An Appraisal of End-of-Life Care in Persons with Chronic Kidney Disease Dying in Hospital Wards

AIM: To review end-of-life care provided by renal healthcare professionals to hospital in-patients with chronic kidney disease, and their carers, over a 12-month period in Northern Ireland.

METHODS: Retrospective review of 100 patients.

RESULTS: Mean age at death was 72 years (19-95) and 56% were male. Eighty three percent of patients had a 'Not For Attempted Resuscitation' order during their last admission and this was implemented in 42%. Less than 20% of all patients died in a hospital ward. No patients had an advanced care plan, although 42% had commenced the Liverpool Care Pathway for the Dying Patient. Patients suffered excessive end-of-life symptoms. In addition, there was limited documentation of carer involvement and carer needs were not formally assessed.

CONCLUSION: End-of-life care for patients with advanced chronic renal disease can be enhanced. There is significant variation in the recording of discussions regarding impending death and little preparation. There is poor recording of the patients' wishes regarding death. Those with declining functional status, including those frequently admitted to hospital require holistic assessment regarding end-of-life needs. More effective communication between the patient, family and multi-professional team is required for patients who are dying and those caring for them.

An international comparison of legal frameworks for supported and substitute decision-making in mental health services

There have been important recent developments in law, research, policy and practice relating to supporting people with decision-making impairments, in particular when a person’s wishes and preferences are unclear or inaccessible. A driver in this respect is the United Nations Convention on the Rights of Persons with Disabilities (CRPD); the implications of the CRPD for policy and professional practices are currently debated. This article reviews and compares four legal frameworks for supported and substitute decision-making for people whose decision-making ability is impaired. In particular, it explores how these frameworks may apply to people with mental health problems. The four jurisdictions are: Ontario, Canada; Victoria, Australia; England and Wales, United Kingdom (UK); and Northern Ireland, UK. Comparisons and contrasts are made in the key areas of: the legal framework for supported and substitute decision-making; the criteria for intervention; the assessment process; the safeguards; and issues in practice. Thus Ontario has developed a relatively comprehensive, progressive and influential legal framework over the past thirty years but there remain concerns about the standardisation of decision-making ability assessments and how the laws work together. In Australia, the Victorian Law Reform Commission (2012) has recommended that the six different types of substitute decision-making under the three laws in that jurisdiction, need to be simplified, and integrated into a spectrum that includes supported decision-making. In England and Wales the Mental Capacity Act 2005 has a complex interface with mental health law. In Northern Ireland it is proposed to introduce a new Mental Capacity (Health, Welfare and Finance) Bill that will provide a unified structure for all substitute decision-making. The discussion will consider the key strengths and limitations of the approaches in each jurisdiction and identify possible ways that further progress can be made in law, policy and practice.

The Shifting Battleground of Article 4(2) TEU: Evolving National Identities and the corresponding need for EU management?

Article 4(2) TEU requires that the European Union (EU) respect the Member States’ national identities, creating a legal obligation enforceable before the CJEU and valuable in political negotiations. However, the concept of national identities is unclear, leaving open questions about the scope or parameters of the provision and its applicability. The CJEU appears likely to take a relatively flexible approach in light of Article 4(2) TEU’s relationship with national constitutional courts’ reserves. This flexible approach would enable Member States to rely upon a range of aspects as part of their national identity, including ones that were previously unidentified. This is a crucial feature if one considers that national identities may evolve gradually or even dramatically, including where Member States purposefully attempt to develop their national identities further. This possibility of an evolved national identity is exemplified by the French Charte de l’Environnement. It may thereby be possible for Member States to stretch the scope and application of Article 4(2) TEU through reference to these evolving national identities. This potential raises significant challenges for the EU regarding the management of Article 4(2) TEU, which it will need to address if it wishes to ensure harmonisation and uniformity in the relevant areas.

Cooperative Beamforming and User Selection for Improving the Security of Relay-aided Systems

A relay network in which a source wishes to convey a confidential message to a legitimate destination with the assistance of trusted relays is considered. In particular, cooperative beamforming and user selection techniques are applied to protect the confidential message. The secrecy rate (SR) and secrecy outage probability (SOP) of the network are investigated first, and a tight upper bound for the SR and an exact formula for the SOP are derived. Next, asymptotic approximations for the SR and SOP in the high signal-to-noise ratio (SNR) regime are derived for two different schemes: i) cooperative beamforming and ii) multiuser selection. Further, a new concept of cooperative diversity gain, namely, adapted cooperative diversity gain (ACDG), which can be used to evaluate security level of a cooperative relaying network, is investigated. It is shown that the ACDG of cooperative beamforming is equal to the conventional cooperative diversity gain of traditional multiple-input single-output networks, while the ACDG of the multiuser scenario is equal to that of traditional single-input multiple-output networks.

A aula universitária:figurações das coreografias de ensino

Tese de doutoramento, Educação (Formação de Professores), Universidade de Lisboa, Instituto de Educação, 2013

Hollywood and world cinema influences: tracing intertextuality in the works of two contemporary filmmakers from Francophone Africa; Mahamat Saleh Haroun and Abderrahmane Sissako

Don’t tell me the moon is shining; show me the glint of light on broken glass Anton Chekhov Representations of Africa in cinema are almost as old as cinema itself and date back to Hollywood’s silent era. Most early examples feature the continent as a mere exotic backdrop and include The Sheik (Melford 1921), soon followed, in 1926, by George Fitzmaurice’s Son of the Sheik starring Rudolph Valentino. The next decade brought Van Dyke’s Tarzan movies, Robert Stevenson’s King Solomon’s Mines (1937), and, on the European side, Duvivier’s Pépé le Moko (1936). For representations of Francophone Africa by Africans themselves, the viewing public more or less had to wait, however, until decolonisation in the 1960s (with, for example, Sembene Ousmane’s Borom Sarret and La Noire de…, both released in 1966 and, in 1968, Mandabi). Since then Francophone African cinema has come a long way and has diversified into various strands. Between Borom Sarret and Mahamat-Saleh Haroun’s 2006 Daratt, Saison sèche - or the same director’s Un homme qui crie, almost half a century has elapsed. Over this period, films inevitably have addressed a spectrum of visual, ideological and political tropes. They range from unadorned depictions of the newly independent states and their societies to highly aestheticised productions, not to mention surreal and poetic visions as displayed for instance in Djibril Diop Mambéty’s Touki Bouki (1973). Most of the early films send an overt socio-political message which is a clear and explicit denunciation of a corrupt state of affairs (Souleymane Cissé’s Baara, 1977). They aim to trigger strong emotional and political responses from the viewer, in unambiguous support for the film-maker’s stand. Sembene himself declared: “I consider cinema a means of political action” (Murphy 2000: 221). Similarly, the Mauritanian director Med Hondo wishes to “take up this technical medium and to make it a mouthpiece on behalf of [his] fellow Africans and Arabs” (Jeffries 2002: 11). All this echoes the claims of the Fédération Panafricaine des Cinéastes (FEPACI, founded in 1969), an organisation “dedicated to the liberation of Africa”. In sharp contrast to the incipient momentum given Francophonie by Bourguiba, the Nigerien Hamani Diori and the Senegalese Senghor, who invoked a worldwide communauté organique francophone, FEPACI called for “the creation of an aesthetics of disalienation… [using] didactic... forms to denounce the alienation of countries that were politically independent but culturally and economically dependent on the West” (Diawara 1996: 40). Sembene’s Xala (1974) became the blueprint for this, to this day the best-known vein of Francophone African cinema. Thus considered, this pedigree seems a million miles from mainstream global cinema with its overriding mission to entertain. A question therefore arises: to what extent can a cinema that sprang from such beginnings be seen to interface in any meaningful way with a global film industry that, overwhelmingly and for a century, has indeed entertained the world – with Hollywood at its centre?

Relatório de estágio

I (Prática Pedagógica) - O estágio foi realizado na Academia de Música de Almada (AMA) com três alunos de níveis diferentes: Aluno x, Iniciação Musical; Aluna y, 2º grau; e Aluna z, 5º grau. A planificação do trabalho foi feita com a colaboração do professor Vasco Broco e sob a supervisão do professor Pedro Saglimbeni Muñoz, tendo por base o programa da AMA e procurando corresponder às necessidades individuais de cada aluno, bem como respeitar os diferentes ritmos de aprendizagem. Dadas as diferenças de idade e de nível, os objectivos que procurei atingir com cada aluno durante o ano lectivo são naturalmente díspares, bem como a perspectiva de cada um em relação ao próprio instrumento e ao ensino da música. Enquanto que os mais novos encaram a aprendizagem musical como uma actividade meramente recreativa, pelo menos por enquanto, a Aluna z ambiciona fazer uma carreira como instrumentista. Mesmo entre os mais novos há diferenças, pois apesar de o Aluno x ainda estar a frequentar a Iniciação Musical, já iniciou a sua aprendizagem há mais tempo do que a Aluna y, encarando o ensino com mais seriedade. A AMA tem a vantagem de ter um pianista acompanhador disponível para cada dia da semana, o que tornou possível desenvolver um trabalho consistente com os alunos em termos de ensaios e audições. As audições e momentos de avaliação foram marcados em reuniões de Departamento Curricular, à excepção da calendarização das Provas Globais que foi feita em reunião de Conselho Pedagógico. O aproveitamento foi positivo para os três alunos no final do estágio, tendo todos transitado para o nível de ensino seguinte.

Localização da página web da VisionSpace – do inglês ao francês

Trabalho de Projeto apresentado ao Instituto de Contabilidade e Administração do Porto para a obtenção do grau de Mestre em Tradução e Interpretação Especializadas, sob orientação do Doutor Manuel Moreira da Silva e coorientação da Mestre Isabelle Tulekian

Ambivalent Islam: the identity construction of Muslims under Portuguese colonial rule

This article wishes to contribute to the study of the historical processes that have been spotting Muslim populations as favourite targets for political analysis and governance. Focusing on the Portuguese archives, civil as well as military, the article tries to uncover the most conspicuous identity representations (mainly negative or ambivalent) that members of Portuguese colonial apparatus built around Muslim communities living in African colonies, particularly in Guinea-Bissau and Mozambique. The paper shows how these culturally and politically constructed images were related to the more general strategies by which Portuguese imagined their own national identity, both as ‘European’ and as ‘coloniser’ or ‘imperial people’. The basic assumption of this article is that policies enforced in a context of inter-ethnic and religious competition are better understood when linked to the identity strategies inherent to them. These are conceived as strategic constructions aimed at the preservation, the protection and the imaginary expansion of the subject, who looks for groups to be included in and out-groups to reject, exclude, aggress or eliminate. We think that most of the inter-ethnic relationships and conflicts, as well as the very experience of ethnicity, are born from this identity matrix.

A marketing plan for Companhia das Quintas to strengthen its position in the Chinese wine market

Companhia das Quintas, Limited Company wishes to conquer the Chinese market with its wines. For that, it decided to enter in a partnership with a local importer and distributor. This project analyses the macroeconomic factors of the country, the local market and the consumer behavior, using on-site research that included interviews with professionals of the industry, unstructured observation of the consumer and existing statistical data analysis. Finally, the project presents a marketing plan to make this partnership a success.

Detection of testosterone administration based on the carbon isotope ratio profiling of endogenous steroids: international reference populations of professional soccer players.

BACKGROUND AND OBJECTIVES: The determination of the carbon isotope ratio in androgen metabolites has been previously shown to be a reliable, direct method to detect testosterone misuse in the context of antidoping testing. Here, the variability in the 13C/12C ratios in urinary steroids in a widely heterogeneous cohort of professional soccer players residing in different countries (Argentina, Italy, Japan, South Africa, Switzerland and Uganda) is examined. METHODS: Carbon isotope ratios of selected androgens in urine specimens were determined using gas chromatography/combustion/isotope ratio mass spectrometry (GC-C-IRMS). RESULTS: Urinary steroids in Italian and Swiss populations were found to be enriched in 13C relative to other groups, reflecting higher consumption of C3 plants in these two countries. Importantly, detection criteria based on the difference in the carbon isotope ratio of androsterone and pregnanediol for each population were found to be well below the established threshold value for positive cases. CONCLUSIONS: The results obtained with the tested diet groups highlight the importance of adapting the criteria if one wishes to increase the sensitivity of exogenous testosterone detection. In addition, confirmatory tests might be rendered more efficient by combining isotope ratio mass spectrometry with refined interpretation criteria for positivity and subject-based profiling of steroids.

Prevalence and factors associated with difficulty and intention to quit smoking in Switzerland.

ABSTRACT: BACKGROUND: Recent data indicate a slight decrease in the prevalence of smoking in Switzerland, but little is known regarding the intention and difficulty to quit smoking among current smokers. Hence, we aimed to quantify the difficulty and intention to quit smoking among current smokers in Switzerland. METHODS: Cross-sectional study including 607 female and 658 male smokers. Difficulty, intention and motivation to quit smoking were assessed by questionnaire. RESULTS: 90% of women and 85% of men reported being "very difficult" or "difficult" to quit smoking. Almost three quarters of smokers (73% of women and 71% of men) intended to quit; however, less than 20% of them were in the preparation stage and 40% were in the precontemplation stage. On multivariate analysis, difficulty to quit was lower among men (Odds ratio and 95% [confidence interval]: 0.51 [0.35-0.74]) and increased with nicotine dependence and number of previous quitting attempts (OR=3.14 [1.75-5.63] for 6+ attempts compared to none). Intention to quit decreased with increasing age (OR=0.48 [0.30-0.75] for [greater than or equal to]65 years compared to <45 years) and increased with nicotine dependence, the number of previous quitting attempts (OR=4.35 [2.76-6.83] for 6+ attempts compared to none) and among non-cigarette smokers (OR=0.51 [0.28-0.92]). Motivation to quit was inversely associated with nicotine dependence and positively associated with the number of previous quitting attempts and personal history of lung disease. CONCLUSION: Over two thirds of Swiss smokers want to quit. However, only a small fraction wishes to do so in the short term. Nicotine dependence, previous attempts to quit or previous history of lung disease are independently associated with difficulty and intention to quit.

Advance directives and the impact of timing. A qualitative study with Swiss general practitioners.

PRINCIPLES: Advance directives are seen as an important tool for documenting the wishes of patients who are no longer competent to make decisions in regards to their medical care. Due to their nature, approaching the subject of advance directives with a patient can be difficult for both the medical care provider and the patient. This paper focuses on general practitioners' perspectives regarding the timing at which this discussion should take place, as well as the advantages and disadvantages of the different moments. METHODS: In 2013, 23 semi-structured face-to-face interviews were performed with Swiss general practitioners. Interviews were analysed using qualitative content analysis. RESULTS: In our sample, 23 general practitioners provided different options that they felt were appropriate moments: either (a) when the patient is still healthy, (b) when illness becomes predominant, or (c) when a patient has been transferred to a long-term care facility. Furthermore, general practitioners reported uncertainty and discomfort regarding initiating the discussion. CONCLUSION: The distinct approaches, perspectives and rationales show that there is no well-defined or "right" moment. However, participants often associated advance directives with death. This link caused discomfort and uncertainty, which led to hesitation and delay on the part of general practitioners. Therefore we recommend further training on how to professionally initiate a conversation about advance directives. Furthermore, based on our results and experience, we recommend an early approach with healthy patients paired with later regular updates as it seems to be the most effective way to inform patients about their end-of-life care options.

Letter From Sir Isaac Brock to James FitzGibbon - July 29, 1812

A two page letter written by Sir Isaac Brock in York, Upper Canada to James FitzGibbon on July 29, 1812. The name of the recipient is not included but according to Mary Agnes FitzGibbon, one can find a transcript of the letter in her "A Veteran of 1812", page 60.[1812], 29 July: Major-General Isaac Brock, York, to James FitzGibbon. I lament that you should have been so long impressed with the idea that I possessed the means of being serviceable to you. I had scarcely heard of Mr. Johnson having declined a Company in the Glengarry (which would have given me the nomination) but I received account of his being reinstated. I consequently thought no more of the business thinking that officer was enjoying the fruits of his good fortune. I know not positively whether Mr. Johnson is reinstated, but being under obligations to promote his views, I cannot possibly interfere to his prejudice. I rather wonder you did not hear that Lieut Lamont had long ago my promise of nominating him to the Company provided it became vacant, which of course would have precluded my application in your behalf. Altho you must be sensible of the impossibility of my taking any step to forward your views in the present case, yet be assured I shall always feel happy in any opportunity that may offer to do your service. To a person unaccustomed to my writing I scarcely would hazard sending this scrawl. I am, Dear Sir, Yours faithfully, Isaac Brock I should like to be among the 49th at this moment. I am satisfied they will support and even add to their former fame. They have my very best wishes. The 41st are behaving nobly at Amherstburg.

Letter - Johnny Lombardi to Donald Ziraldo, 2000

A letter from President and CEO of CHIN radio and television, Johnny Lombardi. Mr. Lombardi thanks Mr. Ziraldo for his "good wishes" as he celebrated his 84th birthday. Lombardi also mentions the CHIN Winter Picnic to happen soon in Acapulco. There is a handwritten note at the bottom that appears to be written in Italian.