midst of the likely chaos that will be happening. The nurse must never forget that their patient is an actual individual with a life and a family, as they are busily working with the health care team to save his or her life. As things may progress, the nurse should take time to let the patient knowwhat is being done and that they are not alone. Instead of just stand- ing in the corner as other clinicians perform cardio-pulmonary resuscitation on the patient, the nurse should proceed to the head of the bed and provide reassurance that they are pre- sent with the patient. Often the patient may be unconscious at that point, but we cannot say with certainty what they can or cannot hear, so be mindful of what is said during that period of time. Following the death, be sure to provide respect and dignity during post- mortem care. Communicating with the family of a deceased patient can be one of the most challenging and difficult encounters a nurse will experience, as with a sudden type of illness trajectory the death was not expected. This means that the family was likely not present or with the patient before or at the time of death, depending on the policy that governs family presence at the bedside within your institution. There can be a lot of emotional and psy- chological stressors associated with the family members of patients with this type of death. Family members might not have been able to say their goodbyes or to mend any differences before their loved one died. There might be guilt associated with this; and if family mem- bers were also involved in an accident and survived, they may experience survivor’s guilt. Survivor’s guilt is a common reaction to a sudden and/or traumatic loss in which the person left behind feels guilt that they survived and their loved one did not (International Society for Traumatic Stress Studies, 2005). Families experiencing difficulty coping after the sud- den death of their loved one often have alterations in the normal grieving process and may likely need to seek assistance in helping deal with the loss.
A law tabled at the French parliament on 8 June 2012, on medically assisted dying and access to palliative care, reopened the debate on the end of life problem. Twice, in 2008 and in 2012, French intensivists, through the SRLF ethics commission, underscored the dangers of an emotional debate on euthanasia and called for a national debate on the issue [8,9]. The SRLF stressed the need to be fully acquainted with Leonetti’s law, which covers alleviation of physical and mental suffering at the end of life, while respecting patients’ dignity. The SRLF also highlighted the need to give all caregivers suitable training in the ethical approach to such situations and in end of lifecare. However, these position statements were not based on objective data. Since the enactment of Leonetti’s law in 2005 and of the decrees covering its application in 2006, numerous training measures have been introduced in intensive care . In particular, Table 2 Knowledge of Leonetti ’ s law (figures in parentheses are percentages)
Abstract Korea has led the way within Asia with its pioneering nursingcare insurance system. This study examines the current state of end-of-lifecare for the elderly, along with future trends, based on surveys and interviews of managers and employees of institutions related to nursingcare and nursingcare insurance. Korea is seeing a gradual increase in its latter stage elderly population. It naturally follows that this puts pressure on dealing with end-of-lifecare, and this study revealed concern that the care environment cannot keep pace with the concurrent increase in medical needs. Korea's system restricts end-of-lifecare to hospital facilities, so care facility staff lack experience and certain kinds of awareness. Workers’ own attitudes toward life and death, as well as those toward caring for the sick, influence the quality of end-of-lifecare. It was found that these attitudes are significantly influenced by religious beliefs and work experience. Social workers had longer experience in caring for the infirm and a stronger tendency to be cognizant of care which focuses on a patient’s family. Results indicated that in the future, it will be necessary to consider how care workers can best think about and approach end-of-lifecare as a team.
Patients receiving cardiac resynchronization therapy require discussions about care preferences for deactivation of the implantable cardioverter-defibrillator (ICD) in the event they develop end-stage disease. As part of the discussion, clinicians need to ensure that patients and families under- stand that turning off the ICD means that the device will no longer provide lifesaving intervention if a fatal heart rhythm occurs and that immediate death and pain will not be caused. 14,34
introduction: Obstructive sleep apnea (OSA) is a multi-factorial disease that can increase risk for numerous comorbidities if left untreated. Dentists and den- tal specialists can provide lifesaving screening assessments and refer patients to sleep medicine specialists for definitive diagnosis and team-based treatment planning. The gold standard treatment for OSA remains positive air pressure (PAP), but following referral from a sleep physician, the dental community can provide successful oral appliance (OA) therapy. To do so, dentists must be knowl- edgeable of and adhere to recent American Dental Association (ADA) guidelines and recommendations so that they continue to operate within their legally de- fined scope of care. materials and methods: A critical review of the dental and medical literature regarding oral appliance therapy for OSA was performed. While systematic review is preferred, due to short study durations, limited num- bers of patients and the lack of well-controlled prospective randomized trials, an appropriate systematic review could not be performed. conclusions: While no single design of mandibular advancement appliance (MAD) is successful in every patient, the preponderance of the evidence suggests that MADs can be a highly effective treatment for selected OSA patients. To date, attempts to predict pa- tients accurately who will respond favorably from those who will not have been unsuccessful. Therefore, dentists who elect to provide OA therapy must follow up on their own patients to manage the dental side effects that may occur, as well as refer the patient back to the sleep medicine team for definitive and objec- tive treatment response assessment.
Researchers in life sciences face several challenges when imaging biological specimens: How can phototoxicity and bleaching of fluorescent labels be balanced against good sig- nal or resolution? How many channels can a cell be imaged in without interfering with native processes? And how can rele- vant and complex information be extracted from large image datasets, without tedious manual annotation and human bias? In the following sections, we will present how AI methods have recently provided efficient solutions to these problems. While there exist some conceptual overlaps, we have sepa- rated these into four categories: image classification, image segmentation, artificial labelling and image restoration.
The role of pediatric care providers in CT is para- mount for several reasons. First, health care provid- ers are responsible for ordering and providing indi- cations and justifications for CT examinations. In addition, the nature of the physician-patient relation- ship can make the pediatric care provider the prin- cipal (or only) source of information about imaging studies, including potential risks. For these reasons, the following material is intended to serve as a con- cise and contemporary review of CT and related radiation issues for the pediatrician, pediatric sub- specialist, nurse practitioner, family practitioner, or other pediatric health care provider. Material empha- sizes the unique aspects of pediatric CT and includes patterns of use and applications, radiation risks, and strategies that can be implemented to manage radi- ation: that is, to reduce or eliminate unnecessary radiation children get from CT examinations.
Firm-level evidence also reveals the importance of imported inputs for African exporters. Figure 5 presents the data on the proportion of material inputs imported directly by firms in a selection of African economies. What is striking is the very high proportion of imported material inputs used by exporters in many of the economies. The share exceeds 50 percent for exporters in Morocco, Mauritius and Madagascar and is significantly higher than for domestic firms. What is noticeable is the relatively low proportion (less than 20 percent) of inputs of foreign origin in South African firms. This may reflect the history of past isolation and a lack of integration into the global production network. The data could also reflect the wide availability of domestically produced intermediate inputs. Further research on these relationships, as well as the adjustment of firms to import liberalisation would require firm data of a panel nature.
Child abuse in some countries is reported to have reached an epidemic level. Every year, in the U.S.A., about one million children under the ages of 6 years are physically abused and brutally beaten and neglected. About three thousand of them are killed by their parents or other care giver (Fontana, 1978). Battered child syndrome is considered by some authors as a reportable disease with a 3 to 4% mrtality rate and 25 to 30% permanent morbidity rate (2). This paper deals with the historical aspects of this syndrome, and discusses some characteristics of the abused and the abusers. It also describes signs, symptoms and diagnostic procedures necessary to identify this syndrome.
There are other factors that can be taken into account when conducting authentication. For instance, Alice’s location can be considered a factor. Alice may carry around a cell phone that has a GPS (Global Positioning System) chip inside of it. When Alice is standing in front of an ATM requesting to withdraw money, Alice’s bank could ask her cell phone company’s com- puter system where she currently is. If the cell phone company’s computer responds with a latitude and longitude that corresponds to the expected location of the ATM, the bank can approve the withdrawal request. However, if Alice’s ATM card and PIN were stolen by a bad guy who is trying to withdraw money, then taking Alice’s location (or specifically, the location of her cell phone) into account could help thwart such a fraudulent withdrawal request. If Alice’s cell phone is still in her possession, when an attacker attempts to use her card at an ATM, the location of the ATM will not correspond to the location of Alice’s cell phone, and the bank will deny the withdrawal request (unless, of course, Alice and her cell phone are being held captive in front of the ATM). In this example, it is advantageous for Alice to keep her cell phone and her ATM card in different places; she should not, say, keep both of them in her purse.
claims that this is what others know. Reference can be made to the media or to the views of family and friends, rather than asking them what they think. Inviting students to name these images and collating them visually allows for a vast range of terminologies, abusive words, identities, explanations and responses to the behaviour to emerge, images that they will hold themselves but are unlikely to wish to admit. This distancing allows for consideration of the implications of these images for social work practice. The list can be puzzled over and the various discourses identified, thus creating the space for reflexive engagement with these powerful statements. The reality of some of the images can be questioned, and also the ways in which they create a specific identity of otherness, allowing students to question the solidity of these images. Being critical of extreme statements that construct difference can open up the possibility of reclaiming sexual offenders as within the spectrum of humanity, therefore possible to engage with. This exercise can be developed further through inviting students to consider what else sex offenders are, which provides the opportunity to explore similarities in a reasonably comfortable way (father, brother, mother, sister and so on). The listing of similarities has the potential to be extensive and open up the possibility that students and social workers have skills that are transferable in engaging with this behaviour.
Before doing so, we address two existing beliefs, which we believe have disrupted thinking in this field. First, there is currently a prohibition about speaking openly about suicide, based on the notion that open discussion will encourage copycat suicide. This notion has not been proven (15) but is strongly held and inhibits detailed reporting of suicide in the press. We propose the view that informed discussion and education about suicide is likely to decrease rather than increase loss of life.
Psychogenic nonepileptic seizures (PNES) are episodes of movement, sensation or behavior changes similar to epileptic seizures but without neurological origin. They are somatic manifesta- tions of psychological distress. The aim of this article is to provide a comprehensive review of the practical aspects of this, most often misdiagnosed disorder, which will be of clinical relevance to all practicing neurologists. Patients with PNES are often misdiagnosed and treated for epilepsy for years, resulting in significant morbidity. Video-EEG monitoring is the gold standard for diagnosis. Five to ten percent of outpatient epilepsy populations and 20 to 40 percent of inpatient and spe- cialty epilepsy center patients have PNES. These patients inevitably have comorbid psychiatric illnesses, most commonly depression, post-traumatic stress disorder (PTSD), other dissociative and somatoform disorders, and personality pathology, especially borderline type. Many have a history of sexual and physical abuse. 75 to 85 percent of patients with PNES are women. Although PNES can occur at any age, they typically begin in young adulthood. Treatment involves disconti- nuing antiepileptic drugs in patients without concurrent epilepsy and referring for appropriate psychiatric care. Additional larger controlled studies to determine the best treatment modalities are needed.
Driving pressure may also be useful in titrating PEEP and has been tested with promising physiological results in obese patients undergoing general anaesthesia [86, 87] and in obese patients with ARDS [88, 89]. An indi- vidual patient data meta-analysis showed that obese patients undergoing surgery receiving higher PEEP levels that resulted in an increased driving pressure had more postoperative pulmonary complications . There is currently insufficient data to suggest using driving pres- sure to titrate PEEP might translate in improved survival of patients with IAH or obesity with or without ARDS. Thus, in our opinion driving pressure should be used to avoid excessive PEEP and not to “optimize” (increase) PEEP.
Adopting a cognitive linguistic approach to foreign language pedagogy, inevitably calls for a reconsideration of L2 teaching goals, techniques and material content. Hence, placing concepts at the heart of L2 teaching modifies its traditional goal, which is the development of a learner’s communicative competence. In this regard,the teaching goal of an applied cognitive linguistic oriented instruction should be the development of what Danesi (1993, 1995) calls conceptual fluency. Conceptual fluency refers to a learner’s ability to know how the target language encodes concepts on the basis of metaphorical thinking (Danesi, 1995). Danesi (1995, 2008) and Danesi & Grieve (2010) argue that the term conceptual fluency originated from the observation that even though L2 learners exhibit a high degree of grammatical accuracy they lack the ability to use L2 concepts efficiently and appropriately. Conceptual fluency is as important as grammatical and communicative knowledge (Danesi, 2000). Given that during second language acquisition not only the two languages are in contact, but also their conceptual systems as well, Danesi (2008) suggests that proficiency in an L2 should be formulated as the ability to express oneself in the target language while relying on the conceptual system of the target culture, rather than using correctly the formal aspects of the target language, but utilizing learner’s native conceptual system.
In contrast to Fred, Alex has altruistic motivations to save his mother. He lies, and yes, he also drags people into his web of lies, but it is all for a good cause, or at least he thinks it is a good cause. Unfortunately, we do not knowwhat the outcome would have been without the charade. Would the mother, who is confined to her bed, have lived longer without his intervention since she would have been able to exercise and enjoy fresh air? Would she have had a better life, a life other than sitting in bed and watching old DDR propaganda? Or would she truly have died of a heart attack? We find out late in the movie that the mother was not the dedicated communist at all as everyone had believed. She admits having put on a show to survive and to forget that her husband had left her by fleeing the regime and going to the West. After this becomes clear, an earlier revelation of the truth might have made her life happier, she could have left the apartment and enjoyed the new freedoms of a unified Germany.
Drawing data from eleven literary works of six Anglophone Cameroonian writers (Asong, Kongnyuy, Ambanasom, Tardzenyuy, Nyamnjoh, Nkemngong Nkengasong, this paper studies how Anglophone Cameroon writers make use of linguistic resources (lexes and discourse) for the preservation and transmission of cultural heritage (values and knowledge) as well as the linguistic strategies of insertion of these cultural values and knowledge in these texts. The analysis reveals that in the ongoing globalized world where cultural values and knowledge in many African countries are gradually losing grounds due to the influence of Western cultural practices, literary texts can be one of the means to preserve these cultural values and knowledge so as to transmit them to future generations. Besides, it is found that various linguistic strategies are utilized by these writers in order to insert these cultural values and knowledge in their literary works: loanwords, loanblends, loantranslations, idiomatic formation, Cameroon Pidgin-English discourses, French discourses and proverbs. It is recommended that in the selection of literary texts to be used in the secondary and high schools of African countries that priority should be given the literary texts which embody the cultural values and knowledge of their countries. This will enable African students in general and Cameroonian students in particular to be more versed with some cultural values and knowledge of their sociocultural environments.