Introduction: Rural emergency nurses face unique obstacles to providing quality end-of-life (EOL) care. Stories provided by emergency nurses embody their most difficult EOL care obstacles. Methods: A questionnaire was sent to 53 rural hospitals. Respondents were asked to share stories that epitomized the obstacles faced while providing EOL care in the rural emergency setting. Results: The lack of an ideal death (nurse personally knows the patient, issues with family members, and unknown patient wishes) was the top obstacle. Other reported obstacles were insufficient ED staff and power struggles between nurses and physicians. Discussion: Rural emergency nurses often provide EOL care to friends and family members, while their urban counterparts are likely to transfer care to nurses with no relation to the dying patient. Not only does caring for patients, that the nurse knows or is related to, cause great distress to rural emergency nurses, this unfortunately common situation may also prevent patients from receiving the highest quality of EOL care. Conclusion: Emergency nurses often face obstacles that hinder their ability to provide high quality EOL care to patients. These obstacles are compounded by a unique set of challenges faced by nurses working in rural emergency departments. Stories from rural emergency nurses revealed that being unable to provide optimal care at the EOL, having difficulties with family members, or not knowing the patient's wishes for EOL care were the most common obstacles. Additional obstacles included stories about the impact of low or unavailable staff and feeling powerless in some EOL situations.

Background: Approximately 25,000 pediatric deaths occur in hospitals in the United States each year with over 50% of these deaths occurring in Newborn Intensive Care Units (NICU). NICU nurses are frequently involved in end-of-life (EOL) care and face unique obstacles. Objective: The objective of this study was to obtain NICU nurses suggestions for improving obstacles in EOL care in NICUs. Methods: Suggestions were obtained through mailed survey research in qualitative study design. Returned surveys yielded 121 nurse respondents who gave a total of 138 suggestions.Results: A total of 10 cohesive themes were identified: (1) environmental design issues, (2) improved communication between healthcare teams, (3) ending futile care earlier, (4) realistic and honest physician communications to families, (5) providing a œgood death, (6) improved nurse staffing, (7) need for EOL education, (8) earlier entry into hospice/palliative care, (9) availability of ancillary staff, and (10) allowing parents more time to prepare for death.Conclusions: Despite the variety of obstacles encountered in providing EOL care to dying infants and their families, NICU nurses can use self-assessment tools to identify obstacles to EOL care and collaborate with key members of the healthcare team to alleviate these obstacles.

A critical and important part of the medical diagnosis is the montioring of the biopotential signals. Patients are always connected to a bulky and mains-powered instrument. This not only restricts the mobility of the patients but also bring discomfort to them. Meanwhile, the measureing time can not last long thus affecting the effects of the diagnosis. Therefore, there is a high demand for low-power and small size factor ambulatory biopotential measurement systems. In addtion, the system can be configured for different biopotential applications.The ultimate goal is to implement a system that is both invisible and comfortable. The systems not onlyincrease the quality of life, but also sharply decrease the cost of healthcare delivery. In this paper, a continuously tunable gain and bandwidth analog front-end for ambulatory biopotential measurement systems is presented. The front-end circuit is capable of amplifying and conditioning different biopsignals. To optimize the power consumption and simplify the system architecture, the front-end only adopts two-stage amplifiers. In addition, careful design of the critical transistors eliminates the need of chopping circuits. The front-end is pure analog without interference from digital parts like chopping and switch capacitor circuits. The chip is fabricated under SMIC 0.18 μm CMOS process. The input-referred noise of the system is only 1.19 μVrms (0.48-2000Hz).Although the power consumption is only 32.1 μW under 3V voltage supply, test results show that the chip can successfully extract biopotential signals.

Symptom control may become challenging for terminally ill patients as they near the end of life. Patients often seek hospital admission to address symptoms, such as pain, nausea, vomiting, and restlessness. Alternatively, palliative medicine focuses on the control and mitigation of symptoms, while allowing patients to maintain their quality of life, whether in an outpatient or inpatient setting. Hospice care provides, in addition to inpatient care at a hospice facility or in a hospital, the option for patients to receive symptom management at home. This option for symptom control in the outpatient setting is essential to preventing repeated and expensive hospital readmissions. This article discusses the impact of hospice care on hospital readmission rates.

This review article addresses end-of-life care issues characterizing human immunodeficiency virus progression by delineating associated stages of medical and nursing care. The initial progression from primary medical and nursing care aimed at functional cure to palliative care is discussed. This transition is considered in accord with the major symptoms experienced, including fatigue, pain, insomnia; decreased libido, hypogonadism, memory, and concentration; depression; and distorted body image. From the stage of palliative care, progression is delineated onward through the stages of hospice care, death and dying, and the subsequent bereavement process.

This bachelor thesis work at MAU (Malmoe University) was carried out in Sweden at Company X. Company X is a Swedish IT company that provide SaaS (Software as a Service) as e-commerce solutions for small- to medium-sized businesses. The purpose of this project is to analyse the current design process of Company X with the aim of improving the communication between front-end developer and client by providing them with a tangible tool in order to align the front-end developer with the expectations of the clients. The two methods that was used to collect data was individual semi-structured interviews and an online co-creation session which were analysed through grounded theory. The analyzations of the results of this thesis clarified that miscommunication occurs depending on several factors which causes different issues. The conclusions of this thesis are that data that is highly abstract is understood differently by different social worlds, resulting in issues within the communication between front-end developer and client as well as limiting the front-end developments contribution to appearance which causes the organisation to exclude the opportunity of business success. Due to data getting altered when going through several actors before reaching the front-end developer, it was argued that miscommunication occur throughout the design process of Company X. The issues within the occurring communication affects the design projects outcome negatively. Subsequently, it was argued that the current design process of Company X is in need of a portfolio containing visual explanations since a portfolio is a simple tool to use in order to make a viewer understand which would potentially decrease the levels of miscommunication as well as aligning the front-end developers with the expectations of the client.

Background Glomerulonephritis is a major cause of end-stage kidney disease (ESRD) in Africa. There is scanty data on the clinico-pathological characteristics and outcome of the mesangioproliferative glomerulonephritides in Africa, despite the non-IgA subtype being reported as a common cause of nephrotic syndrome. This study will assess the outcome of patients with biopsy proven mesangioproliferative glomerulonephritis (MesPGN) from a single centre in Cape Town, South Africa. Methods The study is designed as 10-year retrospective analysis of patients with biopsy proven MesPGN. The MesPGN patterns were divided into non-IgA MesPGN and IgA nephropathy (IgAN), depending on the predominant type of immune deposit. Univariate cox regression analysis was used to determine factors associated with ESRD. Results Data of 109 patients with renal biopsy-proven MesPGN were included for the period between 2005-2014. The mean age at biopsy was 33.8 ±14.9 years, 53.2% were males, and 39.4% were black Africans. Clinically, 58.7% presented with nephrotic syndrome. On histology 79.8% had non-IgA MesPGN, and 20.2% had IgAN. Compared to the non-IgA group, most patients with IgAN were not treated with immunosuppression (72.7% vs. 40.2%; p=0.006). At the last visit, 10.1% reached ESRD (40.9% vs. 2.3%; p<0.0001) and 30.2% achieved complete remission (9.1% vs. 35.7%; p=0.015) for IgAN and non-IgA MesPGN respectively. The 5-year renal survival for IgAN and non-IgA MesPGN respectively, were: 63.3% vs. 97.6%, log rank p=0.001. Overall, hypertension (p=0.019), not receiving immunosuppression (p=0.046) and having IgAN (p=0.007) were independent predictors of progression to ESRD. Conclusion There is a significantly higher ESRD-free survival of patients with biopsy proven non-IgA MesPGN than IgAN. Whether this is related to the limited use of immunosuppressive therapy in IgAN patients or represents a true nature of the disease still requires further research.

Healthcare teams can implement care initiatives to promote a positive dying experience. However, there is a lack of knowledge related to how best to care for dying patients. Nurses do not receive extensive training in nursing school to care for patients at the end of life, yet most, at some point in their careers, experience the provision of this type of care. It is important to ensure that nurses caring for dying patients have been educated about end-of-life care. The purpose of the quality improvement project was to address the lack of end-of-life care education among critical care nurses in an acute care hospital by implementing and testing the effectiveness of an end-of-life care educational program. Kolcaba's theory of comfort was chosen as the theoretical framework for the project. Registered nurses (n = 34) employed on a critical care unit participated in the one-group pretest/posttest design project. The nurses completed the Healthstream online end-of-life care education, and knowledge improvement was determined through comparison of pretest and posttest scores. Descriptive tests were completed to determine the mean score. The descriptive data analysis and tests showed that participants' level of end-of-life care knowledge improved after they completed the formalized educational program. Participants' scores increased from pretest (68% to 100% correct answers) to posttest (93% to 100% correct answers). The primary populations benefiting from the project are nurses, dying patients, and family members of dying patients. The social change implication of the findings is that if nurses receive education on end-of-life nursing, increased knowledge of appropriate care for dying patients is expected.

This two-section thesis explores the subjective nature of villainy. The larger section, "Dream’s End," is an urban-fantasy young-adult fiction piece I’ve written in epistolary form. I preface the fiction with a critical introduction in which I briefly examine existing definitional scholarship on 1) epistolary fiction, 2) the urban fantasy genre, and 3) the young adult genre. Epistolary fiction may be letters, diaries, or journal entries. Following this exploration, I examine the subjective nature of villains and antagonists in narratives. While "Dream’s End" does not specifically discuss or critique feminist theory, it considers criticism of existing female tropes in its portrayal of both the characters and their roles in relation to one another. The second section of the thesis is comprised of a collection of journal entries, divided into six chapters, wherein protagonist Emma keeps a record of the experiences she has while traveling to another world in her dreams. In this alternate dream world, Emma finds community and purpose absent from her waking life, but must ultimately come to terms with a perceived betrayal and various moral quandaries when her two worlds begin to bleed together. The journal entries will eventually be incorporated into a novel as backstory, and so are presented with a brief explanation as to their significance to the larger narrative. Through the various characters in these journal entries, I explore the complex nature of protagonists and antagonists, and discuss how the classification of each is relative to the experience and perceptions of the characters within the narrative, as well as the readers outside it.

This dissertation addresses gaps in the interaction between End-of-Life (EoL) product acquisition systems and disassembly sequencing. The research focuses on two remanufacturing research problems; 1) modeling uncertain EoL product quality, quantity, and timing in regards to EoL product acquisition and disassembly sequencing and 2) designing EoL product acquisition schemes considering EoL product uncertainty. The main research objectives within these areas are; analyzing, predicting, and controlling EoL product uncertainty, and incorporating EoL product uncertainty into operational and strategic level decisions. This research addresses these objectives by researching a methodology to determine optimal or near-optimal partial disassembly sequences using infeasible sequences while considering EoL product quality uncertainty. Consumer incentives are integrated into the methodology to study the effect of EoL product take-back incentives, but it also allows for the study of EoL product quantity uncertainty. EoL product age distributions are key to integrating the disassembly sequence method with EoL product acquisition management, acting both as an indicator of quality and as a basis for determining return quantity when considering incentives. At a broader level, this research makes it possible to study the impact of EoL product quality, and to an extent quantity, uncertainty resulting from strategic level (acquisition scheme) decisions, on operational (disassembly sequencing) decisions. This research is motivated by the rising importance of value recovery and sustainability to manufacturers. Extended Producer Responsibility (EPR) and Product Stewardship (PS) policies are, globally, changing the way products are treated during their use-life and EoL. Each new policy places a greater responsibility on consumers and manufacturers to address the EoL of a product. Manufacturers, in particular, may have to fulfill these obligations by such means as contracting 3rd parties for EoL recovery or performing recovery in-house. The significance of this research is linked to the growing presence of remanufacturing and recovery in the US and global economy, either via profitable ventures or environmental regulations. Remanufacturing, in particular, was surveyed by the US International Trade Commission in 2011-2012, where it was determined that remanufacturing grew by 15% to $43 billion, supported 180,000 full-time jobs from 2009-2011, and is continuing to grow. A partial disassembly sequence, multi-objective genetic algorithm (GA) is used a solution procedure to address the problem of determining the optimal or near-optimal partial disassembly sequence considering a continuous age distribution of EoL or available consumer products, with and without a consumer take-back incentive. The multi-objective GA, novel to the presented approach, relies on infeasible sequences to converge to optimal or near-optimal disassembly sequences. It is verified with a discrete economic and environmental impact case prior to incorporating EoL product age distributions. Considering the age distribution of acquired EoL products allows for decisions to be made based not only on expected profit, but also on profit variance and profit probability per EoL product, which was not observed in previous literature. As such, the research presented here within provides three contributions to disassembly and EoL product acquisition research: 1) integrating EoL product age distributions into partial disassembly sequencing objective functions, 2) accounting for partial disassembly sequence expected profit, profit variation, and profit probability as compared to disassembly sequencing methods that have, historically, only considered expected profit, and 3) studying the impact of EoL product age distributions and consumer take-back incentives on optimal or near-optimal partial disassembly sequences. Overall, this doctoral research contributes to the body of knowledge in value recovery, reverse logistics, and disassembly research fields, and is intended to be used, in the future, to develop and design efficient EoL product acquisition systems and disassembly operations. / Ph. D.