-based palliative care services

Improving symptom management for palliative care patients has obvious benefits for patients and advantages for the clinicians, as workload demands and work-related stress can be reduced when the emergent symptoms of patients are managed in a timely manner. The use of emergency medication kits (EMKs) can provide such timely symptom relief. The purpose of this study was to conduct a survey of a local service to examine views on medication management before and after the implementation of an EMK and to conduct a nationwide prevalence survey examining the use of EMKs in Australia. Most respondents from community palliative care services indicated that EMKs were not being supplied to palliative care patients but believed such an intervention could improve patient care.

Media Village Generates Hype, Few Results in Glasgow

Driven by a desire to redevelop derelict land, attract inward investments, and better exploit the commercial potential of local talent, public authorities in Glasgow are partnering with private developers to transform an abandoned industrial dockland into a riverside business cluster for the creative industries. It’s a strategy increasingly common in a number of other peripheral regions and it highlights the new role “creativity” plays in urban rejuvenation, social renewal, and economic development. At its core, the strategy also betrays a troubling policy shift away from certain democratic conceptions of culture to ones that are more attuned to economic considerations shaped by global influences.

Healthcare users’ experiences of communicating with healthcare professionals about children who have life-limiting conditions: A qualitative systematic review protocol

REVIEW QUESTION / OBJECTIVE The objective of this review is to identify and synthesize the best international qualitative evidence on healthcare users’ experiences of communication with healthcare professionals about children who have life-limiting conditions. For the purposes of this review, “healthcare users” will be taken to include children who have life-limiting conditions and their families. The question to be addressed is: - What are healthcare users’ experiences of communicating with healthcare professionals about children who have life-limiting conditions? INCLUSION CRITERIA - Types of participants: This review will consider all qualitative studies that focus on users of healthcare services for children who have life-limiting conditions. These users are anticipated to include children who have a life-limiting condition and their family members. In instances where children are not under the legal care of one or both parents, service users may also include other types of legal guardians. - Phenomena of interest: This review will consider experiences of communicating with healthcare professionals about children who have life-limiting conditions. - Context: This review will consider studies relating to communication with healthcare professionals about children who have a life-limiting condition, irrespective of whether the healthcare service is based in a hospital, hospice, or community setting. There is no restriction on the country in which a study was conducted.

Reverie I

Reverie I is a large-scale public art work commissioned by the Brisbane City Council for permanent installation on the Gardens Point Road Plinth adjacent to QUT Gardens Point campus in Brisbane. The work forms part of the artist's ongoing exploration of the methodology of self-portraiture and amorphous form. In this work, sculpted curls of hair have been assembled according to contours of its constituent cast panels - their capacity to nest with one another determined the final form of the work. The resulting mass of curls resembles both an oversized wig, a withered mulberry and a leaden cloud to invoke notions of movement, reflection and temporality. From the didactic panel: "The curls of Reverie I are derived from 18th century sculptural portraiture. The twisting forms of the highly styled wig known as a periwig were abstracted and inventive, while also bestowing an air of intellectual authority. Curls also evoke two aspects of this particular site: the erratic movement of water associated with the complex tidal movements of Brisbane River, and a state of mental reflection relevant to both the nearby university grounds (where intellectual work takes place) and the riverside pathway (a site for daydreaming)."

"Aplicación de un sistema multimétrico para evaluar la calidad del agua superficial en la microcuenca El Coyote del Rio Estelí, Nicaragua"

En la microcuenca El Coyote localizada en el municipio de Condega, Estelí, se evaluó la calidad del agua superficial de sde febrero del 2010 a febrero del 2011. El propósito fue la identificación de indicadores que faciliten la vigilancia y monitoreo de la calidad del agua . Se integró un sistema multimétrico utilizando las características físicoquímicas y bacteriológicas, macro invertebrados acuáticos, la caracterización morfométrica de la microcuenca y la información resultante a nivel de comunidad (cambios en el uso del suelo). En la determinación de la relación de la calidad del agua con la estructura de la macrofauna acuática (macroinvertebrados) se usó el método Biological Monitoring Working Party (BMWP/Col ) . La microcuenca tiene 144 afluentes con una forma oval - oblonga - alargada, y su curva hipsométrica refleja un estado de equilibrio relativo de juvenil a madurez. El uso del suelo es inadecuado y su entorno natural fue valorado como subóptimo. Aunque los parámetros fisico químicos indicaron que las aguas son alcalinas, con un nivel aceptable de oxigeno disuelto, categorizadas según el Diagrama de Riverside como aguas aptas par a riego (C2 - S1), y aceptables según valores determinados para DBO 5 y DQO; sin embargo, requieren de un tratamiento de descontaminación previo a su uso doméstico y agropecuario. Además, debido a la presencia de coliformes fecales estas aguas no están aptas para consumo humano . Los macroinvertebrados varían, según la estacionalidad, en riqueza, abundancia y distribución, presentando una disminución en el número de individuos en la época lluviosa (t= 5.21, p<2.18E - 07). E l 6 8 . 91 % de los macroinvertebrados bioin dicadores se distribuyeron en cinco familias : Leptohyphidae , Baetidae , Hydropsychidae , Chironomidae y Physidae , siendo el cariotipo piedra el que present ó mayor diversidad y abundancia . El promedio del BMWP /Col fue de 60.06, indicando una calidad del agua entre dudosa y aceptable , y el índice ASPT de 6.71 señala una contaminación moderada ; estos resultados coincide n con los obtenidos utilizando la batería de indicadores fisicoquímicos y bacteriológicos .

Cuidados paliativos y magisterio de la Iglesia

Resumen: Para entender el Cuidado Paliativo, según el Personalismo ontológico y el Magisterio, se necesita una ética del cuidado, basado en el imperativo del amor al prójimo. El centro de toda la asistencia es la persona, el respeto por su dignidad y la inviolabilidad de la vida humana, sin dejar de hacer referencia al fin último trascendente que fundamenta toda la existencia. Se considera imprescindible el diálogo integrador entre la fe, la razón y las ciencias que permita iluminar los Cuidados Paliativos a través de una antropología y filosofía moral que guíe la praxis de los profesionales y voluntarios. En el Hospice Madre Teresa se cuida al enfermo hasta su fin natural intentando anunciar el Se ayuda a todas las personas a descubrir, a la luz de la razón y de la fe, el significado a su existencia. Se trata de encontrar puntos de diálogo con los no creyentes para promover la cultura de la vida sabiendo que la razón, iluminada por la fe, se libera de los límites propios de la naturaleza humana encontrando la fuerza necesaria para elevarse al conocimiento del misterio de Dios.

Report of an investigation of a plan of elimination of grade crossings on the A.T. & S.F. Ry. in the city of Pasadena, California

The problem of the Atchison, Topeka, and Santa Fe railroad in Pasadena is a very dynamic one, as is readily recognized by engineers, city officials, and laymen. The route of the railroad was first laid out in the eighties and because of certain liberal concessions granted by the City of Pasadena, the right-of-way was located through Pasadena, despite the fact that the grade coming into the city either from Los Angeles or San Bernardino was enormous. Some years later, other transcontinental routes of the Santa Fe out of Los Angles were sought, and a right-of-way was obtained by way of Fullerton and Riverside to San Bernardino, where this route joins the one from Los Angeles through Pasadena. This route, however, is ten miles longer than the one through Pasadena, which means a considerable loss of time in a short diversion of approximately only sixty miles in length.

O hospício como morada: capturas e resistências nas práticas de cuidado em saúde mental

Esta pesquisa é disparada a partir do encontro da pesquisadora com as chamadas moradias dentro de hospitais psiquiátricos no Estado do Rio de Janeiro. No seio da reforma psiquiátrica e da instalação de uma rede de assistência substitutiva ao hospício, ocorrem transformações também no interior deste último: humanizam-se as práticas, retirando de cena o eletrochoque, a lobotomia, a camisa-de-força, fazendo documentos como CPF, RG e etc. Contudo, a edificação manicomial permanece de pé com os seus grandes pavilhões, alguns agora travestidos em moradias, que tanto podem operacionalizar uma passagem de dentro para fora dos muros como perpetuar o hospício. O texto indaga por que motivo, a partir de um certo momento, inaugura-se um novo modo de organização em saúde mental, em que a antiga centralidade hospitalar se fragmenta em moradias internas e se difundem os novos serviços, ditos abertos, para em seguida afirmar que a construção de uma rede substitutiva não assegura, definitivamente, o fim da relação manicomial. Com o suporte teórico de Foucault e Deleuze, propõe uma discussão acerca da biopolítica da espécie humana, da coexistência de tecnologias disciplinares e regulamentadoras e da inauguração, na sociedade de controle, de um exercício de poder difuso, a céu-aberto, dispensando a coação física e a instituição da reclusão. O texto, entretanto, não se deixa abater por essas análises, mantendo suas apostas numa Reforma Psiquiátrica que propõe como um campo de disputas, de embates cotidianos. É então que a temática do cuidado entra em cena. Para tanto, faz-se uma releitura do período helenístico-romano através dos olhos de Foucault. O Cuidado de Si é apresentado ao leitor para, em seguida, ser estabelecido um contraponto entre o mesmo e o modo de ser sujeito moderno e cristão, com exercícios de renúncia a si e práticas de sacrifício, que em muito se assemelham à maneira como os trabalhadores vêm atuando, hoje, no campo da saúde mental. O texto procura dar pistas e visibilizar as resistências presentes em meio às tantas capturas postas em análise. Trata-se de uma experimentação de práticas de liberdade que se atualizem na operação de cuidado.

Análise de uma iniciativa de valorização de rios e lagoas em áreas urbanas: Programa Águas do rio (Guardiões dos rios).

A preocupação com recursos hídricos tem sido crescente em meios urbanos. O despejo de resíduos sólidos em rios é comum por populações ribeirinhas, favorecendo a ocorrência de enchentes, a proliferação de vetores e doenças e o desprezo da comunidade pelos rios. Nesse contexto, programas que relacionam lixo, recursos hídricos e população ribeirinha têm sido objeto de várias iniciativas governamentais. Este trabalho busca avaliar uma delas: o Programa Municipal de valorização de rios e lagoas Águas do Rio (Guardiões dos rios) que foi desenvolvido pela prefeitura do Rio de Janeiro entre abril de 2001 a março de 2008. O programa buscou aliar interesses de ordem técnica, de saúde pública e de cunho social para a comunidade por utilizar mão de obra local para a manutenção da calha do rio, visando à retirada de lixo e entulhos do rio, geralmente em áreas de pequena extensão territorial, com manutenção adequada de margens e entornos. A partir de entrevistas abertas e questionários aplicados junto aos envolvidos de 27 frentes de trabalho, constatou-se um resultado bastante positivo nas comunidades onde o Programa foi implantado: diminuição de enchentes, redução de vetores e melhoria da paisagem urbana. Contudo, observou-se também profundo descontentamento com a interrupção do Programa, atribuído principalmente ao uso indevido por determinados políticos (ampliação descontrolada do Programa com abandono de critérios técnicos) e a transferência da sua gestão para uma instituição municipal que não o manteve funcionando. Conclui-se, sobretudo, que o Programa Guardiões dos rios é uma iniciativa criativa de ações emergenciais em rios urbanos, em nível municipal, que combina a retirada de lixo dos rios, um trabalho social e campanhas de educação ambiental junto às comunidades.

Weighing your options: how to protect your property from shoreline erosion, a handbook for estuarine property owners in North Carolina

If you own property on one of North Carolina’s estuaries, you can use this guide as a tool to learn about the choices you have to control your shoreline erosion and help decide which approach may be right for you. In North Carolina, we make a distinction between waterfront property that is located on the estuary, referred to as estuarine, shoreline, soundfront or riverside property, and waterfront property located directly on the ocean, referred to as oceanfront. Why? State laws and regulations addressing estuarine and oceanfront property, and the available erosion control methods, are quite different. This guide focuses on estuarine property. We’ll introduce you to the six main erosion control options in use in North Carolina and give you information about the out-of-pocket costs and tangible benefits of each option. We’ll also give you information about “hidden” costs and benefits that you may want to factor into your decision-making. You are fortunate to have a piece of estuarine shoreline to call your own, whether it’s your year-round residence or a weekend getaway. And if you’ve noticed some shoreline erosion lately, you’re probably a little concerned. But there are ready solutions.

细粒沉积物多组分粒度特征及其成因机制研究

By using high-resolution laser grain size instrument Mastersizer 2000, the grain size distribution of windblown depositions (loess and sandy dunes), aqueous sediments (lake, river, riverside and foreshore sand), weathering crust, sloping materials and other fine-grain sediments are systemically measured. The multimodal characteristics of grain size distribution of these sediments are carefully studied. The standard patterns and their grain size characteristics of various sediments are systemically summarized. The discrepancies of multimodal distribution among windblown depositions, aqueous sediments and other sediments are concluded and the physical mechanisms of grain size multimodal distribution of various sediments are also discussed in this paper. The major conclusions are followed: 1. The multimodal characteristic of grain size distribution is a common feature in all sediments and results from properties of transportation medium, dynamic intensity, transportation manner and other factors. 2. The windblown depositions are controlled by aerodynamic forcing, resulting in that the median size of the predominant mode gradually decreases form sandy dunes to loess. Similarly, the aqueous sediments are impacted by dynamic forces of water currents and the median grain size of the predominant mode decreases gradually from river to lake sediments. Because the kinetic viscidity of air is lower than of water, the grain size of modes of windblown depositions is usually finer than that of corresponding modes of aqueous sediments. Typical characteristics of sediments grain size distribution of various sediments have been summarized in the paper: (1) Suspended particles which diameters are less than 75μm are dominant in loess and dust. There are three modes in loess’ grain size distribution: fine, median and coarse (the median size is <1μm、1-10μm、10-75μm, respectively). The coarse mode which percentage is larger than that of others is controlled by source distance and aerodynamic intensity of dust source areas. Some samples also have a saltation mode which median size is about 300-500μm. Our analysis demonstrates that the interaction of wind, atmospheric turbulence, and dust grain gravity along the dust transportation path results in a multimodal grain size distribution for suspended dust. Changes in the median sizes of the coarse and medium modes are related to variation in aerodynamic forcing (lift force related to vertical wind and turbulence) during dust entrainment in the source area and turbulence intensity in the depositional area. (2) There is a predominant coarse saltation mode in grain size distribution of sandy dunes, which median size is about 100-300μm and the content is larger than that of other modes. The grain size distribution curve is near axis symmetric as a standard logarithm normal function. There are some suspended particles in some samples of sandy dunes, which distribution of the fine part is similar to that of loess. Comparing with sandy samples of river sediments, the sorting property of sandy dunes is better than of river samples although both they are the saltation mode. Thus, the sorting property is a criterion to distinguish dune sands and river sands. (3) There are 5~6 modes (median size are <1μm, 1-10μm, 10-70μm, 70-150μm, 150-400μm, >400μm respectively) in grain size distribution of lacustrine sediments. The former 4 modes are suspensive and others are saltated. Lacustrine sediments can be divided into three types: lake shore facies, transitional facies and central lake facies. The grain size distributions of the three facies are distinctly different and, at the same time, the transition among three modes is also clear. In all these modes, the third mode is a criteria to identify the windblown deposition in the watershed. In lake shore sediments, suspended particles are dominant, a saltation mode sometimes occurs and the fourth mode is the most important mode. In the transitional facies, the percentage of the fourth mode decreases and that of the second mode increases from lake shore to central lake. In the central lake facies, the second mode is dominant. A higher content of the second mode indicates its position more close to the central lake. (4) The grain size distribution of river sediments is the most complex. It consist of suspension, saltation and rolling modes. In most situations, the percentage of the saltation mode is larger than that of other modes. The percentage of suspension modes of river sediments is more than of sandy dunes. The grain size distribution of river sediments indicates dynamic strength of river currents. If the fourth mode is dominant, the dynamic forcing of river is weaker, such as in river floodplain. If the five or sixth mode is dominant, the water dynamic forcing of rivers is strong. (5) Sediments can be changed by later forcing in different degree to form some complicated deposition types. In the paper, the grain size distribution of aqueous sediments of windblown deposition, windblown sediments of aqueous deposition, weathering crust and slope materials are discussed and analyzed. 3. The grain size distribution characteristics of different sediments are concluded: (1) Modal difference: Usually there are suspended and saltation modes in the windblown deposition. The third mode is dominant in loess dust and the fifth mode is predominant in sandy dunes. There are suspended, saltation and rolling particles in aqueous sediments. In lacustrine sediments, the second and fourth mode are predominant for central lake facies or lake shore facies, respectively. In river sediments, the fourth, or fifth, or sixth mode is predominant. Suspended modes: the grain size of suspended particles of windblown depositions usually is less than 75μm. The content of suspended particles is lower or none in sandy dunes. However, suspended particles of aqueous sediments may reach 150μm. Difference in grain size of suspended modes represents difference between transitional mediums and the strength of dynamic forcing. Saltation modes: the median size of saltation mode of sandy dunes fluctuates less than that of river sediments. (2) Loess dust and lacustrine sediment: Their suspended particles are clearly different. There is an obvious pit between the second and the third modes in grain size distribution of lacustrine sediments. The phenomenon doesn’t occur in loess dust. In lacustrine sediments, the second mode can be a dominant mode, such as central lake facies, and contents of the second and the third modes change reversely. However, the percentage of the third mode is always the highest in loess dust. (3) Dune Sand and fluvial sand: In these two depositions, the saltation particles are dominant and the median sizes of their saltation modes overlay in distribution range. The fifth mode of dune sand fluctuates is sorted better than that of fluvial sand. (4) Lacustrine and fluvial sediments: In lacustrine sediments, there are 5-6 modes and suspended particles can be predominant. The second mode is dominant in central lake facies and the third mode is dominant in lake shore facies. Saltation or roll modes occurred in central lake facies may indicate strong precipitation events. In fluvial sediments, saltation particles (or rolling particles) usually dominant. 4. A estimation model of lake depth is firstly established by using contents of the second, the third and the fourth modes. 5. The paleoenvironmental history of the eastern part of SongLiao basin is also discussed by analyzing the grain size distribution of Yushu loess-like sediments in Jilin. It was found that there is a tectonic movement before 40ka B.P. in SongLiao basin. After the movement, loess dust deposited in Yushu area as keerqin desert developed. In recent 2000 years, the climate became drier and more deserts activated in the eastern part of Song-Liao basin.

SOVEREIGN: An Autonomous Neural System for Incrementally Learning Planned Action Sequence to Navigate Towards a Rewarded Goal

How do reactive and planned behaviors interact in real time? How are sequences of such behaviors released at appropriate times during autonomous navigation to realize valued goals? Controllers for both animals and mobile robots, or animats, need reactive mechanisms for exploration, and learned plans to reach goal objects once an environment becomes familiar. The SOVEREIGN (Self-Organizing, Vision, Expectation, Recognition, Emotion, Intelligent, Goaloriented Navigation) animat model embodies these capabilities, and is tested in a 3D virtual reality environment. SOVEREIGN includes several interacting subsystems which model complementary properties of cortical What and Where processing streams and which clarify similarities between mechanisms for navigation and arm movement control. As the animat explores an environment, visual inputs are processed by networks that are sensitive to visual form and motion in the What and Where streams, respectively. Position-invariant and sizeinvariant recognition categories are learned by real-time incremental learning in the What stream. Estimates of target position relative to the animat are computed in the Where stream, and can activate approach movements toward the target. Motion cues from animat locomotion can elicit head-orienting movements to bring a new target into view. Approach and orienting movements are alternately performed during animat navigation. Cumulative estimates of each movement are derived from interacting proprioceptive and visual cues. Movement sequences are stored within a motor working memory. Sequences of visual categories are stored in a sensory working memory. These working memories trigger learning of sensory and motor sequence categories, or plans, which together control planned movements. Predictively effective chunk combinations are selectively enhanced via reinforcement learning when the animat is rewarded. Selected planning chunks effect a gradual transition from variable reactive exploratory movements to efficient goal-oriented planned movement sequences. Volitional signals gate interactions between model subsystems and the release of overt behaviors. The model can control different motor sequences under different motivational states and learns more efficient sequences to rewarded goals as exploration proceeds.

The Medway Valley: a Kent landscape transformed

In 1750 the lower Medway Valley, the area between the towns of Maidstone and Rochester, was firmly part of Kent's 'Garden of England'. A century later, this tranquil, agrarian landscape had been transformed into a hive of industry and commerce, through the emergence of papermaking, cement manufacture, brickmaking, brewing, ship and barge building, seed crushing and engineering. The lower Medway Valley became synonymous with the production of Portland cement, stock bricks and the steam engines of Aveling and Porter, yet, by the end of the Second World War, much of this industry was gone. "The Medway Valley: A Kent Landscape Transformed", the first Victoria County History publication in Kent for over 75 years, charts this cyclical story of landscape change. It explores how the quiet, rural landscape of a collection of eight riverside parishes around Rochester was dramatically transformed during industrialization, before returning to its formal rural state. This volume traces the impact of industrial development and decline on the valley and its people. It details changing patterns of work and society, the creation of new settlements and the pivotal role of the river in all aspects of village life reflecting two centuries of change and upheaval.

Bereavement needs assessment in specialist palliative care: A review of the literature

Bereavement needs assessment for specialist palliative care services has been highlighted as important by NICE guidance on palliative care for adults with cancer. Identifying and implementing appropriate bereavement measurement tools has remained a challenge. This paper identifies and reviews bereavement measurement tools to determine their suitability for use within bereavement services and hospice settings. Cochrane, MEDLINE, PsycINFO and CINAHL, electronic databases were searched, yielding 486 papers. From fifty-nine full text papers appraised, 10 measurement tools were analysed in detail. Some tools had been tested on specific populations which limited transferability to specialist palliative care settings; some lacked adequate theoretical links and were not effective in discriminating between normal and complicated grief reactions; and some lacked clear evidence of validity or reliability. Based on these criteria, conclusions are drawn about the suitability of particular tools for UK bereavement services and hospice settings where intervention is delivered by both trained professionals and volunteers.