Marginalisée et cantonnée jusqu’alors à la périphérie de la guerre froide, l’Afrique devient dans les années 1970, l’enjeu de rivalités entre les grandes puissances. Et pour cause. Les nombreuses faiblesses et l’intérêt stratégique du continent ainsi que les changements qui affectent le monde dans les années 1970 offrent aux deux grands l’occasion de s’y affronter. L’initiative de cet affrontement revient à l’Urss et à ses alliés qui, profitant de l’effacement relatif des Occidentaux, s’introduisent successivement en Afrique australe et dans la Corne de l’Afrique faisant de l’Afrique Subsaharienne un terrain de l’expansionnisme soviétique. Ces rivalités influencent considérablement la vie politique, économique et sociale du continent. De sorte que la fin de ce conflit entraîne un bouleversement du paysage politico-stratégique de la période de guerre froide et la perte de la valeur stratégique du continent. / Previously marginalized and relegated to the periphery of the cold war, Africa became in the 1970 s, the challenge of competition between major powers. And for good reason. The many weaknesses and the strategic interest of the continent and the changes that affect the world in the 1970 s offer two major an opportunity to confront each other. The initiative of this confrontation is for the USSR and allies who, taking advantage of erasure of western, introduce successively in the southern Africa and Horn of Africa and transform sub-saharan Africa in an area of soviet expansionism. This competition has considerable influence on political, economic and social point of the continent. So that the end of this conflict leads to a disruption.

Background: A growing number of older people, mainly women, live in single households. They represent avulnerable group as staying at home may turn out challenging when care needs increase, particularly at the end oflife. Non-kin-carers can play an essential role in supporting individuals' preferences to stay at home. In research Little attention has been paid to non-kin-carers, such as friends and neighbors, yet. Thus, the Older People Living Alone (OPLA) study will evaluate whether non-kin support is robust enough to enable care dependent people to stay athome even at the end of life. This paper aims to introduce the research protocol. Methods: We plan to apply a qualitative longitudinal study to better understand how older people living aloneand their non-kin-carers manage to face the challenges with increased care needs towards the end-of-life. We willconduct serial interviews with the older persons living alone and their non-kin-carers. A total of 20-25 completedata sets and up to 200 personal interviews were planned. These will be complemented by regular telephonecontacts. All interviews will be analysed following the grounded theory approach and strategies for reconstructingcase trajectories, supported by MAXQDA software. In the course of the study, inter- and transdisciplinary workshopsshall assure quality and support knowledge transfer. Discussion: This study protocol aims to guide research in a field that is difficult to approach, with regard to itstopic, methodology and the interdisciplinary approach. As this study introduces longitudinal qualitative Research methodology in the field of home care in Austria, a deeper understanding of (end-of-life-) care trajectories will beenhanced, which is of major relevance for future care planning. With investment in additional reflexivity andcommunication procedures innovative results and robust knowledge are expected outcomes.

A tubulização representa uma possível alternativa para reparo de lesões de nervos periféricos, por permitir a aplicação local de fatores de crescimento e neurorregenerativos assim como por facilitar o estudo dos mecanismos de ação relacionados à regeneração das fibras nervosas. O objetivo do presente estudo foi verificar se há crescimento de fibras amielínicas no nervo fibular comum de ratas Wistar adultas após a tubulização látero-terminal (TLT) sem a utilização de indutores de crescimento, através de análise morfológica e morfométrica das referidas fibras. Para tanto, o nervo fibular comum direito foi seccionado a 3 mm da sua emergência, o coto proximal sepultado e suturado na musculatura adjacente e um tubo de silicone (6 mm) interposto entre o coto distal do fibular e a lateral do nervo tibial (grupo TLT). O controle usado foi o segmento distal esquerdo do nervo fibular (grupo GN). Setenta dias após, foram realizados cortes semifinos e ultrafinos para análise de aspectos morfológicos e morfométricos através de microscopia de luz e microscopia eletrônica de transmissão (MET). Houve evidente brotamento axonal de fibras amielínicas, que cresceram a partir do nervo tibial intacto no grupo TLT em comparação ao grupo GN, sendo que o número total de axônios amielínicos foi similar nos dois grupos. Estudo morfométrico evidenciou diferenças significativas (p<=0,05) em relação à maior densidade de axônios amielínicos regenerados e em relação ao diâmetro mínimo axonal. No presente estudo os axônios amielínicos no nervo receptor, usando o modelo da TLT, foram quantificados. Esse modelo poderá ser útil e importante para estudo da plasticidade do sistema nervoso periférico. / Side-to-end tubulisation is a model recently developed in our laboratory to study nerve plasticity. In this model, collateral sprouting of fibers grow from intact donor nerve fibers to the distal stump of a receptor nerve. The objective of the present study was to study unmyelinated fibers using this model. Adults female Wistar rats were used and morphological and morphometric analysis were done. The fibular common nerve was sectioned 3 mm from its origin. The proximal stump was buried and sutured in the adjacent musculature. A silicone tube (6 mm) was fixed on the adjacent lateral portion of the intact tibial nerve and the fibular common nerve distal stump was sutured in the other extremity of the tube (SET group). The left fibular common nerve distal segment was used as control. Semithin and ultrathin sections were obtained and studied using light and transmission electron microscopy. Seventy days after, there was profuse axonal sprouting of unmyelinated fibers that grew from the nerve tibial, reaching the same number of axons when compared with the controls. In the present study unmyelinated axons in the receptor nerve using SET were quantified. SET is an important tool to study plasticity of peripheral nerve fibers.

Der Einsatz der Vitamin B 1 Vorstufe Benfotiamin hat sich im Tiermodell durch Verhinderung oder gar Aufhebung typischer diabetischer Folgeschäden wie Ne- phropathie, Retinopathie und Neuropathie ausgezeichnet. Diese Wirkung wird unter anderem der Aktivitätssteigerung des Enzyms Transketolase zugeschrie- ben, welches auch bei Dialysepatienten ohne diabetische Grunderkrankung sup- primiert ist. Das Ziel der vorliegenden Arbeit war, die Auswirkungen einer ora- len Benfotiaminsubstitution auf den Stoffwechsel von Langzeithämodialysepati- enten zu untersuchen. Die 15 rekrutierten Patienten mit und ohne Diabetes mel- litus erhielten über einen Zeitraum von 2 Monaten eine Dosis von 300 mg/d Benfotiamin, die in den folgenden 2 Monaten bis maximal 450 mg/d gesteigert wurde. Um einen Eindruck über den Verlauf der Entzündungssituation und des oxidativen Stresses zu gewinnen, wurden im Patientenvollblut AGEs und pro- inflammatorische Zytokine gemessen. Außerdem wurden peripheren Lympho- zyten mit Hilfe des alkaline Comet-Assay und des Mikrokerntestes auf DNA- Schädigungen analysiert. In beiden Patientengruppen lässt die Senkung der Mi- krokernraten den Schluss zu, dass Benfotiamin DNA-Schäden und somit eventu- ell das Krebsrisiko reduziert. Dieses vielversprechende Ergebnis korreliert jedoch nicht mit dem Resultat des Comet-Assay. Da hier der relative DNA-Schaden ten- dentiell ansteigt, sollte es Ziel weiterer Studien sein, diesen Sachverhalt an ei- nem größeren Patientenkollektiv mit Kontrollgruppen zu überprüfen. Eventuell ist letzteres Testsystem wegen seiner hohen Sensitivität in diesem Fall nicht op- timal geeignet. Außerdem sollte gezielt auf die beobachtete schnellere und stär- kere Mikrokernsenkung der diabetischen Patienten eingegangen werden, da die- se in der vorliegenden Studie zahlenmäßig unterrepräsentiert waren. Positiv zu bewerten ist der leichte CRP-Abfall sowie der Anstieg des Gesamtproteins und Albumin im Serum, was auf eine Reduktion der Mikroinflammation und oder eine verbesserte Ernährungssituation hinweist. Andererseits spricht der Anstieg des Neopterin- und Interleukin 6-Spiegels gegen die Veränderung des Inflamma- tionsstatus. Entgegen der Erwartung ließ sich in dieser Studie keine Reduktion der zirkulierenden AGEs und AOPPs im Serum erzielen. Um eine Reduktion des oxidativen Stresses besser beurteilen zu können, sollten in Folgestudien direkte und leicht veränderliche Marker wie der Glutathionspiegel verwendet werden. Zusammenfassend reduzierte Benfotiamin bei Hämodialysepatienten mit und ohne Diabetes mellitus DNA-Schäden in peripheren Lymphozyten bei unver- änderter Inflammationssituation und steigerte die Plasmaproteinkonzentration. Dies wurde eventuell durch Reduktion von oxidativem Stress und oder Beein- flussung seiner Ursachen wie Reduktion von Urämietoxinen erreicht.Weitere kli- nische Studien sind notwendig, um dieses vielversprechende Medikament in der täglichen Praxis einsetzen zu können. Besonders vorteilhaft ist seine gute Verträg- lichkeit auch in hoher Dosierung. Darüber hinaus soll das Präparat auch neuro- patische Schmerzen reduzieren, die sich bei Dialysepatienten häufig manifestie- ren, und wirkt somit multikausal. / It has been shown in animal models, that Benfotiamine, a precursor of the vitamine B1, prevents typical complications of diabets, like nephropathy, retinopathy and neuropathy. This effect is attributed to the increased activity of the enzyme trankelotase. The latter is also suppressed in patients of the hemodialysis program who are not diabetic. The goal of this thesis was to show the effects of an oral administration of benfotiamine on longterm hemodialysis patients. Fifteen patients were treated with 300 mg per day of benfotiamine which was increased in the following two months to 450 mg per day. The patient group consisted of a sub-group of diabetic and non-diabetic individuals. Advanced glycation endproducts (AGEs) and proinflammatory cytocines were measured in patients full-blood to show the impact on the inflammation and the oxidative stress situation. The DNA-damage in peripheral lymphocytes was determined using the alkaline comet-assay and the micronucleus-assay. The rate of micronuclei was diminished in both patient groups which could be attributed to the reduction of DNA-damage by benfotiamine and so eventually to a reduced risk of cancer. However, this result does not agree with the comet-assay experiments. The relative DNA-damage increased in the course of the study and so seems to be unaffected by the benfotiamine therapy. This may be attributed to the high sensitivity of the comet-assay technique. Therefore, further investigations with a bigger patient group in a double-blind study are necessary. Additionally, there should be a greater focus on diabetic patients that showed a faster and increased reduction of micronuclei which were underrepresentated in this study. The slight reduction of CRP and the increased protein and serum-albumine concentration correlates to a better nutritional status. On the other hand, the increasing neopterine and interleukine 6 level do not agree to the changes in the inflammatory situation. Against all expectations there was no reduction of AGEs and AOPPs in patients serum. Following studies should focus on rapidly changing direct markers like the glutathione level. In summary, benfotiamine reduces DNA-damage in peripheral lymphocytes in hemodialysis patients with or without diabetes. The plasma protein concentration was increased but unexpectedly the inflammatory situation was stable. These effects may be due to a reduction of oxidative stress or its causes like diminished ureamic toxines. One of Benfotiamines advantages is its good tolerance, even in increased dosages. Furthermore it seems to diminish neuropathic pain which is frequent in hemodialysis patients. However, more clinical studies are neccessary for a use in daily practice.

Med palliativ vård menas att inriktningen på vården är att lindra symptomen, möjligheten att bota sjukdomen finns inte längre. Läkaren ska då försäkra sig om att livsuppehållande behandlingar inte längre kan påverka sjukdomsförloppet, ta största möjliga hänsyn till patientens önskemål och ta det avgörande beslutet att avsluta eller avbryta en livsuppehållande behandling. Palliativ vård är på många områden numera utbyggd till avancerade hemsjukvårdsteam. Tidigare studier har i huvudsak fokuserat på anhöriga eller vårdpersonal och då särskilt sjuksköterskans upplevelser av att vårda palliativa patienter. Därför är det viktigt att tydliggöra patientperspektivet. Syftet med denna litteraturstudie var att beskriva befintlig forskning om hur patienter inom palliativ vård upplever den sista tiden i livet. Metoden som använts är litteraturstudie och resultatet är funnit i 10 vetenskapliga artiklar. Resultatet redovisas med hjälp av fyra kategorier; Hopp och hopplöshet, Mening och maktlöshet, Tillgänglighet och ensamhet samt Acceptans. Slutsatsen är att den som är allvarligt sjuk och står inför döden bör mötas och behandlas av palliativ vård som grundas i hopp, mening, tillgänglighet och acceptans. För att förbättra den sista tiden i livet för patienten inom palliativ vård när det gäller bevarad värdighet finns det, med stöd i studiens resultat, specifika aspekter att beakta. Patienten bör delta i sin vård så långt det är möjligt; Hopp är inte alltid kopplat till bot; Vårdarna bör underlätta sociala kontakter; Vårdarna bör vara tillgängliga, även när det inte finns något att säga; Allvarlig information bör ges stegvis; och Teamarbete med flera olika professioner.

Abstract This pilot study aimed to establish if an exercise programme utilizing the world’s first manual compression foot-pump, commonly known as “Venous Anti-Stasis Slippers”, could be used as an intervention to improve dialysis efficacy (Kt/V) and the quality of life (QOL) of patients with end stage renal disease (ESRD). The entire population of 34 self-care renal patients at the Flora Clinic renal unit were screened and 19 patients who met the inclusion criteria for the study were invited to participate in this 16 week pilot study. Baseline dialysis efficacy values were obtained from the analysis of routine blood tests and quality of life values were established with the use of the South African English version of the EQ-5D health questionnaire. This was followed by an eight week non-intervention period. Pre-intervention values were then established prior to the implementation of an eight week exercise programme using the manual compression foot pumps. A single group time series design was used and 12 of the initial 19 subjects completed the study by performing seated calf raising exercises, with manual compression foot pumps on their feet, for 20 minutes per hour during the first three hours of their routine dialysis sessions (2 - 3 times per week) over a period of eight weeks. Exercise diaries were kept to record exercise times, heart rates and exercise intensities. At the end of the eight week exercise programme, dialysis efficacy and quality of life values were re-measured. An intention to treat analysis of routine blood test results revealed statistically significant changes in dialysis efficacy (Kt/V) values between baseline (1.70 ± 0.48), pre-intervention (1.39 ± 0.43) and post intervention (1.50 ± 0.47) with a resultant 7.91% improvement in Kt/V values as a result of the exercise programme. There were however no statistically significant changes observed in overall quality of life (QOL) values, but noticeable improvements in self-care ability and a reduction in depression/anxiety scores were observed during this pilot study. The frequency of exercise per week had no significant effect on the changes in Kt/V.

The Nigerian video film industry has emerged to become the first “popular” film industry in black Africa. Its means of production and consumption has redefined the parameters of African Cinema. The video films employ themes and images that captivate the audiences’ imagination and curiosity. Some of the most used themes in the Nigerian video films are those relating to the supernatural, magic and witchcraft. Whilst some scholars and filmmakers criticise the prevalence of themes of witchcraft, magic and the supernatural, it is these very themes that draw local audiences. This research project explores images and themes of witchcraft, magic and the supernatural in two genres of the video films; the evangelical or Christian genre, and the horror or voodoo genre, using the films End of the Wicked and Child of Promise as case studies of the two genres respectively.

O presente trabalho teve como objetivo compreender a vivência do familiar cuidador durante e após cuidar de um ente querido em seu processo de fim de vida e morte. Com os crescentes avanços científicos e tecnológicos, a expectativa de vida da população mundial tem aumentado, além disso, pessoas de quaisquer faixas etárias têm sobrevivido por mais tempo a doenças graves e/ou acidentes. Essas mudanças significativas ocorridas na população têm aumentado a demanda por cuidados, que têm sido realizados, em sua maior parte, por familiares mais próximos. Dessa forma, o objetivo desta pesquisa foi conhecer melhor esse familiar cuidador; os impactos para ele na experiência de cuidar, o seu papel no processo, e como lida com as idiossincrasias dessa intensa vivência. O trabalho foi fundamentado no método fenomenológico de pesquisa de Amedeo Giorgi. Foram realizadas entrevistas individuais abertas com os colaboradores, que partiram da pergunta: Como foi para você ter acompanhado e cuidado de seu ente querido em seu processo de fim de vida? E como foi ter vivido a perda dele? Que foram acompanhadas de acordo com o que os familiares consideravam relevante. Participaram deste estudo seis adultos, três mulheres e três homens, com idades entre 26 e 63 anos, cuidadores de familiares acometidos por doenças potencialmente fatais. Os colaboradores foram localizados pela divulgação do trabalho entre pessoas conhecidas e escolheram participar voluntariamente. A compreensão das narrativas mostrou que: 1) Quando uma pessoa com doença potencialmente fatal é diagnosticada e passa a ser tratada/cuidada, é fundamental englobar nesses cuidados também sua família, em especial o membro cuidador, pois esse é fortemente afetado pela doença e seus desdobramentos, vivenciando impactos e rupturas, acompanhados de muito sofrimento e angústia; 2) A relação entre a pessoa com a doença/familiar cuidador e os profissionais de saúde mostrou-se importante, influenciando todo o processo de fim de vida e morte. Porém, os profissionais também apresentam suas dificuldades em lidar com o sofrimento e a finitude humanas. Assim, é imprescindível apontar a necessidade de também receberem cuidados em meio à sua prática cotidiana; 3) Destacou-se ainda a importância dos cuidados nãofarmacológicos/ não-técnicos no cuidado a cuidadores familiares e cuidadores profissionais. É necessário recuperar modos de escuta e acolhimento, em um movimento de se desvincular da grande dependência do tecnicismo, abrindo espaço para as subjetividades; 4) E ainda, é preciso enfatizar a necessidade do próprio cuidador, em sua intensa vivência, poder se ver/se perceber em todo esse processo. Perceber-se enquanto ser que sofre, angustia-se perante a dor e a morte. É importante que acolha a própria dor e angústia e, assim, possa crescer/projetar-se para as inúmeras perspectivas que o poder-ser da existência humana possibilita. Tendo como base os achados, ao final, há a apresentação de palavras diretamente escritas a profissionais e cuidadores. Dessa forma, este trabalho, enquanto amplia as compreensões a respeito da intensa vivência que é o cuidar de um ente querido/paciente em seus últimos momentos de vida, pode auxiliar familiares cuidadores e profissionais de saúde em sua profunda jornada / This study aimed to understand the experiences of family caregivers during and after caring for a loved one in the process of end of life and death. With important progress in scientific and technological areas, life expectancy of the world population has increased. Moreover, people of any age have survived longer with serious illnesses and/or accidents. These significant changes in population has increased the demand for care, which have been conducted, mostly by close relatives. Then, the aim of this research was learning more about this caregiver; understanding the impacts to him in care experience, their role in the process and knowing better how he deals with the idiosyncrasies of this intense experience. This work is based on the phenomenological research method developed by Amedeo Giorgi. The interviews had a non-directive approach and were started with the question: How did you experienced the taking care of your loved one in an end of life process? And how did having lived his/her loss? They were conducted taking in account what the participants considered as relevant issues. Six adults participated, three men and three women, ranging from 26 to 63 years of age; they were the main caregivers of relatives with potentially fatal diseases. The collaborators had knowledge about the study through divulgation for known people and voluntarily wished to cooperate. The comprehensive analysis of the narratives showed that: 1) It is fundamental to include family, especially the caregiver member, in the care when a person with advanced disease is diagnosed and is treated/cared. It because the caregiver is strongly affected by the disease and its consequences, experiencing impacts and disruptions, accompanied by much suffering and anguish; 2) The relationship between the person with the disease/caregivers and health professionals proved important, because it influences the whole end of life process and death. However, professionals also have their difficulties in dealing with suffering and human finitude. Therefore, it is essential to foreground the need to also receive care in their daily practice; 3) It was also highlighted the importance of nonpharmacological/ non-technical care in caring for family caregivers and professional caregivers. It is necessary to recover ways of listening and acceptance, in a movement to avoid the heavy reliance on technicality and to make room for subjectivities; 4) And, it is necessary to emphasize the need for the caregiver to see and perceive himself/herself throughout this process. Perceive himself as being who suffers and anguishes in front of pain and death. It is important to embraces his/her pain and anguish and, then, can grow/project himself to the numerous perspectives that the can-be human existence allows. At the end, based on findings, there is a presentation of words written directly to professionals and caregivers. Thus, this paper, while expanding understandings about the intense experience that is caring for a loved one/patient in the last moments of life, can help family caregivers and health professionals in your deep journey

Do planejamento à execução da prótese mucosa-dento-suportada, a literatura apresenta trabalhos que aponta m as dificuldades do desempenho de uma prótese que se relaciona com tecidos de comportamentos distintos, dente e fibromucosa. Estes trabalhos abordam os problemas biomecânicos e os prejuízos que sofrem o osso e os dentes, sob pressão, durante a mastigação, bem como as dificuldades de distribuição das cargas sobre os tecidos bucais no movimento ocluso-gengival. Porém, essa prótese também sofre forças de tração, por diversas situações clínicas, as quais levam a sela a se deslocar da fibromucosa num movimento gêngivo-oclusal. O objeto desta pesquisa foi desenvolver e testar, em laboratório, um método que possibilitasse à prótese mucosa-dento-suportada dispor de maior retenção na região da fibromucosa, reduzindo o movimento gêngivo-oclusal, e conferindo maior estabilidade à prótese e conforto ao paciente. Para realizar o experimento , foi construída uma base acrílica modificada, correspondente à sela da prótese, com uma canaleta na região que contata a fibromucosa. Esta canaleta foi preenchida com reembasador macio para prótese, à base de silicone. Em seguida, a base foi reembasada no modelo resiliente, especialmente construído para simular a fibromucosa. Uma haste metálica foi fixada em suas extremidades, sendo uma à base acrílica, e a outra extremidade fixada ao mandril do equipamento utilizado para o tracionamento (Versa-Test). Estando a base posicionada sobre o modelo, foram realizados os movimentos de pressão e de tração. A avaliação dos testes foi realizada na base acrílica convencional (sem canaleta) e na base acrílica modificada, cujos valores foram registrados em newton. As bases acrílicas sobre os modelos eram imersas em óleo vegetal, devido ao necessário meio viscoso, com tensão superficial, possibilitando os fenômenos de adesão. Os resultados demonstraram que, na presença de silicone, foi necessária força de tração maior e estatisticamente significante para remover a base do modelo, em relação à base sem silicone. / From the planning to the execution of the tissue-dento-supported prosthesis, the literature presents a range of works standing out the difficulties related to the prosthesis performance when facing distinctive tissues, tooth and fibromucous. These works approach the biomechanical problems and the damages suffered by osseous tissues and teeth under pressure, during the mastication, as well as the difficulties of distribution of the loads on oral tissues in the oclusal-gengival movements. However, this prosthesis also suffers traction forces, in several clinical situations, leading the saddle to move of the fibromucous in a gengival-occlusal movement. The aim of this research was to develop and to test, in a laboratory, a method to improve the tissue-dento-supported prosthesis retention in the fibromucous area reducing the gengival-occlusal movement and allowing a larger stability to the prosthesis and comfort to the patient. In order to accomplish the experiment, a modified acrylic base was confectioned, corresponding to the saddle of the prosthesis and constituted by a small channel in the fibromucous contact area. This channel was filled out with soft reliner for prosthesis, silicon composed. Afterwards, the base was rebased in the resilient model, especially confectioned to simulate the fibromucous. A metallic stem was fixed in two extremities, being one to the acrylic base, and other extremity fixed to the equipment arbor used for the traction (Versa-Test). With the base positioned on the model, the pressure movements and traction were accomplished. The evaluation of the tests was accomplished in the conventional acrylic base (without channel) and in the modified acrylic base, whose values were registered in Newton. The acrylic bases on the models were immersed in the vegetable oil, due to the necessary viscous condition, with superficial tension, making possible the adhesion phenomena. The results demonstrated that in the presence of silicon was necessary a larger and statistically significant traction force to remove the base of the model in relation to the base without silicon.

Thesis advisor: Pamela J. Grace / Significance/Background: Surrogate decision-makers (SDMs) take part in 1.5 million end-of-life (EOL) decisions per year. Most find the role burdensome, often do not make decisions concordant with patients' wishes, and many suffer negative psychological aftereffects. Specific Aims: 1) Identify and describe the psychological processes of recent SDMs for adults at EOL in the intensive care unit (ICU) and 2) develop a theoretical model of SDMs' psychological processes. Methods/Analysis: Descriptive, multiple case study research design using a cognitive task analysis (CTA) interviewing approach. Participants completed an in-depth semi-structured CTA interview and a demographic form. Verbatim transcribed interviews were encoded and analyzed until theoretical saturation was met. Results: Nineteen SDMs (female=11) with a mean age of 59 years (± 11) who made decisions for patients (mean age, 67±13 years) who died in the ICU completed interviews. Data analysis yielded 27 psychological processes representing the hypothesized theoretical links amongst 20 individual psychological concepts. The PREDICAMENTS model (Psychology, Reasoning, and Ethics Demonstrated In Choices about the Acceptability of Medical Treatments and Patient Conditions Encountered in Life Threatening Situations) of surrogate decision-making was assembled from these psychological processes and concepts. The model depicts a complex web of psychological processes wherein SDMs ultimately express acceptance or rejection of medical treatments and/or the patient's physical condition based on their perception of the acceptability (or lack thereof) of medical treatments and/or the patient's physical condition. Conclusions: The PREDICAMENTS model offers an initial picture of the underlying psychological processes operating in SDMs decision-making. Implications for Practice and Research: The PREDICAMENTS model can be used to assess and understand SDMs' thought processes, emotions, and ethical concerns. Further research is needed to test and corroborate constructs and linkages in this model with the aim of developing decision support interventions. Ethicists need to discuss the implications of this descriptive theoretical model for the normative ethical standards expected of SDMs. / Thesis (PhD) — Boston College, 2013. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.