Sammanfattning    Bakgrund: Diagnosen av en obotlig sjukdom kan förr eller senare leda till att personen blir i behov av palliativ vård. I denna situation är hopp oftast en viktig del i att fortsätta leva och uppleva välbefinnande samt en god livskvalitet. Syfte: Syftet med denna litteraturöversikt var att beskriva upplevelse av hopp hos personer som vårdas palliativt. Metod: En litteraturöversikt genomfördes där 11 artiklar med kvalitativ design inkluderades och analyserades deduktivt med hjälp av Herth Hope Index. Artikelsökningen gjordes i databaserna CINAHL och PsycINFO. Resultat: Trots en dålig prognos och medvetandet om att döden närmar sig fortsatte deltagarna i studierna att hoppas och sätta upp framtida mål. Hoppet påverkades både positivt och negativt beroende på det förflutna, nuet och framtiden. Det som främjade hoppet mest visade sig vara familj och närstående.  Vissa deltagare tyckte att det inte fanns något att hoppas på då framtiden såg mörk ut. Tron på Gud/och eller Jesus samt högre makter hjälpte deltagarna att upprätthålla samt öka hopp. Slutsatser: Resultatet som framkom kan ge en vägledning för hälso- och sjukvårdspersonal om hur personer som vårdas palliativt upplever hopp och på vilket sätt det kan främjas, utökas och vad det är som gör att hopp upprätthålls. Nyckelord: erfarenheter, förhoppningar, livets slutskede, obotliga sjukdomar / Experiences of hope among people receiving palliative care - A literature review Summary   Background: The diagnosis of an incurable disease may sooner or later lead to the need for palliative care. In this situation, hope is usually one of an important part in continuing to live and experience well-being as well as a good quality of life. Purpose: The aim of this literature review was to describe the experience of hope among people receiving palliative care. Method: A literature review was performed where 11 articles with a qualitative design were included and with the help of Herth Hope Index analyzed deductively. The article search was made in the CINAHL and PsycINFO databases. Result: Despite a bad forecast and the awareness that death is approaching, the participants in the studies continued to hope and set future goals. Hope was affected both positively and negatively, depending on the past, the present and the future. What promoted hope most proved to be family and related. Some participants thought there was nothing to hope for when the future looked dark. Faith on God / and or Jesus as well as higher powers helped participants to maintain and increase hope.Conclusion: The result that emerges can provide guidance for health professionals about how palliative patients experience hope and how it can be promoted, expanded and what makes hope maintained.   Keywords:  expectation, experience, incurable diseases, terminal care

Development of the nervous system is a highly organized process that utilizes genetic mechanisms conserved across the animal kingdom. Components of the nervous system such as inhibitory GABAergic neural networks are common among most multicellular animals. The nematode Caenorhabditis elegans, utilizes similar genetic pathways to that of mice and humans to develop its GABAergic neural networks. These GABAergic neural networks are composed of two types of GABAergic motor neurons: the VD and DD sub-classes. The GABAergic differentiation of both these sub-classes requires the conserved transcription factor, Pitx/UNC-30. The VD sub-class is differentiated from the DD motor neurons by the expression of another transcription factor, COUP TFII/UNC-55. The transcriptional mechanisms regulating the expression of Pitx/UNC-30 and Coup TFII are unknown. We sought to determine how Pitx/UNC-30 and COUP TF-II/UNC-55 were transcriptionally regulated in an attempt to understand how mechanisms of GABAergic fate specification and class specification may be connected. We hypothesized there would be different mechanisms regulating the GABAergic differentiation and sub-class specification of the two sub-classes of GABAergic motor neurons. To test this, we dissected the transcriptional mechanisms responsible for the expression of Pitx/UNC-30 and COUP TFII/UNC-55. We found that different isoforms of the Hox cofactor Meis/UNC-62 stabilize and activate the expression of UNC-55. Furthermore, we conclude that Pitx/UNC-30 expression is regulated differently between the two motor neuron sub-classes by Meis/UNC-62, Hox-B7/MAB-5 and NeuroD/CND-1, each of which are vital to the development of different components of the nervous system in vertebrates. Our findings suggest that the GABAergic identity and the sub-class specification of neurons are under the control of multiple conserved transcription factors responsible for neuron fate determination and post mitotic identities.

Direct generation of enantioenriched mono-α-alkylated aldehydes by intermolecular nucleophilic substitution is a general and long-standing problem in synthesis, and is of importance due to the diverse reactions such aldehydes undergo for introducing asymmetry into molecules. The work described in this thesis initially details the development of the first lithium amide capable of efficiently converting terminal epoxide into enamine functionality, where the latter also demonstrates effective C-alkylation activity. Not only addition to Michael acceptors, but more notably substitution using activated organohalides (α-bromoacetates, benzyl, allyl and propargyl bromide) gave the corresponding α-substituted aldehydes in good to excellent yields. Alkylation with propargyl bromide yielded only the propargyl-substituted aldehyde with none of the corresponding allene observed; this result shows that N-alkylation followed by [3,3] sigmatropic rearrangement is not occuring. Importantly, a range of short-, longer-chain and secondary unactivated alkyl iodides also proved viable. Significantly, with chiral lithium amides, the corresponding chiral enamines could be alkylated with strongly electrophilic benzyl, allyl and propargyl (no allene seen) bromides in very good yields, and with short chain alkyl iodides – MeI and EtI in satisfactory yields, to provide the first direct access to α-alkylated aldehydes with high asymmetric induction by intermolecular nucleophilic substitution.

Background: Active euthanasia is legal in Netherlands, Belgium and Luxembourg. In Switzerland, Estonia and the states of Wasington and Oregon in USA are only doctor-assisted euthanasia legal. When patient’s receive a diagnosis of a terminall illness studies shows that various kinds of suffering, pain, religion and feeling that you are dependent on relatives are factors which affect people's quality of life and attitude to euthanasia. Some patients want to end their life while others want to manage their lives. There are disagreements about whether euthanasia could be a option. Aim: To describe the attitude of patients with an incurable terminal illness has to euthanasia and what factors as affecting their attitude. The aim is also to describe the research group in the articles. Method: A descriptive design has been used in this litterature study. Twelve articles have been used, seven Qualitative and five Quantitative. Results: The results depends on various factors such as pain, religion, depression, physical function and suffering. These factors affected the patient’s attitudes towards euthanasia. The composition of the articles emerge that 680 patients were positive to euthanasia, 483 patients were against, and 34 patients had not answered the question. Conclusion: A positive attitude to euthanasia can be seen clearly in the research of the articles results. However, only one study came from Sweden and therefore the authors think that more research is needed to gain an understanding of patient’s attitude. There are concerns that euthanasia will be miss-used or abused when the patient’s have been asked about their attitudes. [1]Totalt 1197 svarande, 680 patienter för, 483 patienter emot, 34 svarande ej. / Bakgrund: I Nederländerna, Belgien och Luxemburg är det lagligt med aktiv dödshjälp. I länderna Schweiz, Estland och delstaterna Washington och Oregon i USA är det lagligt med läkar-assisterat självmord. När patienter får en diagnos med en dödlig sjukdom framkommer det i studier att vid olika typer av sjukdomar uppfattas lidande, smärta, religion samt att vara andra närstående till besvär som faktorer vilket påverkar personernas livskvalité och inställning till eutanasi. En del patienter vill avsluta sitt liv andra vill hantera sitt liv därför råder det delade meningar kring inställningen till eutanasi. Syfte: Syfte med denna studie var att beskriva vilken inställning patienter med obotligt dödliga sjukdomar har till eutanasi och vilka faktorer som påverkar deras inställning. Syftet var även att beskriva vilken undersöknings grupp de valda artiklarna hade. Metod: En deskriptiv design har används i denna litteraturstudie. Tolv artiklar har används, sju Kvalitativa och fem Kvantitativa. Huvudresultat: Resultatet är beroende av olika faktorer såsom, smärta, religion, depression, fysiska funktionen och lidandet. Dessa faktorer påverkade patienternas olika inställning till eutanasi. I sammansättningen av artiklarna framkom det 56,8% patienter var för eutanasi, 40,3% patienter var emot och 2,8 % patienter har inte svarat på frågan1. Slutsats: Stora skillnader kan ses till inställningen om eutanasi i sammanställningen av artiklarnas resultat. Dock framkommer endast en studie ifrån Sverige och därför anser författarna att mer forskning behövs för att få en förståelse för patienternas inställning. Även en risk för att eutanasi skall missbrukas uppkommer i studien när patienter skall besvara frågan om de är för eller emot.

Transcription of human protein-coding genes and most small nuclear RNA genes is mediated by RNA Polymerase II (Pol II). During a cycle of transcription, Pol II recruits a variety of factors that facilitate transcription elongation, RNA processing and termination, through its long, unstructured C-terminal domain (CTD). The CTD in humans comprises 52 tandem heptapeptide repeats with the consensus sequence Y₁S₂P₃T₄S₅P₆S₇. Each amino acid of the heptapeptide can be chemically modified, which influences the recruitment of other protein factors to the transcription machinery. Not all enzymes that modify the CTD have been discovered. Recent studies have identified a novel CTD phosphatase: RPAP2 in humans and its yeast homologue Rtr1, which dephosphorylate phospho-Ser5 of the heptapeptide repeats. RPAP2 has been shown to stimulate 3' end cleavage of nascent snRNAs through recruitment of the Integrator complex, and unpublished work suggests the involvement of RPAP2 in regulating vertebrate developmental programs. However, the exact mechanisms that regulate the function of human RPAP2, and thus impact on CTD modification, are not well-understood. This thesis presents a novel mechanism whereby RPAP2 recruits protein phosphatase 1 (PP1) to snRNA genes, where PP1 is postulated to activate P-TEFb to phosphorylate Ser2 of the CTD. At the same time, P-TEFb may have a role in activating the phosphatase activity of RPAP2. Furthermore, RPAP2 itself is shown to be recruited to a number of gene promoters by the RPRD1A protein, which also stimulates its phosphatase activity. RPAP2 was shown to have another role in regulating transcription termination: by recruiting the Integrator complex, which is shown here to mediate termination of snRNA genes, and by a so far unknown mechanism on a long protein-coding gene. An attempt was made to purify and crystallise the human RPAP2 to obtain a crystal structure, however the crystallisation trials were not successful. Finally, a correlation was found in human embryonic stem cells and induced pluripotent stem cells between low levels of RPAP2 and high levels of CTD Ser5P, suggesting a potential involvement of RPAP2 in regulating transcription at a key developmental stage. The results presented here contribute to the understanding of human transcriptional mechanisms and the numerous interactions within the transcription machinery. In particular, the mechanism of terminating the transcription of snRNA genes is identified. An interesting possibility is the regulation of development and stem cell differentiation by RPAP2; however the exact pathways by which this occurs are yet to be discovered.

Energy storage using Phase Change Materials (PCMs) offers the advantage of higher heat capacity at specific temperature ranges, compared to single phase storage. Incorporating PCMs in lightweight buildings can therefore improve the thermal mass, and reduce indoor temperature fluctuations and energy demand. Large atrium buildings, such as Airport terminal spaces, are typically thermally lightweight structures, with large open indoor spaces, large glazed envelopes, high ceilings and non-uniform internal heat gains. The Heating, Ventilation and Air-Conditioning (HVAC) systems constitute a major portion of the overall energy demand of such buildings. This study presented a case study of the energy saving potential of three different PCM systems (PCM floor tiles, PCM glazed envelope and a retrofitted PCM-HX system) in an airport terminal space. A quasi-dynamic coupled TRNSYS®-FLUENT® simulation approach was used to evaluate the energy performance of each PCM system in the space. FLUENT® simulated the indoor air-flow and PCM, whilst TRNSYS® simulated the HVAC system. Two novel PCM models were developed in FLUENT® as part of this study. The first model improved the phase change conduction model by accounting for hysteresis and non-linear enthalpy-temperature relationships, and was developed using data from Differential Scanning Calorimetry tests. This model was validated with data obtained in a custom-built test cell with different ambient and internal conditions. The second model analysed the impact of radiation on the phase change behaviour. It was developed using data from spectrophotometry tests, and was validated with data from a custom-built PCM-glazed unit. These developed phase change models were found to improve the prediction errors with respect to conventional models, and together with the enthalpy-porosity model, they were used to simulate the performance of the PCM systems in the airport terminal for different operating conditions. This study generally portrayed the benefits and flexibility of using the coupled simulation approach in evaluating the building performance with PCMs, and showed that employing PCMs in large, open and thermally lightweight spaces can be beneficial, depending on the configuration and mode of operation of the PCM system. The simulation results showed that the relative energy performance of the PCM systems relies mainly on the type and control of the system, the night recharge strategy, the latent heat capacity of the system, and the internal heat gain schedules. Semi-active systems provide more control flexibility and better energy performance than passive systems, and for the case of the airport terminal, the annual energy demands can be reduced when night ventilation of the PCM systems is not employed. The semi-active PCM-HX-8mm configuration without night ventilation, produced the highest annual energy and CO2 emissions savings of 38% and 23%, respectively, relative to a displacement conditioning (DC) system without PCM systems.

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal.

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal.

v anglickém jazyce: The aim of the thesis is to provide description of nursing and medical aspects and offer ethical and legal context concerning the issue of living will. The body of the thesis is divided into theoretical section and practical section. The theoretical section deals with the issue of living will from the nursing and medical point of view with characterization of several serious conditions in intensive care such as apalic syndrome, terminal state etc. The chapter on legal aspects of living will defines the term 'lege artis', 'do not resuscitate - DNR', and characterizes the matter of decision making in the case of serious and terminal states. The chapter on ethical perspective discusses the process of dying and the Christian point of view on the issue of dying. The practical section processes the results of a survey based on 104 non-professional respondents and their replies to a provided questionnaire. The research section analyzes the level of knowledge which non-professional population has of the issue of living will. The closing discussion evaluates the confirmation of established hypotheses and provides practical suggestions. Keywords: living will, dying, ethic, resuscitation, terminal state.

Orientador: Ana Cristina Nassif Soares / Banca: Helen Barbosa Raiz Engler / Banca: Josiani Julião Alves de Oliveira / Banca: Glória Lúcia Alves Figueiredo / Banca: Maria Cherubina de Lima Alves / Resumo: As atitudes perante a morte e o morrer têm se modificado ao longo do tempo, acompanhando o desenvolvimento social, cultural, religioso, científico e tecnológico. A morte deixou de ser um acontecimento social, público e comunitário; deixou de ser um acontecimento doméstico, junto dos familiares e amigos, para ocorrer no hospital. Isso traduz uma hospitalização da morte e, consequentemente, um maior envolvimento dos profissionais de saúde. Os cuidados paliativos são considerados como uma abordagem à saúde humana que rompe com o paradigma biomédico, para aproximar-se de uma assistência integral às pessoas que vivem ou lidam com doenças ameaçadoras da vida, como o câncer. A teoria das representações sociais trata da produção dos saberes sociais, centra-se na análise da construção e transformação do conhecimento social e tenta elucidar como a ação e o pensamento humanos se interligam na dinâmica social. O objetivo desta pesquisa foi identificar as tendências de produção científica acerca do tema "as representações sociais sobre a morte e o morrer para profissionais de saúde em cuidados paliativos nos serviços de oncologia do Brasil". Utilizamos de uma revisão da literatura científica neste estudo, nas pesquisas desenvolvidas para defesas de teses e dissertações em programas de pós-graduação brasileiros, limitamos a área de conhecimento a Ciências da Saúde, Ciências Humanas, Ciências Sociais Aplicadas e Multidisciplinar. Escolhemos o banco de teses da Coordenação de Aperfeiçoamento... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The attitudes towards death and dying have changed over time following the cultural, religious, scientific and technological development. Death ceased to be a social, public and community event: ceased to be a domestic event,with relatives and friends, to accur in the hospital. This means a hospitalization for death and, consequently, a greater involvement of health professionals. Palliative care is considered as na approach to human healthy, which breaks with the biomedical paradigm, to approavh full care for people who live or deal with threatening diseases of live, such as cancer. The theory of social representations deals with the production of social Knowledge, focuses on the analyses of the construction and transformation of social Knowledge and tries to elucidate how human action and thoughtsimterwine in social dynamics. The objective of this research was to identify the scientific production trends of the theme "The Social representations about death and dying for health professionals in Palliative Care in oncology services of Brazil". We used a review of the scientific literature in this study, in the research developed for defenses of theses and dissertations in brazilian postgraduation programs, we limited the área of knowlegde to Health Science,Human Science,Applied Social Sciences and Multidisciplinary. We choose the theses bank of the top level staff development coordination (CDSTL) and took advice from some search expressions for possible descriptors for this s... (Complete abstract click electronic access below) / Resumen: Las actitudes ante la muerte y el morir se han modificado a lo largo del tiempo, acompañando el desarrollo social, cultural, religioso, científico y tecnológico. La muerte ha dejado de ser un acontecimiento social, público y comunitario; ha dejado de ser un acontecimiento doméstico, junto a los familiares y amigos, para tener lugar en el hospital. Esto se traduce en una hospitalización de la muerte y, consecuentemente, en una mayor implicación de los profesionales de la salud. Los cuidados paliativos están considerados como un abordaje a la salud humana que rompe con el paradigma biomédico, para acercarse a una asistencia integral a las personas que viven o conviven con enfermedades amenazantes a la vida, como el cáncer. La teoría de las representaciones sociales aborda la producción de los saberes sociales, se centra en el análisis de la construcción y transformación del conocimiento social e intenta elucidar cómo la acción y el pensamiento humanos se interconectan en la dinámica social. El objetivo de esta investigación fue identificar las tendencias de producción científica acerca del tema "las representaciones sociales sobre la muerte y el morir para profesionales de salud en Cuidados Paliativos en los servicios de oncologia de Brasil". En el estudio, en las investigaciones desarrolladas para defensas de tesis y disertaciones en programas de postgrado brasileños, limitamos el área de conocimiento a las Ciencias de la Salud, Ciencias Humanas, Ciencias Sociales Aplicadas y ... (Resumen completo clicar acceso eletrônico abajo) / Doutor