Timely completion of DNA replication in each cell cycle is crucial for maintaining genomic integrity. This is often challenged by the presence of various replication fork barriers (RFBs). On collision with a RFB, the fate of the replication fork remains uncertain. In some cases, the integrity of the fork is maintained until the barrier is removed or the fork is rescued by merging with the incoming fork. However, fork stalling can cause dissociation of all of the associated replication proteins (fork collapse). If this occurs, the cell's recombination machinery can intervene to help restart replication in a process called recombination-dependent replication (RDR). Programmed protein-DNA barriers like the Replication Terminator Sequence-1 (RTS1) have been used to demonstrate that replication fork blockage can induce recombination. However, it remains unclear how efficiently this recombination gives rise to replication restart and whether the restarted replication fork exhibits the same fidelity as an origin-derived fork. It is also unknown whether accidental replication barriers induce recombination in the same manner as programmed barriers. In this study, I introduce recombination reporters at various sites downstream of RTS1 to obtain information on both the fidelity and efficiency of replication restart. I find that unlike break induced replication (BIR), the restarted fork gives rise to hyper-recombination at least 75 kb downstream of the barrier. Surprisingly, fork convergence, rather than inducing recombination, acts to prevent or curtail genetic instability associated with RDR. I also investigate a number of genetic factors that have a role in either preventing or promoting genome instability associated with the progression of the restarted fork. To compare RTS1 with an accidental protein-DNA barrier, a novel site-specific barrier system (called MarBl) was established based on the human mariner transposase, Hsmar1, binding to its transposon end. Replication fork blockage at MarBl strongly induces recombination, more so than at RTS1. This appears to be a general feature of accidental barriers as introduction of the E. coli TusB-TerB site-specific barrier in S. pombe gives rise to a similar effect. Here, I compare and contrast accidental barriers with programmed barriers. I observe that there is very little replication restart, if any, at MarBl measured by direct repeat recombination downstream. This points to the fact that accidental barriers do not trigger fork collapse in the same way as programmed RFBs and that the increased recombination that they cause may be a consequence of the inability of replication forks to terminate correctly, owing to the bi-directional nature of the barrier. Several genetic factors are assessed for their impact on MarBl-induced recombination, which further highlights both similarities and differences with RTS1-induced recombination.

This thesis determines and examines the obstacles to Saudi women's right to work in terms of religious and cultural barriers and limited access to higher education through an analysis of Sharia sources, Saudi domestic law and international human rights treaties pertaining to Saudi women's right to work in the Kingdom of Saudi Arabia. It also delineates the provisions for women's right to work in Sharia and Saudi domestic law in the public and private sectors. The thesis also examines the reservations that the Kingdom of Saudi Arabia has entered into, and some of the international human rights treaties it has ratified, with a particular focus on the application of the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW). It also examines Saudi Arabia's obligations under International Labour Organization (ILO) Conventions. In the context of Saudi domestic law, it identifies obstacles that underlie Saudi Arabia's decision not to ratify the International Covenant on Economic, Social and Cultural Rights (ICESCR); it examines the arguments for the Kingdom of Saudi Arabia signing up to the ICESCR; and it examines Saudi Arabia's obligations to respect, protect and fulfil women's right to work under CEDAW. The protection of women's right to work under customary international law, by its sources will be explored. This section will look through customary international law elements; whether or not women's right to work is protected. Finally, the thesis provides recommendations for action which can be taken by the Kingdom of Saudi Arabia to provide Saudi women with equal rights to work. It also makes recommendations concerning ratified and pending international human rights treaties which have the capacity to protect Saudi women's right to work.

Magister Educationis (Adult Learning and Global Change) - MEd(AL) / Adult learners’ perception of factors that are internal to their perceived control of their lives can be challenging to overcome when making a decision to participate in learning. There are complex relationships between psychological, and social barriers to participation in adult learning. Psychosocial barriers can deter adults’ participation in learning programmes. Understanding the nature of such barriers can enable policymakers, educators and adult learners create strategies to reduce such barriers in order to increase adults’ participation in adult learning. This study investigated the research question: What are adult learners’ perceptions of psycho-social factors that undermine participation in adult education and learning? The psycho-social interaction model adopted as a conceptual framework allowed the study to contextualise and analyse the effects of socio-economic status on the adult learner’s decision and readiness to participate. The model provided the broad segments of the adult learners’ pre-adulthood and adulthood learning years and through a thematic analysis attempted to analyse psychosocial factors that emerged as barriers to participatory behaviour in learning. An interview guide was used during a semi-structured interview. The study investigated a group of adult learners attending a non-formal learning programme in Central Johannesburg, South Africa. The selection of participants included 6 males and 4 females between 21 years to 49 years of age. The study findings showed that the adult learners’ perceptions of family support as well as the learning environment support are key enabling factors, which assist the adult learner to develop learning capabilities. Negative experiences with prior schooling was also described as a psychosocial barrier to participation. Age was a socio-economic variable that influenced the type of stimuli participants identified as a psycho-social factor which influenced their decision to take up further learning. Adult learners felt confident to successfully complete their current and future studies however perceived their learning press as a motivating factor that impacted their decision to participate. Findings also suggested that experiences of adult learners are unique to their specific context and educational planning can integrate ways to address enhancement of learning experiences for a diverse learner audience in non-formal learning programmes. The study concluded that while adult learners acquire social competencies through accessing nonformal programmes, further learning support is necessary to overcome the social and psychological complexities needed to develop basic academic learning capabilities.

Thesis deals with the needs of disabled people in tourism. Disabled people have the biggest problems with their mobility. In the Czech Republic is more than one million people with disabilities, over half a million of body disabilities. The work is focused on wheelchair users because if all barriers for wheelchair people are removed there will be no more barriers for anyother disabled people with mobility problems. Attention is paid to three basic fields of tourism, which are accommodation, catering and transportation. The main part of the thesis is to describe the legislation that deals with the solution of the barriers with which the disabled meet almost daily, also when traveling. And another important part of this thesis is a questionnaire made with wheelchair users of all ages and sexes.

Made available in DSpace on 2015-04-22T22:10:59Z (GMT). No. of bitstreams: 1 glaice anne.pdf: 6270694 bytes, checksum: c8bd74f31f6bc7c46c27211274d2b162 (MD5) Previous issue date: 2013-08-07 / The university-industry interaction has been the subject of research in Production Engineering regarding the process of technology transfer and generation of new knowledge, in this regard the university is essential to the dissemination of knowledge, possessing features that go beyond the academic and professional, because they play an important role in the interaction with companies. Thus, this descriptive study conducted with the leaders of research groups with the aim of analyzing the university-industry interaction in the Federal University of Amazonas from the perspective of groups certificates, verifying their perception about the process of university-company, the aspects of the entrepreneurial university, the types of interactions present, the motivations and barriers encountered in the process, using the questionnaires. Thus, through the study, it was possible to visualize how the phenomenon is perceived in the Institute, the motivations that lead researchers to seek interaction and barriers that hinder the process dynamics. Therefore identified that the interaction of research groups with companies is still poorly performed , showing no strong features of the entrepreneurial university, and between groups that perform there is little interaction with companies. / A interação universidade-empresa vem sendo objeto de pesquisa na Engenharia de Produção no que tange ao processo de transferência de tecnologia e geração de novos conhecimentos, nesta perspectiva, a universidade é essencial para a disseminação do conhecimento, possuindo características que vão além da formação acadêmica e profissional, pois desempenham um importante papel na interação com empresas. Neste sentido, este trabalho realizou pesquisa descritiva junto aos líderes de grupos de pesquisa com o objetivo de analisar a interação Universidade-Empresa no Instituto Federal do Amazonas na perspectiva dos grupos certificados, verificando-se a percepção dos mesmos quanto ao processo de interação universidade-empresa, os aspectos de universidade empreendedora, os tipos de interações presentes, as motivações e as barreiras encontradas no processo, utilizando-se a aplicação de questionários. Desta forma, através do estudo realizado, foi possível visualizar como o fenômeno é percebido no Instituto, quais as motivações que levam aos pesquisadores buscarem a interação e as barreiras que dificultam a dinâmica do processo. E, portanto, identificou-se que a interação dos grupos de pesquisa com empresas ainda é pouco realizada, não apresentando fortes características de universidade empreendedora, e entre os grupos que a realizam ainda há pouca interação com empresas.

A cobrança da sociedade pela melhoria da qualidade dos serviços de saúde implica na busca de ações pela enfermagem, para a implementação da Prática Baseada em Evidências (PBE), uma vez que a assistência, pautada em evidências geradas por meio de métodos científicos, pode contribuir para aumentar os resultados do cuidado de saúde. A utilização de resultados de pesquisas na prática clínica é um dos componentes da PBE, entretanto, ainda, é desafio para a enfermagem. Assim, dentre as ações que podem minimizar a lacuna entre o conhecimento produzido e sua aplicação, está a identificação de barreiras que impedem a interdependência entre pesquisa e prática. O presente estudo teve como objetivos gerais: realizar a adaptação cultural do instrumento The Barriers to Research Utilization Scale e analisar as propriedades métricas de validade e confiabilidade do instrumento The Barriers Scale, versão para o português brasileiro. Trata-se de pesquisa metodológica conduzida por meio das seguintes etapas: processo de adaptação cultural - tradução e retrotradução; validade de face e conteúdo - Comitê de Juízes; validade de construto - dimensionalidade e grupos conhecidos e análise de confiabilidade - teste-reteste. The Barriers Scale possui 29 itens distribuídos em quatro fatores, a saber: Fator 1 - Enfermeiro, Fator 2 - Organização, Fator 3 - Pesquisa e Fator 4 - Comunicação, com valores de respostas que variam de 1 (inexistente) a 4 (enorme), sendo que os valores maiores refletem maiores barreiras para utilização de resultados de pesquisas na prática. Os dados foram coletados em dois hospitais, por meio da aplicação de um instrumento para caracterização sociodemográfica e profissional dos enfermeiros e The Barriers Scale - versão para o português brasileiro, no período de outubro de 2014 a junho de 2015, com a participação de 335 enfermeiros. O nível de significância foi de 0,05. Os resultados evidenciaram que a maioria dos participantes era do sexo feminino (88,7%), com idade média de 33,9 anos, solteiros, mestres, com um único vínculo empregatício e em regime celetista. A maioria dos enfermeiros não havia realizado curso sobre a utilização de resultados de pesquisas, na prática clínica (85,1%), e desenvolvia ou já tinha conduzido pesquisas em enfermagem (68,4%). Na avaliação das propriedades métricas, a análise fatorial confirmatória demonstrou que a versão para o português brasileiro, composta por quatro fatores, está adequadamente ajustada à estrutura dimensional, originalmente proposta pela autora principal. A validade de construto foi determinada por grupos conhecidos, os resultados demonstraram diferenças estatisticamente significativas, sendo que os enfermeiros que atuavam em instituição, com cultura organizacional direcionada para a PBE, eram mestres ou doutores, tinham características favoráveis à PBE e identificaram menores barreiras para a implementação de resultados de pesquisas, na prática clínica. A confiabilidade, avaliada em intervalo de sete dias, indicou valores apropriados para o Coeficiente de Correlação Intraclasse, entre 0,75 e 0,84, e com diferença estatisticamente significativa. A avaliação da consistência interna demonstrou valor adequado para a versão para o português brasileiro de The Barriers Scale (? de Cronbach=0,92). Concluiu-se que The Barriers Scale, versão para o português brasileiro, é válida e confiável na amostra estudada / The society\'s demand to improve the quality of health services implies the search for nursing actions for the implementation of Evidence-Based Practice (EBP), since care guided by evidence generated through scientific methods can help increase health care results. The use of research results in clinical practice is one of the EBP components; however, it is still a challenge for the nursing team. Thus, one of the actions that can minimize the gap between the knowledge produced and its application is the identification of barriers that prevent the interdependence between research and practice. This study\'s overall objectives were: to perform the cultural adaptation of The Barriers to Research Utilization Scale and analyze the metric properties of validity and reliability of the instrument The Barriers Scale - Brazilian Portuguese version. A methodological study was conducted through the following steps: cultural adaptation process - translation and back-translation; face and content validity - expert committee; construct validity - dimensionality and known groups and reliability analysis - test-retest. The Barriers Scale consists of 29 items distributed into four factors, namely: Factor 1 - Nurse, Factor 2 - Organization, Factor 3 - Research, and Factor 4 - Communication. The response values range from 1 (nonexistent) to 4 (massive), wherein the highest values reflect greater barriers to using research results in practice. Data were collected at two hospitals, through the application of an instrument for sociodemographic and professional characteristics of the nurses and The Barriers Scale - Brazilian Portuguese version, from October 2014 to June 2015, with the participation of 335 nurses. Significance was set at 0.05. The results showed that most participants were women (88.7%), with a mean age of 33.9 years, bachelors, masters, with a single job and under the Consolidation of Brazilian Labor Laws (CLT regime). Most nurses had not taken a course on the use of research results in clinical practice (85.1%) and were developing or had already conducted studies in nursing (68.4%). In the evaluation of the metric properties, the confirmatory factor analysis demonstrated that the Brazilian Portuguese version of scale, consisting of four factors, is properly adjusted to the dimensional structure originally proposed by the main author. Construct validity was determined by known groups. Results showed statistically significant differences, and the nurses working in an institution with organizational culture directed to the EBP were either masters or doctors, had favorable characteristics to the EBP and identified lower barriers to the implementation of research results in clinical practice. The reliability, evaluated in seven-day intervals, indicated appropriate values for the intraclass correlation coefficient, between 0.75 and 0.84, with a statistically significant difference. The evaluation of the internal consistency demonstrated appropriate values for the Brazilian Portuguese version of The Barriers Scale (Cronbach\'s ? = 0.92). In conclusion, The Barriers Scale - Brazilian Portuguese version is valid and reliable as per the studied sample

Made available in DSpace on 2016-04-28T20:19:14Z (GMT). No. of bitstreams: 1 2007-Luiz Carlos Rodrigues.pdf: 235429 bytes, checksum: 902320e5ad6edeca4733ba120064bb6b (MD5) Previous issue date: 2007-07-27 / Nowadays, one of the great challenges in organizations is to promote the inclusion of deficiencies carriers in the functional context . With the creation of the article 93 of the Law n?. 8.213 of July 24, 1991 that establishes obligatory quotas to be respected for the employers in the admission and resignation of professionals carrying deficiencies, created a certain discomfort for the companies, once the majority of them is not structurally prepared for the inclusion of the deficiency carrier. However, one also observes some impasses in the efficient respect of this law. The main problems for the inclusion of the deficiency carrier in the organization are the social, educational and structural barriers, where are involved a series of responsibilities that are not being duly assumed. On one part the law, there is compelling to contract the deficiency carrier and on the other hand the organizations facing a series of structural, educational and social problems of that difficults this inclusion. The results of the research show that a small part is being done, but they still show that there are a lot of things to be done, not implying this fact in great financial investments from the companies only with small alterations in the work environment and the preparation of the deficiency carrier as of the others employees to the conclusion of this inclusion. The results of the research also show that the carriers of certain types of deficiencies still are out of the market because of structurals barriers, where the lack of a simple slope hinder the access of these people in the working world. / Atualmente, um dos grandes desafios das organiza??es ? promover a inclus?o de portadores de defici?ncias no contexto de seus quadros funcionais. A cria??o do artigo 93 da Lei n?. 8.213 de 24 de julho de 1991 que estabelece cotas compuls?rias a serem respeitadas pelos empregadores na admiss?o e demiss?o de profissionais portadores de defici?ncias, gerou certo desconforto para as empresas, uma vez que a maioria delas n?o estava preparadas estruturalmente para a inclus?o do portador de defici?ncia. Entretanto, observa-se tamb?m alguns impasses no cumprimento eficaz desta lei. Os principais problemas para a inclus?o do portador de defici?ncia na organiza??o s?o as barreiras sociais, educacionais e estruturais, onde est?o envolvidas uma s?rie de responsabilidades que n?o est?o sendo devidamente assumidas. De um lado, a lei obriga a contrata??o do portador de defici?ncia e do outro as organiza??es enfrentam uma s?rie de problemas de car?ter estrutural, educacional e social que dificulta essa inclus?o. Para o desenvolvimento do trabalho, foi necess?ria a utiliza??o do m?todo de levantamento bibliogr?fico e o de pesquisa de campo, cujos resultados mostram que uma pequena parte a respeito da inclus?o do portador de defici?ncia est? sendo feita, mas que ainda h? muito por fazer, n?o implicando esse fato em grandes investimentos financeiros por parte das empresas, mas em pequenas altera??es no ambiente de trabalho e na prepara??o tanto do portador de defici?ncia quanto dos demais empregados para a efetiva??o dessa inclus?o. De acordo com os resultados deste trabalho os portadores de certo tipos de defici?ncias ainda est?o fora do mercado de trabalho devido ?s barreiras estruturais, onde a falta de uma simples rampa, por exemplo, impede o acesso desses indiv?duos no mundo do trabalho.

Esta tese tem como objetivo analisar as políticas públicas de universalização do atendimento de eletricidade, por meio de sistemas fotovoltaicos, em algumas comunidades isoladas e propor procedimentos de aprimoramento. A pesquisa de campo foi baseada em dados qualitativos através de estudo de caso. O trabalho deu-se em três comunidades tradicionais de Ilhabela-SP, onde cem domicílios receberam sistemas capazes de fornecer 30 kWh mensais - SIGFI 30 -, em 2012. cujo financiamento foi pelo Programa Luz para Todos. Foram identificados aspectos facilitadores e barreiras para a adoção dos sistemas fotovoltaicos nessas comunidades. São apresentadas proposições para aprimoramento. O trabalho conclui que nas comunidades de Ilhabela não foi ainda garantida a consecução plena dos objetivos da política pública de poder suprir as necessidades básicas de iluminação, comunicação e refrigeração, notadamente, porque não havia geladeiras; os sistemas fotovoltaicos e a luz elétrica foram muito bem recebidos e foi constatada melhoria da qualidade de vida. / This thesis aims at analyzing public policy of electricity service universalization, by means of photovoltaic systems, in some isolated communities, as well as suggesting improvement procedures. The field research was based on qualitative data collected through case study. The work was performed in three traditional communities in Ilhabela-SP, where a hundred of households received systems capable of supplying monthly 30 kWh SIGFI 30 -, in 2012 which was financed by Light for All Program. Facilitator aspects and barriers for the adoption of the photovoltaic systems in these communities were identified. Suggestions for improvement have been presented. As a result, it is possible to conclude that a plain achievement of the public policy aimed at supplying the basic needs for illumination, communication and refrigeration in those Ilhabela communities, hasnt yet been guaranteed due to the absence of refrigerator. Photovoltaic systems and electricity were well accepted ant it was observed an improvement of quality of life.

Submitted by PPG Ci?ncia da Computa??o (ppgcc@pucrs.br) on 2018-10-24T18:17:00Z No. of bitstreams: 1 ALEXANDRE LAZARETTI ZANATTA.DIS.pdf: 3682553 bytes, checksum: f4e0c608791ce6787d609d8099456e04 (MD5) / Approved for entry into archive by Sheila Dias (sheila.dias@pucrs.br) on 2018-10-26T11:47:02Z (GMT) No. of bitstreams: 1 ALEXANDRE LAZARETTI ZANATTA.DIS.pdf: 3682553 bytes, checksum: f4e0c608791ce6787d609d8099456e04 (MD5) / Made available in DSpace on 2018-10-26T11:56:21Z (GMT). No. of bitstreams: 1 ALEXANDRE LAZARETTI ZANATTA.DIS.pdf: 3682553 bytes, checksum: f4e0c608791ce6787d609d8099456e04 (MD5) Previous issue date: 2018-08-13 / Software crowdsourcing development platforms require a continuous influx of crowdworkers for their continuity. Crowdworkers should be encouraged to play an important role in the online communities by being active members, but they face difficulties when attempting to participate. For this reason, we investigated the difficulties that crowdworkers face in crowdsourcing software development platforms. We conducted empirical studies relying on multiple data sources and research methods including literature review, peer review, field study, and procedures of grounded theory. We observed that crowdworkers face many barriers ? related to competence, collaboration, and time management ? when making their contributions in software crowdsourcing development, which can result in dropouts. Based on the identified barriers, literature review and, crowdworkers suggestions, we list 13 recommendations for participants as potential solutions to overcome such barriers. The recommendations were evaluated by surveying software crowdsourcing experts. The main contributions of this dissertation are a) empirical identification of barriers faced by crowdsourcing software development crowdworkers; and b) recommendations on how to minimize the barriers. We conclude that the crowdworkers need competency and an efficient time management effort to take part collaboratively in tasks of the Competition-Based Crowdsourcing Software Development of the Topcoder platform. / O desenvolvimento de projetos por meio de software crowdsourcing depende de um fluxo cont?nuo de trabalhadores da multid?o para sua continuidade. Estes trabalhadores necessitam ser membros ativos, por?m enfrentam dificuldades quando tentam participar em projetos de software crowdsourcing. Por esta raz?o, investigou-se quais foram as dificuldades que os trabalhadores da multid?o enfrentam em plataformas de desenvolvimento de projetos via software crowdsourcing. Foram realizados v?rios estudos emp?ricos baseados em m?ltiplas fontes de dados e m?todos de pesquisa, incluindo revis?o da literatura, revis?o por pares, estudo de campo e procedimentos da teoria fundamentada. Observou-se que os trabalhadores enfrentam muitas barreiras - relacionadas ? compet?ncia, colabora??o e gerenciamento do tempo - ao fazerem suas contribui??es no desenvolvimento projetos por software crowdsourcing, o que pode resultar em desist?ncias. Com base nas barreiras identificadas, revis?o de literatura e sugest?es dos trabalhadores foram apresentadas 13 recomenda??es para que estes trabalhadores possam superar tais barreiras. Estas recomenda??es foram avaliadas por especialistas em software crowdsourcing. As principais contribui??es desta tese foram: a) identifica??o emp?rica das barreiras enfrentadas pelos desenvolvedores de software em projetos de software crowdsourcing; e b) recomenda??es para minimizar estas barreiras. Conclui-se que os trabalhadores da multid?o precisam de compet?ncia e um esfor?o eficiente de gerenciamento de tempo para participar de forma colaborativa nas tarefas do desenvolvimento de projetos em software Crowdsourcing no modelo competitivo da plataforma Topcoder.

O objetivo deste estudo é analisar as informações fornecidas por profissionais envolvidos durante a morte e como compreenderam as suas próprias ações no momento de comunicação da morte. É assim, visando esse objetivo acima citado, que este trabalho pretende responder à questão de quais foram as preocupações dos profissionais médicos, numa unidade de terapia intensiva, ao depararem-se com a comunicação de óbito aos familiares de pacientes internados. As informações foram obtidas através de pesquisa descritiva, de abordagem qualitativa, após entrevistas semiestruturadas conduzidas aos profissionais que forneceram a comunicação, durante o período de três meses no ano de 2013. A análise das entrevistas e de seus respectivos conteúdos proporcionou a divisão em duas categorias – Compreensão da Notícia e Limitação da Medicina/Proximidade da Morte. Ambas as categorias proporcionaram intensa análise e comparação com referências bibliográficas sobre como esses momentos eram encarados em diversos aspectos: médicos, psíquicos, filosóficos e até mesmo religiosos. Podemos, sob o aspecto subjetivo que é inerente a esta pesquisa, perceber que nos momentos finais da vida os pediatras selecionados neste trabalho preocuparam-se, principalmente, com o caminho no qual a comunicação encontrava o seu receptor e quais entendimentos os familiares obtinham através da informação que era fornecida. Também nota-se a preocupação dos médicos em estabelecer o limite terapêutico, e quando a proximidade da morte era maior que a possibilidade de interferência de potenciais intervenções terapêuticas. Os entrevistados demonstraram a necessidade de estabelecer o momento em que se deveria evitar a agregação de terapias fúteis e obstinadas, mantendo a família, em sua visão, com a maior informação possível desses limites. / We aimed with this study, to analyse how information was given by pediatrician to the families who underwent with a children who died in a Pediatric Intensive Care at Porto Alegre, Brazil, and how this pediatricians understood they’re own actions at the moment of the breaking bad news. Information was given through a descriptive research, with qualitative analysis, after semi-structured interviews conducted to the physicians who were breaking the bad news in the period of three months of 2013. Analysis of the interviews and respective contents allowed division in two main themes – Comprehension of the news and The edge between Medicine and proximity of death. Both categories allowed intense analysis and links with medical literature about how this moments are faced, through several aspects: medical, psychological, philosophical an even religious. We can, through this kind of analysis, sense that at the final moments of life, pediatricians selected were worried, mainly, with the potential distance between breaking bad news and comprehension of the parents. Also, in this study, we can notice, several times, during the interviews, concerning of the medical team to state when therapeutical limits were reached. Pediatricians at this study showed needs to maintain clear communication when these limits were set, and through a continuous process to inform the family. Interviewers showed importance in keep families connected with the ideas when new treatments were futile.