The general aim of this study was to determine the experiences of a sample of terminally ill patients in using spiritually focused psychotherapy. This was a qualitative study conducted to a sample of 2 terminally ill patients from hospice in Grahamstown, South Africa. The research was conducted in 3 phases: an initial in-depth interview conducted to determine the participants' level of spirituality as well as the extent to which their terminal illnesses had affected their functioning. This was followed by a minimum of 6 spiritually focused therapy (SFT) sessions as a second phase of the research. To determine the participants' experiences of SFT, 2-3 in-depth interviews were conducted during the 3m phase of the research study. The research revealed that a belief in a higher power helps terminally ill patients cope better with their illness and that social disconnectedness is related to HIV / AIDS stigma. It also revealed that terminal illness is co-morbid with other psychiatric symptoms such as depression, evokes existential concerns, results in a change in the level of spirituality and affects the whole family. Participants blamed themselves for their illness, but found that engaging in the process of forgiveness of self and others brought about psychological healing for them. They experienced SFT as a coping resource that assisted them to deal with the fear of death as well as increased insight into the development of psychopathology and spiritual blockages. It is recommended that a comprehensive and holistic assessment during intake be undertaken so that where spiritual needs are available, therapy can be spiritually augmented to ensure that such needs/ struggles are addressed. / KMBT_363 / Adobe Acrobat 9.54 Paper Capture Plug-in

Terminally ill patients and their families describe hospital care as nonsupportive to their needs during the final phase of life. Nurses generally are not comfortable with a supportive role when caring for the dying and tend to adhere to a curative role. The purpose of this descriptive, correlational study therefore was to describe the attitudes of general staff nurses working on medical-surgical units in hospitals towards the care of the dying and to ascertain the relationship between these attitudes and the education and experience of the nurses. An adaptation of the model for role episode, conflict, and ambiguity by Kahn, Wolfe, Quinn, Snoek and Rosenthal (1964) was the applied theoretical framework. The sample consisted of 197 randomly selected registered nurses employed full or part-time on general adult medical-surgical hospital units in British Columbia. The majority of the sample were married, Protestant females, between the ages of 26 and 45 years who were prepared at the diploma level in nursing. The mean length of time worked as a nurse was 8.5 years with a mean of 7.5 years on medical-surgical units. Attitudes towards the care of the dying were generally ambiguous, neither negative nor positive as measured by scores obtained on the ‘Questionnaire for Understanding the Dying Person and His Family’. Additionally, half the respondents did not believe that nurses should be the primary health care professionals equipped to deal with the emotional reactions of the dying yet three-quarters of the sample believed that patients turned to nurses to discuss such emotional issues. Data revealed that close to two-thirds of the respondents had received structured death and dying content in their basic nursing education yet less than half furthered their death and dying education since graduation. Overall death education for the sample was low. A small positive correlation (r=-0.26) was found between respondents' death education and their attitudes towards the care of the dying; no significant association was found between respondents' level of general nursing education and their attitudes. Although there was variability in the amount of professional and personal death experience, over half of the respondents experienced between one and three terminally ill patient deaths on their medical-surgical units per month. Additionally, the majority of respondents had experienced the death of an immediate family member. Overall death experience was low to moderate. A small, but significant positive correlation (r=0.24) was found between overall death experience and attitudes' towards the care of the dying; no significant association was found between general experience and attitude. Findings suggest that supportive nursing care is not being demonstrated with dying patients and their families. However, the influencing natures of death education and death experience on nurses' attitudes are positive, thereby providing the nursing profession with two possible ways of positively influencing nurses' attitudes to the care of the dying. / Applied Science, Faculty of / Nursing, School of / Graduate

Background: The withdrawal of invasive mechanical ventilation (MV) within the context of withdrawal of life-sustaining measures (WLSM) is common in the intensive care unit (ICU). The method by which invasive MV is withdrawn during WLSM remains an ongoing topic of discussion and research; two methods are terminal weaning (TW) and terminal extubation (TE). Aims: To statistically describe and compare the processes of TW and TE as undertaken in two ICUs. Study Design: A secondary data analysis using data from a longitudinal retrospective chart audit. Results: A total of 78 patient charts were included. MV was withdrawn in 88.5% of patients undergoing WLSM. TW was used in 62.3% of the cases while TE was used in 37.7%. Patients who underwent TW were on average younger, had a longer ICU stay, higher respiratory support requirements, a longer duration of invasive MV, and shorter period from first change in MV parameters to patient death. Conclusion: This study highlights the nuances and complexities within MV withdrawal and WLSM in the ICU.

Objective: To determine the association of features occlusal with age and gender in children with deciduous dentition of a public educational institution in the district of Ate Vitarte in 2013. Methods: The sample was conformed by 108 children with complete deciduous dentition between 3 and 5 years of the IE Amauta No. 1285-216 located in Ate Vitarte in 2013. All variables were recorded on the data collection form, these were, type of arch, primate spaces, palatine hall relation of molars, bilateral terminal molar relation, bilateral canine relationship, curve of Spee, midline, overjet and overbite. In addition to the age and gender of the scholar. Frequencies were obtained and the chi square test were conducted to determine associations between variables. Results:. Only found statistically significant association between superior primates spaces (p=0.041) and inferior (0.002), bilateral terminal molar relation (p=0.040), lower midline (p=0.032) and age. Conclusions: In this study, was found that most of the children presented normal occlusal characteristics. No association of most occlusal characteristics were found with age and gender. / Objetivo: Determinar la asociación de las características oclusales con la edad y género en niños con dentición decidua de una Institución Educativa Pública del distrito de Ate Vitarte en el año 2013. Métodos: La muestra estuvo conformada por 108 niños con dentición decidua completa entre 3 y 5 años de la IE Amauta Nº 1285-216 ubicado en Ate Vitarte en el 2013. Todas las variables fueron registradas en la ficha de recolección de datos, estas fueron el tipo de arco, los espacios primates, relación vestíbulo palatina de molares, plano terminal bilateral, relación canina bilateral, curva de Spee, línea media, overjet y overbite. Además de la edad y género del escolar. Se obtuvo las frecuencias y se realizó la prueba de chi cuadrado para determinar asociaciones entre las variables. Resultados: Se encontró asociación estadísticamente significativa entre los espacios primates superior (p=0.041) e inferior (p=0.002), plano terminal bilateral (p=0.040) y la línea media inferior con la edad (p=0.032). Conclusiones: Se encontró asociación de los espacios primates superior e inferior, plano terminal bilateral y la línea media inferior con la edad. Palabras Claves: Dentición decidua, relación oclusal, plano terminal, espacios primates / Tesis

La croisière contemporaine connait un essor indéniable depuis les années 2000 et notamment en Europe. Cette thèse vise à mieux comprendre les enjeux posés par le développement de ce secteur dans les villes portuaires et pour leurs acteurs via une compréhension générale du contexte de la croisière, une analyse du système croisière en détaillant certaines de ses composantes telles que les jeux d'acteurs ou son ancrage spatial et enfin la proposition d'un modèle du port de croisière. Ce dernier a permis de d'explorer différentes pistes de développement qui peuvent être appliquées à ces ports, voire potentiellement à des ports dans d'autres régions du Monde. / The contemporary cruise has undeniably grown since the 2000s, particularly in Europe. This thesis aims to better understand the stakes posed by the development of this sector in the port cities and for their actors via a general understanding of the context of the cruise, an analysis of the cruise system by detailing some of its components such as the sets of actors or its spatial anchor and finally the proposal of a model of the cruise port. The latter made it possible to explore different development paths that can be applied to these ports, even potentially to ports in other regions of the World.

El documento ¨Formulación técnica, económica, financiera y social en la implementación de Clínicas de Hemodiálisis” definirá la viabilidad del funcionamiento de una clínica privada que presta servicio de tercerización de la hemodiálisis a Essalud – Seguro Social de Salud y cuyo servicio de hemodiálisis es diferente del resto de las clínicas privadas del país por su calidad de productos y tecnología de equipos que propenden a mejorar la calidad de vida del paciente renal crónico. Para determinar esta viabilidad, este documento nos mostrará las características y planes económico financiero y estratégicos que generen respuesta a la siguiente pregunta: ¿El proyecto de clínicas de hemodiálisis para tercerización con Essalud genera valor al inversionista y es económicamente rentable? La Enfermedad Renal Crónica Terminal (ERCT) es una enfermedad progresiva que evoluciona en las personas en diferentes estadios y que da inicio a un tratamiento sustitutivo de la función mediante diálisis o trasplante de riñón con unas tasas de incidencia y prevalencia crecientes en las dos últimas décadas. Nuestro enfoque va direccionado al servicio de hemodiálisis que se ofrecerá en tercerización al Seguro Social de Salud que actualmente cobertura al 66.66% de pacientes asegurados a nivel nacional en Perú. Las tercerizaciones se realizan mediante un Concurso Público para la Contratación del Servicio. / The document "Technical, economic, financial and social formulation in the implementation of Hemodialysis Clinics" will define the feasibility of operating a network of private clinic that provide outsourcing of hemodialysis to Essalud - Social Health Insurance and whose hemodialysis service It is different from the rest of the private clinics in the country because of its quality of products and equipment technology that tend to improve the quality of life of the chronic renal patient. To determine this viability, this document will show us the economic and strategic economic characteristics and plans that generate an answer to the following question: Does the hemodialysis clinic project for outsourcing with Essalud generate value for the investor and is it economically profitable? Terminal Chronic Kidney Disease (ERCT) is a progressive disease that evolves in people at different stages and that begins a substitute treatment of function by dialysis or kidney transplant with increasing incidence and prevalence rates in the last two decades. Our approach is directed to the hemodialysis service that will be offered in outsourcing to the Social Health Insurance that currently covers 66.66% of insured patients nationwide in Peru. Outsourcing is carried out through a Public Tender for the Service Hiring. / Trabajo de investigación

No description available.

El proyecto está situado en la costa de Pucusana, un balneario reconocido por su gran diversidad de recursos hidrobiológicos. Actualmente, existe un terminal pesquero en la costa, sin embargo, las condiciones precarias de las instalaciones y la falta de logística entorpecen el correcto procesamiento de los recursos hidrobiológicos. La pesca artesanal es la economía primaria de Pucusana, por lo tanto, una infraestructura deficiente afecta directamente la calidad de vida e ingresos de los pobladores del distrito. La municipalidad de Pucusana ha previsto la reconstrucción del terminal para potenciar el desarrollo de la actividad pesquera. Además, existen una serie de artículos que hacen mención a la implementación de espacios públicos y áreas verdes en el distrito, además de la mejora del malecón. Para lograr la conexión entre la naturaleza y el contexto urbano, se aplicó una interpretación de la teoría de los “Límites Difusos” de Toyo Ito, cuya evolución incorpora términos como trasferencia intencional, permeabilidad y arquitectura flexible. Basada en la abstracción, la teoría estudia una arquitectura del más allá, en la que no se puede intuir el límite entre las barreras físicas y el entorno natural, es decir, un diseño que interactúa a semejante nivel interior – exterior o natural – artificial, que el espacio logra su fuga. El proyecto de tesis comprende el desarrollo del malecón y el terminal pesquero turístico, enfatizando la fluidez a partir de la superposición de plataformas que continúan la forma natural de la franja costera; permitiendo un entorno legible y en constante interacción con la naturaleza. / The project is set in the coast of Pucusana, a Peruvian beach known for its vast diversity of marine species and resources. Currently, a fishing terminal is located there, but the deplorable sanitary conditions of the premises and lack of logistics hinder the processing of the hydrobiological resources. Artisanal fishing is the primary economy of Pucusana, therefore a deficient infrastructure directly affects the quality of the fishermen’s lives and incomes. The municipality of the district had envisioned the reconstruction of the terminal to ensure the improvement of the fishing activity. There were also several articles mentioning the upgrade of public and green areas around the coast, which evidences the need for a fishing terminal which emphasizes its touristic and recreational character. In order to reassure the connection between nature and the urban environment, an interpretation of the Toyo Ito’s “Blurring Architecture”. Based on the concept of abstraction, the theory follows an architecture that lays beyond, in which the user may not intuit the limit between the inside – outside or natural – artificial compounds. This is reflected in a design that allows an interaction with its natural environment, letting the spatiality leak out of the concrete casket. The thesis project comprehends the development of the boardwalk and the tourist fishing terminal; emphasizing the fluidity of the design through the overlapping of platforms that continue the natural form of the coast border, which allow a clear environment and a constant interaction with nature. Terminal Pesquero; Interacción; Conexión; Naturaleza; Limites Difusos. / Tesis

Bakgrund: Beslutet om artificiell nutrition och hydrering (ANH) i det terminala skedet har länge varit ett högaktuellt ämne världen över. Sjuksköterskan är den i vårdteamet som står närmast patienten, identifierar dess behov och initierar en behandling med ANH. Därför var det av intresse att undersöka sjuksköterskans medverkan vid beslutsprocessen. Syfte: Syftet med studien var att beskriva sjuksköterskans medverkan vid bedömning av behovet av artificiell nutrition och hydrering i det terminala skedet. Metod: En allmän litteraturstudie med induktiv ansats. Elva vetenskapliga artiklar användes i resultatet. Resultat: Resultatet av litteraturstudien delades upp i tre teman: Faktorer som påverkar sjuksköterskan, Relationer som påverkar beslutet och Beslutsprocessen. Resultatet visade att de sjuksköterskor som arbetade på en vårdavdelning som hanterade ANH-beslut och de sjuksköterskor som hade lång erfarenhet medverkade i beslutsprocessen i större utsträckning. Det framkom också att relationen mellan sjuksköterskan och ansvarig läkare hade betydelse för sjuksköterskans delaktighet i beslutet. Konklusion: För att sjuksköterskan ska känna sig trygg i att medverka i beslutsprocessen krävs utbildning inom ämnet, tydliga riktlinjer och ett arbetsklimat präglat av goda relationer kollegorna emellan. / Introduction: The decision making process regarding artificial nutrition and hydration (ANH) at the terminal stage of life has been a highly topical subject worldwide. The nurse is the member of the team who’s closest to the patient, the one who identifies the patients’ needs and initiates the ANH treatment. Because of this, examining the nurses’ participation in the decision-making process was of interest. Aim: The aim of the study was to describe the nurses participation regarding the decision-making process surrounding ANH at the terminal stage of life. Method: A general literature review with an inductive approach. Eleven articles were used in the result. Results: The results of the study were divided into three themes. Factors influencing the nurse, Relations that influence the decision, The decision-making process. The result shows that the nurses working in wards often managing ANH treatment decisions and the nurses with more experience participated in the decision making process to a greater extent. The results also showed that the character of the relationship the nurse had with the doctor was important and made a difference regarding the nurses participation in the decision. Conclusion: In order for the nurses to feel comfortable and safe to participate in the decision making process they need education, guidelines and good relations with colleagues.

[pt] O crescimento do mercado de contêineres e a busca dos terminais pela melhoria em seus processos portuários tem obtido a atenção da área científica. Com enfoque nos estudos de simulação, o presente trabalho tem por objetivo modelar e simular um sistema logístico de um terminal portuário, cuja especialização é a movimentação de contêineres. Foram desenvolvidos 6 cenários com finalidade de avaliar os recursos necessários capazes de movimentar um volume específico de contêineres por uma unidade de tempo. O modelo é construido no software ARENA e a análise dos resultados realizada através dos indicadores comuns em terminais de contêineres. Esses indicadores são analisados para cada um dos cenários desenvolvidos e como conclusão avalia-se a capacidade instalada para cada um dos cenários. Para validação do modelo foram construídos 2 cenários e os outros 4 cenários avaliaram como os recursos de três berços de atracação de navios, 6 Portêineres, 6 Rubber Tyred Gantry, 11 Reach Stackers, 26 carretas, 4 Gates , 1 Scanner e 30 slots de Inspeção de comportam com a movimentação de 440.000 contêineres/ano e 660.000 contêineres/ano. / [en] The growth of the container s market and the search of terminals for the improvement in their port processes has gotten the attention of the scientific area. With focus on simulation studies, the present work aims to model and simulate a logistic system of a port terminal, whose specialization is the containers movements. Six scenarios have been developed in order to assess the resources needed to handle a specific volume of containers by a unit of time. The model is built in the software ARENA and the analysis of results was performed through common indicators in container terminals. These indicators were analyzed for each of the scenarios developed and finally evaluated the installed capacity for each of the scenarios. For de model validation were built two scenarios and for the other four sceanrios assessed how the resources of three berths for ships, 6 ship to shore, 6 rubber tyred gantry, 11 reach stackers, 26 trucks, 4 gates, 1 scanner and 30 inspection slots behaves with 440.000 container/year and 660.000 container/year.