Thesis (M.S.)--University of Nevada, Reno, 2007. / "December 2007." Includes bibliographical references (leaves 24-25). Library also has microfilm. Ann Arbor, Mich. : ProQuest Information and Learning Company, [2008]. 1 microfilm reel ; 35 mm. Online version available on the World Wide Web.

Thesis (M.S.)--University of Michigan, 1988.

Thesis (D. Min.)--Midwestern Baptist Theological Seminary, 2004. / Abstract. Includes bibliographical references (leaves 184-188).

Thesis (M.A.)--Trinity International University, 2001. / Abstract. Includes bibliographical references (leaves 107-122).

Thesis (M.L.A.)--University of Hong Kong, 2005. / Includes special report study entitled: Sensuous garden for healing.

Thesis (M.Nurs.)--Washington State University, August 2007. / Includes bibliographical references (p. 40-48).

La problématique porte sur la façon dont les ports en général et le Terminal à conteneurs du Port de Beyrouth au Liban, en particulier, pourraient améliorer leur gestion et optimiser le fonctionnement de leurs opérations au quotidien. Nous avons également introduit la théorie de la structuration de Giddens qui est une théorie du social et des rapports sociaux, pour voir dans quelle mesure certains de ses principes pourraient être bénéfiques à notre étude.Le thème de la gestion d’un terminal à conteneurs et les failles qui résident dans sa gestion et qui nuisent à ses performances est un sujet qui n’a pas été traité en profondeur auparavant. Notre immersion dans cet environnement, à savoir le Terminal à conteneurs du Port de Beyrouth durant un an nous a permis de comprendre la véritable nature de ces problèmes ainsi que leurs sources.Notre présence sur le terrain nous a donné l'occasion de conduire une série d’entretiens avec les chefs de département afin de comprendre les lacunes et les obstacles auxquels ils font face et être en mesure de proposer des solutions adaptées à leurs problèmes par le biais de cette thèse.Nos entretiens avec les chefs de département ont eu pour but de recueillir pour chaque département une description du fonctionnement quotidien des opérations, les principaux problèmes et défis les plus récurrents auxquels ils font face afin de trouver les manières de les contrer.Cette thèse a pour but de dresser une liste de recommandations par département afin d’améliorer leur performance dans le futur et d’augmenter ainsi la performance globale du Terminal à conteneurs du Port de Beyrouth. / The problematic covers the way ports in general and the container terminal of the port of Beirut in Lebanon, in particular, manage and optimize the flow of their daily operations.We also included the theory of structuration of Giddens which is a social theory and a theory of social relations, to see how some of its principles could be valuable to our study.The subject of the management of a container terminal and the flaws that reside in its management and that affect its performance is an issue that has not been discussed in depth before. Our deep dive in the container terminal of Beirut port for a year has allowed us to understand the true nature of its problems and their sources.Our presence on the ground gave us the opportunity to conduct a series of meetings with heads of departments in order to understand the gaps and obstacles they face and be able to suggest solutions to their problems through this thesis.Our interviews with heads of departments were aimed at gathering for each department a description of the daily running of operations, the most recurrent problems and challenges they face and come up with possible ways to counter them.This thesis aimed to develop a list of recommendations by department in order to improve each department’s performance in the future and thereby increase the overall performance of the Beirut container terminal.

This collection of work represents an interest in education in palliative care over the last ten years. These papers are written either by myself or in collaboration with colleagues in Britain and New Zealand. During those years the way in which palliative care is taught and learned has changed and continues to change. The overview of the work submitted here describes the rationale behind the development of new approaches to the teaching and learning of care at the end of life. In many ways this collection represents a personal journey - one that involves investigation, growth, research and evaluation. By publishing these papers and promoting discussion in this area of education I have made an original contribution to the changing way in which doctors are taught and learn to care for people who are dying and into our understanding of the nature of learning to care for those people. The papers are listed here in chronological order. Throughout the text of the overview they are referenced along with other relevant papers but appear in the reference list in bold. I declare that I am the author of the papers contained in thesis unless otherwise stated. All references documented have been consulted in the writing of these papers. References appear in the texts in the form required for each individual journal. The papers have all been published in peer reviewed journals. MacLeod, R.D., Nash, A.: 1991 : Teaching palliative care in General Practice - a survey of education needs and preferences. Journal of Palliative Care 7: 4, 9-12. (reference 6) (RDM 70% - AN 30%) MacLeod, R.D., Nash, A.: 1992 : "Taking the lid off1 -observations of the process of palliative care education for General Practitioners. Postgraduate Education for General Practice 3, 28-3 (reference 9) (RDM 60% - AN 40%) James, C., and MacLeod, R.D.: 1993 : The problematic nature of education in palliative care. Journal of Palliative Care 9:4, 5-10 (reference 10) (RDM60%-CRJ-40%) MacLeod, R.D.: 1993 : Education in palliative medicine : a review. Journal of Cancer Education 8: 4, 309-312 (reference 11) MacLeod, R.D., Nash, A.: 1994 : Multidisciplinary palliative care education. Journal of Interprofessional Care 8:3.283-288 (reference 12) (RDM 70% - AN 30%) MacLeod, R.D., Nash, A. and Charny, M.: 1994 : Evaluating education in palliative medicine. European Journal of Cancer Care 3: 163-168 (reference 14) (RDM 60% - AN 30% - MC 10%) MacLeod, R.D.: 1997 : Teaching holism in palliative care and hospice. American Journal of Hospice & Palliative Care 14:1, 12-16 (reference 36) MacLeod, R.D., James, C.R.: 1997 : Improving the effectiveness of palliative care education. Palliative Medicine 11:5, 375-380 (reference 38) (RDM 60% - CRJ 40%) MacLeod, R.D., Robertson, G.: 1999: Teaching about living and dying. Education for Health 12:2,185-192 (reference 65) (RDM 80% - GR 20%) MacLeod, R.D.: 2000 : Learning to care: a medical perspective. Palliative Medicine 14:3, 209-216 (reference 66) MacLeod, R.D.: 2001 : On reflection: how doctors learn to care for people who are dying. Social Science & Medicine 52,1719-1727 (reference 67).

Introdução: Os pacientes criticamente doentes em ventilação mecânica apresentam risco elevado de refluxo gastroesofágico (RGE) e de aspiração pulmonar, conhecidos fatores de risco para pneumonia nosocomial.. Acredita-se que haja associação entre a ocorrência de RGE e aspiração pulmonar. A detecção de pepsina na via aérea tem sido apontada como o elemento chave para o diagnóstico dessa associação. As características e a gravidade do RGE nessa população são pouco conhecidas. Apesar de largamente utilizada, a pesquisa de pepsina na via aérea apresenta várias limitações relativas à coleta das amostras, à sua análise laboratorial e à sua interpretação clínica. Objetivos: Avaliar as características do RGE quanto ao seu pH (ácido e não ácido) e quanto à altura atingida pelo material refluído (proximal e distal), bem como detectar a presença de pepsina A e pepsina C na secreção traqueal em crianças criticamente doentes em ventilação mecânica e dieta enteral. Num subgrupo dos pacientes com diagnóstico de bronquiolite viral aguda, tivemos como objetivos: correlacionar o número de episódios de RGE e a concentração de pepsina na secreção traqueal, e a influência desses eventos no desfecho dos pacientes. Metodologia: Trinta e seis crianças - internadas em unidade de terapia intensiva (UTI) em ventilação mecânica e dieta enteral plena - foram submetidas à MII-pHmetria e à coleta de secreção traqueal para análise quantitativa (ELISA) e qualitativa (Western-Blot) de pepsina. Os parâmetros de RGE analisados foram: número total de episódios de RGE, número de episódios ácido e não ácido, número de episódios proximal e distal e índice de refluxo ácido. Os valores de pepsina nas amostras foram correlacionados com o número de episódios de RGE. Foi avaliada a associação do desfecho clínico dos pacientes (número de dias em ventilação mecânica e tempo de internação em UTI) com a concentração de pepsina nas amostras e com os parâmetros de RGE. Resultados: Foram incluídas 34 crianças, com mediana de idade de 4 meses (1-174 meses). Dois pacientes foram excluídos devido a artefatos apresentados no traçado de MII-pHmetria. MII-pHmetria detectou 2172 episódios de RGE, sendo 77.0% não ácidos e 71.7% proximais. A mediana (percentil 25-75) do número total de episódios de RGE/paciente foi 59,5 (20,3-85,3). O número de episódios de RGE não ácido/paciente foi maior de que o número de ácido [43,5 (20,3–68,3) vs 1,0 (0,0–13,8), p<0,001]. Pepsina A foi detectada em 100% das amostras e pepsina C, em 76.5%. O uso de anti-ácidos e a posição da sonda de alimentação não tiveram influência aos resultados. Nos 23 pacientes com bronquiolite, a concentração mediana de pepsina nas amostras foi 4,76ng/mL (variando de 0,49 a 136,97 ng/mL). Não houve associação entre a concentração de pepsina e os parâmetros de RGE teoricamente associados ao risco de aspiração pulmonar: número total de episódios de RGE (p=0,068) e número de episódio de RGE proximal (p=0,064). O número total de episódios de RGE e o número de episódios de RGE proximal não influenciaram o tempo em ventilação mecânica (p=0,778 e p=0,643, respectivamente) e não influenciaram o tempo de permanência em UTI (p=0,542 e p=0,612, respectivamente). Também não houve associação entre os níveis de pepsina e o desfecho clínico dos pacientes, tempo em ventilação mecânica (p=0.289) e tempo de permanência em UTI (p=0.304). Discussão e conclusões: Aspiração pulmonar esteve presente em 100% das crianças, porém esse fato não atribuiu piora no desfecho clínico dos pacientes. A presença de pepsina C em quase 80% das amostras reitera a necessidade da diferenciação entre pepsina A e C para um acurado diagnóstico de aspiração de conteúdo gástrico. Os métodos que avaliam RGE não foram capazes de predizer aspiração pulmonar. A interpretação da presença de pepsina na via aérea, do ponto de vista clínico, deve ser realizada com cautela.

The aim of this pilot study, which was carried out under the auspices of the Grahamstown Hospice, is to evaluate the functioning of families with a terminally ill member, in order to establish whether these families require family therapy. The Family Assessment Device (FAD), based on the McMaster Model of Family Functioning, was used. Data from 20 families was analysed and the extent to which these families constitute a clinical sample is highlighted. In terms of the dimension of General Functioning, 15 families emerged as functioning at a problematic level. Communication emerged as the most dysfunctional of the seven dimensions of the FAD, with 17 families functioning at a problematic level. As a result of these findings it is argued that family therapy should be incorporated into the range of services offered by hospices. Limitations of this study and directions for future research are also discussed.