The purpose of this descriptive study is to investigate the perception of practice of health care professionals at a mental institution, as it pertains to their work with dying patients, and also to identify areas of change. The conceptual framework is constructed of six factors important to palliative care that have been identified from the literature. These are personal death anxiety, organizational structure of the hospital system, role expectations of professionals, teamwork, education and training for care of the dying, and conveyance and exchange of diagnostic information. The sample surveyed by a written questionnaire included physicians, psychiatrists, health care workers, social workers and pastoral care workers from the Geriatric Division of Riverview Hospital, Port Coquitlam. The findings indicate that age, sex, marital status and length of working experience at Riverview Hospital had no significant association with personal death anxiety. Informal education such as workshops and in-services had a significant correlation with personal death anxiety, as did perception of being competent and/or confident about working with the dying. The study also raised concerns that not all was being done for the dying patients and their families at this institution. Suggestions such as education and training, support mechanisms, and less stereotyping of professional roles were offered to improve this situation. As well, findings indicated that there was a need for palliative care service either in the form of a team or separate unit, or simply the practicing of the palliative care philosophy. / Arts, Faculty of / Social Work, School of / Graduate

Voltage source converter high voltage direct current (VSC-HVDC) technology has become increasingly cost-effective and technically feasible in recent years. It is likely to play a vital role in integrating remotely-located renewable generation and reinforcing existing power systems. Multi-terminal VSC-HVDC (MTDC) systems, with superior reliability, redundancy and flexibility over the conventional point-to-point HVDC, have attracted a great deal of attention globally. MTDC however remains an area where little standardisation has taken place, and a series of challenges need to be fully understood and tackled before moving towards more complex DC grids. This thesis investigates modelling, control and stability of MTDC systems. DC voltage, which indicates power balance and stability of DC systems, is of paramount importance in MTDC control. Further investigation is required to understand the dynamic and steady-state behaviours of various DC voltage and active power control schemes in previous literature. This work provides a detailed comparative study of modelling and control methodologies of MTDC systems, with a key focus on the control of grid side converters and DC voltage coordination. A generalised algorithm is proposed to enable MTDC power flow calculations when complex DC voltage control characteristics are employed. Analysis based upon linearised power flow equations and equivalent circuit of droop control is performed to provide further intuitive understanding of the steady-state behaviours of MTDC systems. Information of key constraints on the stability and robustness of MTDC control systems has been limited. A main focus of this thesis is to examine these potential stability limitations and to increase the understanding of MTDC dynamics. In order to perform comprehensive open-loop and closed-loop stability studies, a systematic procedure is developed for mathematical modelling of MTDC systems. The resulting analytical models and frequency domain tools are employed in this thesis to assess the stability, dynamic performance and robustness of active power and DC voltage control of VSC-HVDC. Limitations imposed by weak AC systems, DC system parameters, converter operating point, controller structure, and controller bandwidth on the closed-loop MTDC stability are identified and investigated in detail. Large DC reactors, which are required by DC breaker systems, are identified in this research to have detrimental effects on the controllability, stability and robustness of MTDC voltage control. This could impose a serious challenge for existing control designs. A DC voltage damping controller is proposed to cope with the transient performance issues caused by the DC reactors. Furthermore, two active stabilising controllers are developed to enhance the controllability and robust stability of DC voltage control in a DC grid.

The purpose of this study was to explore spiritual and psychological issues as experienced by persons who know they have a terminal illness. An existentialphenomenological method was chosen to understand and articulate the structure and meaning underlying the experience of living with the knowledge that one has a terminal illness. The study had its genesis at the bedside(s) of people who were dying, yet living or living, yet dying. The experience of knowing one has a terminal illness serves to bring life and consciousness to those who may have otherwise continued to live unconsciously, to exist in a potentially weary and dormant state, oblivious to the fact that life was passing them by. The evidence of experience of knowing what it means to have a terminal illness exists in the words and expressions of the twenty-one people who graciously participated in this study as co-researchers. They have given testimony of their own experience to those of us who seek to understand that experience, to understand what it means to have a terminal illness, to confront one's end to life as it is known, to embrace life or to prepare to die. For some it was a single in-depth interview, for others there were numerous indepth interviews over the course of two to eleven months. Eight of the twenty-one coresearcher narratives were presented in this study. Each interview was recorded by audio and video tape, the former being used for transcription. Subsequently, transcriptions were reviewed for accuracy. As a measure of trustworthiness, themes were identified by the principal investigator and presented in the context of the narrative to the coresearchers who confirmed the data and validated the themes. Implications based on the themes identified in this study are presented under theory development, professional practice and future research. One of the strongest implications pertains to clinical practice in that the results could serve as the framework for a palliative care program which models palliative care as defined by the World Health Organization. The co-researchers were eager to tell their stories and to speak their truth with the hope that the care of persons with terminal illness would some day include care of people as whole persons—physical, psychological and spiritual. / Graduate and Postdoctoral Studies / Graduate

This dissertation will examine the legality of assisted dying procedures performed in the Republic of South Africa. This is due to the rising awareness about terminal patients’ dignity and autonomy at the end of their life. The physician’s liability, who assists such a patient to end their life, will be examined and whether there is any legal recourse available will be explored. Comparisons will also be made between other legal systems, including Canada, the Netherlands, Oregon of the United States of America and England and Wales. These jurisdictions have been chosen to provide a wide variety of perspectives and possible alternatives that South Africa should take into consideration should parliament or the courts decide to argue the matter. Other sources are also considered, such as the influence of the history and development of the common law crime of murder, as well as the role the Health Professions Council of South Africa will play. Possibly most importantly, the material criminal law of South Africa is thoroughly studied with all forms of assisted dying in mind. This is to establish what kind of liability, criminal or otherwise, a physician might incur should they decide to assist a patient in these circumstances. Lastly, recommendations are made based on the research done throughout this dissertation, which would ideally assist in any future arguments made on the topic. / Dissertation (LLM)--University of Pretoria, 2017. / Public Law / LLM / Unrestricted

Kan man kombinera en opera med båtterminal och vad händer då med operans roll?

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / In the management of port terminals, a common problem has been evidenced, high traffic of trucks and long waiting times given the variability of trucks arrival. This is a significant challenge for ports. This situation has given the opportunity to investigate in this matter and make use of a Truck Appointment System (TAS) together with other tools corresponding to industrial engineering for the optimization of truck service processes within a port terminal in Peru. To do this, a diagnosis is made of the company object of study and through a simulation of discrete systems, the technical viability of the proposal is validated. It was demonstrated that a procedure of attention based on appointments, Last in, First Out (LIFO) management for containers and development of visual management within the container yard; it is a highly viable option to shorten waiting times and unproductive movements of containers.

This study investigates socialization and ideal expectations for the health professional role in the provision of quality terminal care. Guiding the research are role theory, socialization theory, and Talcott Parsons' (1951) pattern variables. The research was conducted in three phases. The first phase involved development of an analytical framework elaborating upon Parsons' five pattern variables, which were first conceptualized as dimensions describing the ways in which roles could vary. Specific indicators for each of the pattern variables were developed. Typologies characterizing (1) the medical, or conventional, model and (2) the holistic model (specifically, the hospice model) for the provision of health care based on these indicators then were developed. Using the analytical framework, the second and third phases consisted of: (1) a content analysis of the physician and nurse socialization literature to determine the role prescriptions learned by these health professionals; and (2) a content analysis of open-ended interviews with a group (N = 94) of terminally ill elderly patients (n = 17), family members (n = 38), and health professionals (n = 39) from 10 urban health care programs (five conventional and five hospice) to identify ideal role expectations for the health professional. Major findings were that: (1) Parsons' pattern variables, with elaboration, can provide a useful framework for role analysis; (2) physicians and nurses appear to be socialized to a number of role prescriptions consistent with the medical model, although there is evidence of conflicting socialization (to both models) for some role prescriptions; (3) respondents' expectations generally were consistent with those prescribed by the hospice model with some notable exceptions; (4) the role expectations of the three groups of respondents were more congruent than was expected, although subgroups' (conventional versus hospice) expectations tended to differ. Implications of the findings for: (1) role analysis; (2) socialization of health professionals to minimize role strain and conflict with patients and families; (3) continued implementation of conventional and hospice models for the provision of quality terminal care; (4) assessment of the quality of terminal care are explored; and (5) further research are explored.

The master´s thesis deals with the design of the transfer terminal on the proposed high speed railway Prague - Hradec Kralove - Wroclaw near the town of Podebrady and exit 39 from the D11 motorway. The work includes the design of station layout, platforms, access roads, bus stops and parking house. As part of the railway station design naintenance base with the loading area. The integral parts of the thesis is design of the railway superstructure, substructure and drainage system.

According to the WHO cancer is one of the leading causes of morbidity and mortality in the world. In 2012 there was 14 million of new cases worldwide. A number of new cases is expected to rise in future. An increasing number of cases demanding a new approach from health care systems regarding the staff education, hospital equipment and interprofessional cooperation in order to give full service to the customers (patients). For several years palliative care education is a top priority in the education of nurses due to the fact that there are serious deficiencies in that area (Komaromy et al. 2000, Miller et al. 2004, Goodridge et al. 2005, Hasson et al. 2008). Nurses are the forefront of caring for terminally ill patients and their families approaching the end of life, which does not minimize role of other healthcare professionals, but nurses have main role in this process. Definition and competencies of nurses involved in this process must be precisely identified and measured from time to time in order to improve the process of end of life care and palliative care nursing. Continuous development of guidelines and protocols for palliative care nursing is particularly relevant (Watts, 2013; Gambles et al 2009, Hockey et al 2005, Jack et all 2003). Development of competencies is one of key issues in contemporary education it and can be achieved with development of proper curriculum and education schedule, especially development of a proper instrument for measurement of competencies. This research has identified most important 10 competencies in accordance with WHITE paper for EAPC and WHO. General objective. This research has one general objective and it is creation and validation of new questionnaire about competencies in field of palliative care nursing with aspect of realization of core competences in developed and under developing systems. This questionnaire is a new instrument in field of competence measurement in palliative care nursing. Specific objectives of the research are based on evaluation and comparison of competences among nurses from Bosnia and Herzegovina and Spain (Valencia area). Methodology. Methodology comprises research, cross – section, analytical method of research. Actions taken in this process were literature review, analysis of data available curricula of nursing schools, literature research, development of new instruments for measurement of competences in palliative care nursing, interviews with nurses in Bosnia and Herzegovina, development of online platform for nurses in Spain, translation of instruments to Spain language, data processing, Comparison of results from both group were done by every single item of instrument and by every competences. Results. Results are presented in two different parts: Part I (one) of results is about development of instrument PALCOM and part II (two) is about the data collected from Bosnia and Herzegovina and Spain. All results are shown in proper table and graphs that are reflecting research process. Results show the significant statistical difference between groups in Bosnia and Herzegovina and Spain (Valencia area) in some aspects, while in several aspect there is no difference. Working experience and level of education are in directly linked with self-competence measurement. There is a high statistical difference between groups with different level of education, and working experience, which has a direct impact on development of competence of nurses. Conclusion. Need for measurement of competencies is expressed in the daily development of palliative care, community palliative care, hospice care and subspecialty palliative care. Questionnaire that can measure all competencies does not exist but using general competencies in PALCOM questionnaire can cover this entire field with measurement of various domains and competencies specific to that domains. PALCOM as an instrument for evaluation of competencies in the field of palliative care, is, for the time being, a reliable instrument. With the development of palliative care, improvement can be done in the area of competencies in palliative care nursing. PALCOM is applicable in various health care systems and educational systems and it does not depended on external factors. PALCOM as instrument measures the competence level of nurses and preparedness for work in palliative care settings. First scale measure knowledge, while second scale is self-measurement of competences in accordance with the level of education and work experience. Need for the appropriate instrument for measuring competences in palliative care nursing leads us to this instrument following most economical and reasonable way of developing.

Retinal terminal profiles in the goldfish optic tectum were identified electron microscopically after (1) labeling with horseradish peroxidase and (2) in the early stages of degeneration in short‐term eye enucleates. All labeled terminals shared certain common morphological characteristics which were identical to those of a population of terminals in normal tecta. Terminals of this type disappeared 30 days after enucleation of the contralateral eye. Retinal terminal presynaptic profiles were characterized by (1) round and oval synaptic vesicles; (2) mitochondria with irregular, randomly oriented cristae, large intracristal spaces, dilated membrane spaces, and primarily light matrices; (3) a wide range in profile area, 0.06–6.82 μm2; (4) large numbers of synaptic vesicles per profile area 168± 33 synaptic vesicles per μm2; (5) asymmetric synapses; and (6) multiple synaptic contacts (1.46 ± 0.73 per terminal profile). The postsynaptic elements included both dendritic and, less commonly, pleomorphic vesicle‐containing profiles. The majority of postsynaptic dendritic profiles were small (0.01–0.40 μm2). Serial synaptic contacts were occasionally seen. The combination of vesicular and mitochondrial morphology (1 and 2 above) was necessary and sufficient to establish the retinal origin of a terminal, but use of such criteria would underestimate the number of retinotectal terminals by omitting those which did not have a mitochondrion in the plane of section. The number of such terminals was calculated from independent measurements, and the total number of retinal terminal profiles per area of neuropil was estimated.