OBJECTIVE: To understand dental service utilization by frail older adults residing in a long-term care (LTC) setting in the last two years of their life. To understand the types of dental services utilized by this demographic, the frequency of utilization and determine the characteristics that may be predictors of ‘higher dental service utilization’. METHODS: A retrospective cohort study was conducted by an electronic chart review of all LTC patients at two sites who died between 11/1/2014 - 12/30/2016 and had a dental visit in the two-year period prior to death, resulting in a sample of 369 patients. Based on the number of dental appointments attended prior to death, the patients were categorized into five groups: 0,1-2,3-5,6-9 and10 or more appointments. A multivariate logistic regression model was created to identify the factors associated with higher dental service utilization. RESULT: The study found that 84% of patients who died in the study period, utilized on-site dental services in the last two years of their life. Approximately 66% had 3 or more dental appointments. Diagnostic and preventive procedures were most commonly utilized (utilized by 81% and 73% of patients respectively). Multivariate analysis suggested that dentate patients and patients wearing removable dental prosthesis were about 7 and 12 times more likely respectively to have a higher utilization of dental services (OR=6.5 and OR=11.7). Medicaid beneficiaries were more likely (OR=1.9) to have a higher utilization of dental services than the others. CONCLUSIONS: This study showed that a large percentage of frail older adults utilized dental services even in the last years of their lives when given access to these services. As people are living longer and retaining their teeth longer, there is a rising need and subsequent demand for end-of-life dental services. Certain administrative and policy implementation strategies need to be developed to provide dental services to LTC patients in the last years of their lives.

Background Nurses work to promote health, prevent disease, restore health and relieve suffering. However, when the patient transitions into end of life care, the goal is no longer to cure, but to relieve. End-of-life care is about seeing the patient and helping them move on by doing what favors the patients’ well-being. Aim The aim of this study was to describe how nurses can preserve the patients’ dignity in end of life care. Method This study is based on a method to contribute to evidence-based nursing with foundation in analysis of qualitative research. 7 qualitative and 2 articles with mixed methods were analyzed using a five step model described by Friberg. Results Through the analysis three main themes and five sub-themes were developed. The main themes were: Involving the patient, Preserving the patient’s quality of life, Seeing the patient. Conclusion Through the actions performed by the nurse, dignity can be preserved. By protecting the patients’ integrity and autonomy through a person-centered care, the best conditions for giving a worthy death are created.

Les soins palliatifs constituent un domaine du soin où la fin de vie des personnes est en question. Ces derniers ont émergé dans un contexte médical marqué par des innovations techniques et scientifiques sans précédent et en cela, ils s’inscrivent dans une ère où les avancées sont caractéristiques d’un système qui performe. Les soins palliatifs sont donc à appréhender en lien avec la clinique de l’extrême qu’ils portent, les ramenant au rang d’une spécialité médicale parmi d’autres. Pourtant, ils sont aussi et surtout à considérer dans toute leur singularité, une clinique de l’incertitude, notamment en raison de la confrontation permanente des soignants avec la mort des patients. L’incertitude fondamentale traversant les soins palliatifs est ainsi à interroger en rapport avec une pensée autour de la mort, nécessairement significative à la croisée des expériences de chacun en soins palliatifs. C’est en direction des écrits du philosophe Vladimir Jankélévitch que nous nous tournons pour approfondir cette pensée de l’incertitude en lien avec la mort. Abordant la thématique de la mort dans sa double dimension de phénomène et de mystère, ses développements permettent de considérer la mort dans sa dimension métaphysique, existentielle mais aussi morale. En raison de ses développements autour de la morale, il ouvre également la voie pour tenter de saisir les implications éthiques, organisationnelles et politiques de l’incertitude fondamentale, au cœur de l’accompagnement mis en œuvre dans la pratique palliative. / Palliative care is a field where end of life is a central subject. They emerged in a medical context caracterised by technical and scientifical innovations. So, they exist in a era where progress represents a powerful system. We can read palliative care as regard to their dimension of « clinical of the extreme of life ». In this, they take part of medical system as « medical speciality ». They also have to be considered in their deep specificity, in relation to their dimension of « clinical of uncertainty » because of the daily confrontation with death. The fundamental uncertainty which is the main caracteristic of palliative care can be analysed in connection with a thought of death. The latter has a deep meaning for the experience of each part of palliative care experience. We can deal with this theory of fundamental uncertainty thanks to the philosopher Vladimir Jankélévitch. He approaches death in its double reality of « event » and « mystery ». His theory allows for considering death in its metaphysical, existential and moral signification. Moreover, his moral considerations open the field for analizing ethics, institutionals and politics consequences of the theory of fundamental uncertainty in connexion with the importance of caring, in palliative medicine.

A Enfermagem como profissão se ocupa com o alívio do sofrimento, com a minimização da dor, com a dignidade diante da morte, com aspectos envolvidos com a condição humana, com o percurso da vida, com o cuidado do outro e de si. Falar sobre o final da vida, sobre como lidar com o luto são permanentes temáticas na mídia, nas redes sociais, nos grupos de conversas, o que o torna tema para a problematização de pesquisas. As tentativas de minimizar as angústias, as frustrações e os medos dos profissionais e estudantes que cuidam de pessoas que estão morrendo são inúmeras, assim, fui instigada a repensar minha maneira de ensinar e meus modos de agir em relação a pessoas que estão no final da vida. Neste contexto, considerando as vivências dos alunos durante a formação em Enfermagem, organizei a seguinte questão de pesquisa: como é iniciar as práticas hospitalares cuidando de pacientes no final da vida? Deste modo, tracei como objetivo conhecer as vivências de estudantes de graduação em enfermagem que iniciaram suas práticas hospitalares cuidando de pacientes no final da vida. Trata-se de uma pesquisa qualitativa, descritiva, que utilizou a técnica de grupo focal para produção de dados. Participaram do grupo estudantes do Curso de Enfermagem da Universidade Federal do Rio Grande do Sul (UFRGS) que vivenciaram a primeira prática hospitalar no Núcleo de Cuidados Paliativos do Hospital de Clínicas de Porto Alegre (HCPA). Para análise dos dados foi utilizada a análise do discurso proposta por Michel Foucault que explicita a íntima relação entre discurso e poder. Os discursos foram organizados de modo a destacar o domínio, a descrição dos acontecimentos, a língua e o acontecimento discursivo. A partir deste percurso, procurei signos que designam coisas e essas coisas é que foram descritas. Da análise das falas emergiu a categoria Aprendendo a ser trabalhador que é apresentada com dois marcadores discursivos denominados: Mesmo estando ali, parece que eu não faço nada e Caiu a ficha, que caracterizam o processo vivenciado pelos estudantes. A partir das falas dos estudantes e com a contribuição teórica de Jorge Larrosa (1994) foi possível modificar a palavra vivência, presente na pergunta e objetivo da pesquisa, por experiência. Assim, refletiu-se sobre experiência, experiência de si, tecnologias do eu entre outros conceitos sustentadores para procurar entender o processo de aprender a ser trabalhador. Os estudantes têm a impressão de que não fazem nada, considerando que historicamente a enfermagem empreende ações para “salvar vidas” e não para ajudar a morrer. É possível pensar que a morte do paciente desencadeia uma ausência de autoconfiança, uma debilidade, vergonha, culpa, e até abala a identidade com a profissão. Depois, cai a ficha, quando percebem que podem fazer muito pelos pacientes, seja um banho, uma troca de bolsa de colostomia, um conforto. Tais experiências representam o processo de ser trabalhador, que passa por domínios de saber, tipos de normatividade e subjetivação. Ao problematizar como estudantes experenciam o cuidado de enfermagem diante do final da vida pretendi demonstrar que mesmo que alunos e alunas tenham conhecimento sobre o final da vida, sobre o corpo, cada morte de paciente será evento novo, diferente do outro, pois cada pessoa, cada circunstância tem singularidades que necessitam ser consideradas. Cabe aos profissionais, estudantes e professores/as (re)conhecerem que a experiência é evento único, que se desenvolve a partir de determinadas tecnologias do eu. / Nursing, as a profession, is concerned about the relief of suffering, the minimization of pain, the dignity before death, about aspects related to the human condition, way of life and taking care of each other and of themselves. Talking about the end of life and dealing with mourning are permanent themes in the media, social networks, groups of conversations among other social forums, which makes this subject relevant to a research issue. Attempts to minimize the anxieties, frustrations and fears of professionals and students taking care of people who are dying are numerous. Since life is permeated by discourses and knowledge, I was instigated to rethink the way I teach, as well as the way I face what causes discomfort for the students, regarding this issue. On the context of the end of life and the experiences of the students through education in nursing, I performed the following research question: How to start hospital practices taking care of patients at the end of their lives? Thereby, traced as an objective to know the experiences of undergraduate nursing students who started their hospital practices caring for patients at the end of their lives. The present research is qualitative and descriptive and, through the focus group technique, analyzed discourses of students of the Nursing Course who experienced the first hospital practice in the Center of Palliative Care of the Hospital of Clinics of Porto Alegre (HCPA). As a result from the analysis emerged the category named as “Learning to be a worker”, presented with two markers denominated: “even being there, it seems that I do not do anything” and “I realized” that characterize the process experienced by the students. From these markers, it was possible to reflect on the experience, self-experience, technologies, among other supportive concepts for the possibility of understanding the process of learning how to be a worker. Students have the impression that they do nothing, considering that historically nursing undertakes actions to "save lives" and not to help to die. It is possible to think that death triggers an absence of self-confidence, weakness, shame, guilt, and even loss of identity with the profession. To discuss how students experience nursing care facing the end of life was not to confirm what is already said and written about the lack of preparation of the students. The aim was to demonstrate that independent of the knowledge about the end of life, each event of death will be different from the other, each person; each circumstance has singularity, individuality, both of himself and of the other. It is up to the professionals, students and teachers to know that the experience is a single event, that develops the self-technologies, that makes possible the theory of practice, allows the reflection on the technicality on the fragmentation of the care. Thus, caring will not be purely prescriptive, automatic/mechanical, aiming at the object, it will enable the subjectivity of human conditions and the uniqueness of oneself and the other.

O cenário competitivo da indústria da moda, no qual se insere a indústria calçadista, configura ciclos curtos e rápidos de produção e comercialização característicos do modelo fast fashion, porém, a crescente preocupação com aspectos sociais e ambientais tem despertado o interesse da sociedade por uma mudança de postura frente a estas questões. O posicionamento de marcas com foco na preservação ambiental pode viabilizar melhorias em produtos que ainda são projetados e manufaturados de forma convencional, ou resultar em inovações significativas no desenvolvimento de produtos ambientalmente amigáveis. A proposta do estudo foi realizar um diagnóstico do cenário atual do design de calçados ambientalmente orientado, identificando as práticas utilizadas nos processos de design que colaboram na redução do impacto ambiental do final de vida útil dos calçados. Para melhor compreender os fatos, o estudo foi subdividido em quatro etapas. A primeira etapa contempla a revisão de literatura; a segunda etapa é resultado de pesquisa desk; na terceira etapa, realizou-se levantamento de dados por interrogação direta de pessoas através de entrevistas em diferentes amostras; e na quarta etapa realizadas as análises e interpretação dos resultados. A pesquisa básica, de abordagem qualitativa e objetivos exploratórios, utilizou-se de amostras não-probabilísticas definidas conforme os critérios estabelecidos para cada fase Os resultados alcançados apontam que, mesmo com tecnologia e informação globalizada, na prática, pouco é feito em design e produção de calçados em prol da redução de impactos ambientais. Incluem-se nessa realidade clusters tradicionais de produção, como o do Vale dos Sinos no Rio Grande do Sul, Brasil, sendo as iniciativas calçadistas que levam em consideração o cuidado com o meio ambiente, ainda, restritas e isoladas representando nichos distintos. A indústria calçadista segue aos moldes tradicionais de produção e percebe-se que, quando há uma mudança, esta é impulsionada, principalmente, por legislações ou acidentes ambientais gerados por seus dejetos, ou então são empresas que surgem com foco em desenvolver produtos ambientalmente orientados para nichos de mercado. Desta forma, na maior parte do desenvolvimento os designers reproduzem o sistema de criação rápida, obedecendo ao contexto de coleções e preços cada vez mais enxutos. O conhecimento sobre o assunto ainda é pouco explorado e, por consequência, falta articulação entre os atores da cadeia para uma mobilização efetiva na busca por soluções para o desenvolvimento sustentável do setor. / The competitive landscape of the fashion industry, which includes the footwear industry, sets up short and fast production and marketing cycles characteristic of the fast fashion model, but the growing concern with social and environmental aspects has aroused society's interest in a change position on these issues. The positioning of brands focused on environmental preservation can enable improvements in products that are still designed and manufactured in a conventional way, or result in significant innovations in the development of environmentally friendly products. The purpose of the study was to carry out a diagnosis of the current scenario of environmentally oriented footwear design, identifying the practices used in the design processes that collaborate in reducing the environmental impact of the end of the shoe life. To better understand the facts, the study was subdivided into four stages. The first stage contemplates the literature review; the second stage is the result of desk research; in the third stage, data were collected by direct interrogation of people through interviews in different samples; and in the fourth stage, the analyzes and interpretation of the results were carried out. The basic research, with a qualitative approach and exploratory objectives, was used of non-probabilistic samples defined according to the established criteria for each phase. The results show that, even with technology and globalized information, in practice little is done in the design and production of footwear in favor of reducing environmental impacts Traditional clusters of production, such as Vale dos Sinos in the Rio Grande do Sul, Brazil, are included in this reality. Footwear initiatives that take into account the care for the environment are still restricted and isolated, representing different niches. The footwear industry follows the traditional patterns of production and it is noticed that when there is a change, this is mainly driven by environmental laws or accidents generated by their waste, or else they are companies that are focused on developing environmentally oriented products for niche markets. In this way, in most of the development, the designers reproduce the system of fast creation, obeying to the context of collections and prices more and leaner. The knowledge about the subject is still little explored and, as a consequence, there is a lack of articulation between the actors in the chain for an effective mobilization in search of solutions for the sustainable development of the sector.

Bakgrund: Vård i livets slutskede strävar efter att förbättra livskvaliteten hos patienter med livshotande sjukdom och för deras anhöriga. En av sjuksköterskans viktigaste uppgifter är att vårda patienter i livets slutskede samt möta deras anhöriga. Sjuksköterskestudenter är morgondagens sjuksköterskor och därmed bör de besitta kunskap om vårdande i livets slutskede. Syfte: Syftet var att beskriva sjuksköterskestudenters erfarenheter av vårdande i livets slutskede. Metod: En allmän litteraturstudie utfördes som grundades på 11 vetenskapliga artiklar. Databearbetningen resulterade i fyra kategorier: otillräcklighet vid vårdande i livets slutskede, hantering av svåra situationer vid vårdande i livets slutskede, samverkan vid vårdande i livets slutskede och okunskap om vårdande i livets slutskede. Resultat: Sjuksköterskestudenter blev känslomässigt engagerade i mötet med patienter i livets slutskede och deras anhöriga. De erfor att det fanns olika sätt att hantera de svåra situationerna som uppkom vid vårdande i livets slutskede. Det var också viktigt att skapa relationer med patienter samt inkludera anhöriga i vården. De beskrev dock kommunikationen med patienter och anhöriga som en utmaning. Sjuksköterskestudenter erfor även okunskap och att de inte hade tillräckligt med kompetens om vårdande i livets slutskede. Slutsats: Vårdande i livets slutskede väckte känslor av otillräcklighet, ensamhet och ångest hos sjuksköterskestudenter. Händelserna som uppkom vid vårdande i livet slutskede hanterades genom att vara närvarande eller genom att hålla sig på avstånd under vårdförloppet. Samverkan genom kommunikation med både patienter och anhöriga erfors av sjuksköterskestudenter som betydelsefullt. Dock erfor sjuksköterskestudenter att utbildningen inom vårdande i livets slutskede var otillräcklig. / Background: End-of-life care strives to improve the quality of life for patients with a life-threatening illness and their relatives. One of the nurses’ most important tasks are to provide care for patients at the end of their lives and for their relatives. Nursing students are tomorrows nurses, therefore they need to have knowledge about caring in end-of-life. Purpose: The purpose was to describe nursing student’s experiences of caring in end-of-life. Method: A general literature study based on 11 scientific articles. The data process resulted in four categories: insufficiency about caring in end-of-life, handling difficult situations in end-of-life, cooperation in caring in end-of- life and lack of knowledge about caring in end-of-life. Results: Nursing students became emotionally engaged when they met patients in end-of-life and their relatives. They experienced different ways to cope with the difficult situations that arose when caring in end-of-life. Nursing students also felt that it was important to establish relationships with patients as well as include the relatives in the care, they also described that communication with patients and their relatives could be challenging. However, it was also found that nursing students experienced insufficient skills and knowledge about caring in end-of-life. Conclusion: Caring in end-of-life caused feelings of insufficiency, loneliness and anxiety for the nursing students. Coping strategies included both total involvement in the care, and distancing one’s self from it. Nursing students experienced cooperation with both patients and relatives through communication as meaningful. However, nursing students experienced that the education in end-of-life care are inadequate.

abstract: Solar photovoltaic (PV) deployment has grown at unprecedented rates since the early 2000s. As the global PV market increases, so will the volume of decommissioned PV panels. Growing PV panel waste presents a new environmental challenge, but also unprecedented opportunities to create value and pursue new economic avenues. Currently, in the United States, there are no regulations for governing the recycling of solar panels and the recycling process varies by the manufacturer. To bring in PV specific recycling regulations, whether the PV panels are toxic to the landfills, is to be determined. Per existing EPA regulations, PV panels are categorized as general waste and are subjected to a toxicity characterization leaching procedure (TCLP) to determine if it contains any toxic metals that can possibly leach into the landfill. In this thesis, a standardized procedure is developed for extracting samples from an end of life PV module. A literature review of the existing regulations in Europe and other countries is done. The sample extraction procedure is tested on a crystalline Si module to validate the method. The extracted samples are sent to an independent TCLP testing lab and the results are obtained. Image processing technique developed at ASU PRL is used to detect the particle size in a broken module and the size of samples sent is confirmed to follow the regulation. / Dissertation/Thesis / Masters Thesis Engineering 2017

abstract: The aging mechanism in devices is prone to uncertainties due to dynamic stress conditions. In AMS circuits these can lead to momentary fluctuations in circuit voltage that may be missed by a compact model and hence cause unpredictable failure. Firstly, multiple aging effects in the devices may have underlying correlations. The generation of new traps during TDDB may significantly accelerate BTI, since these traps are close to the dielectric-Si interface in scaled technology. Secondly, the prevalent reliability analysis lacks a direct validation of the lifetime of devices and circuits. The aging mechanism of BTI causes gradual degradation of the device leading to threshold voltage shift and increasing the failure rate. In the 28nm HKMG technology, contribution of BTI to NMOS degradation has become significant at high temperature as compared to Channel Hot Carrier (CHC). This requires revising the End of Lifetime (EOL) calculation based on contribution from induvial aging effects especially in feedback loops. Conventionally, aging in devices is extrapolated from a short-term measurement, but this practice results in unreliable prediction of EOL caused by variability in initial parameters and stress conditions. To mitigate the extrapolation issues and improve predictability, this work aims at providing a new approach to test the device to EOL in a fast and controllable manner. The contributions of this thesis include: (1) based on stochastic trapping/de-trapping mechanism, new compact BTI models are developed and verified with 14nm FinFET and 28nm HKMG data. Moreover, these models are implemented into circuit simulation, illustrating a significant increase in failure rate due to accelerated BTI, (2) developing a model to predict accelerated aging under special conditions like feedback loops and stacked inverters, (3) introducing a feedback loop based test methodology called Adaptive Accelerated Aging (AAA) that can generate accurate aging data till EOL, (4) presenting simulation and experimental data for the models and providing test setup for multiple stress conditions, including those for achieving EOL in 1 hour device as well as ring oscillator (RO) circuit for validation of the proposed methodology, and (5) scaling these models for finding a guard band for VLSI design circuits that can provide realistic aging impact. / Dissertation/Thesis / Masters Thesis Electrical Engineering 2017

Bakgrund:Att som patient befinna sig i livets slut är en subjektiv upplevelse, dock finns det generella drag. Det är därför relevant för sjuksköterskor att få kunskap om upplevelser i livets slut. Detta för att vägleda och ge stöd under patientens sista tid. Anhöriga kan uppleva rädsla då de vistas med sin familjemedlem, då de var oroliga över att deras familjemedlem skulle avlida i deras närvaro. Problem: Aktuell forskning visar på brister i vården gällande livets slut. Det fanns en bristande delaktighet i samtalet kring patientens tillstånd. Syfte: Var att beskriva patienters upplevelser i livets slut. Metod: Detta är en systematisk litteraturstudie med beskrivande syntes där 11 vetenskapliga artiklar har analyserats. Resultat: Analysen resulterade i två teman vilka var lindrat lidande och lidande. Inom dessa teman skapades fem subteman: lindrat lidande genom tro, lindrat lidande genom acceptans, lindrat lidande genom sociala relationer, lidande genom att förlora sitt jag, lidande genom att inte vara färdig med livet, lidande genom oro för framtiden och lidande genom att uppleva smärta. Slutsats: Patienter upplevde både ett lidande och lindrat lidande i livets slut. Variationer av upplevelserna kunde bero på åldersgrupper och etniskt ursprung.

Orientador: Antonio José Maria Cataneo / Resumo: Introdução: O implemento de cuidados paliativos (CP) está associado a melhor qualidade de vida do paciente em estado terminal (PET), buscando reduzir o sofrimento de todos os envolvidos no processo de morte. Justificativa: Acredita-se que PET não deveria estar internado e nem morrer em UTI. Objetivos: Determinar se a instalação de equipes de CP podem diminuir o tempo de internação e a mortalidade na UTI de PET. Métodos: Revisão sistemática de artigos que compararam PET internados em UTI que receberam cuidados de fim de vida após a instituição de uma equipe de CP (intervenção) com aqueles que receberam os cuidados quando ainda não havia sido instituída a equipe de CP (controle). Os desfechos analisados foram o tempo de internação em UTI apresentado pela diferença de média com o correspondente IC a 95%, mortalidade em UTI apresentado como razão de risco com o correspondente IC a 95%, e qualidade de vida. Foram pesquisadas as bases de dados: PUBMED, LILACS, SCOPUS, EMBASE e Cochrane CENTRAL. Resultados: Após leitura de títulos e resumos de 399 artigos, foram selecionados 27 estudos para a análise de texto completo, e finalmente excluídos 19, restando 8 artigos para inclusão, envolvendo 7846 participantes. Sete estudos foram realizados nos Estados Unidos e um na Austrália. Foi realizada metanálise para o tempo de internação em UTI, utilizando quatro estudos, que resultou em redução de aproximadamente 2,5 dias no tempo de internação com a aplicação da intervenção: media -2,44 dia... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: The palliative care (PC) procedure is associated with better quality of life for terminally ill patients (TIP), in order to reduce the suffering of everyone involved in the death process. Rationale: it is believed that TIP should not be admitted nor die in the ICU. Objectives: To determine if the installation of CP teams can reduce the length of stay and mortality in ICU TIP. Methods: A Systematic review of articles comparing TIP in ICU beds who received end of life care following the imposition of a team of PC (intervention) to those who received care when they had not yet been introduced the PC team (control). The outcome measures were the time of ICU admission presented by average difference with the corresponding 95% CI, mortality in ICU presented as risk ratios with corresponding 95% CI and quality of life. Databases were searched: PUBMED, LILACS, Scopus, EMBASE and Cochrane CENTRAL. Results: After reading titles and abstracts of 399 articles, 27 studies were selected for full text analysis, and finally 19 were excluded, leaving 8 articles for inclusion, involving 7846 participants. Seven studies were performed in the United States and one in Australia. Meta-analysis was performed to the ICU length of stay, using four studies, which resulted in a reduction of approximately 2.5 days in the length of stay with the application of intervention: Media -2.44 days (CI -4.41 to -0 48) p = 0.01, I2 = 86%. It was also performed a meta-analysis of mortality in ICU... (Complete abstract click electronic access below) / Mestre