Counseling Parents of Defective Newborns

This monograph addresses some of the specific problems related to counseling parents of defective newborns. It describes the experience of the writer over a five year period, 1972- 1977, in the neonatal unit of Goergetown University Hospital , Washington, D.C. During this period approximately two hundred fifty parents of defective newborns and may times that number of parent of children with lesser problems, utilized the hospital\u27s services. My direct counseling experience was with thirty of these parents during the process of making the very difficult decisions about continuing support care for their critically ill infants. At Georgetown I worked intimately with Dr. David Abramson, Chief of Neonatology. Over a period of three years, we formulated the method of working with parents described in this monograph. We also worked closely with Dr. Mary Kate Davitt, who became the Chief of Neonatology after Dr. Abramson left. Together Drs. Abramson, Davitt and myself conferred in great detail about what we were trying to do with parents and how best to accomplish it . Our clinical findings about what happens psychologically to parents of defective newborns , and what can be done to help them are very similar to the scientific findings of Klaus and Kennell (1977). In 1975 Or . Abramson and I met with two ethicists who were interested in this decision making process, Richard McCormick, sj, and John C. Fletcher, Ph . D. These meetings stimulated our thinking and improved our work with parents . In addition I worked closely with staff, residents, students, doctors and nurses. I also taught counseling parents of defective newborns to medical students, learning much from these meetings. During these years I had the opportunity to speak with many other professionals both at Georgetown and at other hospitals such as Columbia Hospital for Women, (Washington , D. C.) , Fairfax Hospital (Virginia), Eastern Maine Medical Center (Bangor) and Grace New Haven Hospital (Connecticut), regarding this subject. Interviews and case studies were my major research techniques. I interviewed five neonatologists, ten pediatricians, five residents, ten nurses and eight clergy . I interviewed five sets of parents and two mothers for their retrospective views of the process they had been through with their defective newborns. I am grateful to all the parents who were willing to share their thoughts and feelings with me. I am grateful to all the professionals who related their thoughts on the issues of ethics, their feelings about illness, death and dying and their counseling of parents . I am particularly grateful to Dr. Raymond Duff for his help and support . I am also grateful to my special friends and colleagues , Susan Bradford, Catherine Bell and Patricia McHenry for their help and support in writing this paper . Dr . Georgia Fuller gave me support and help, particularly with the chapter on religion , for which I am grateful. From these years of counseling, teaching, discussing and interviewing , I formulated ideas about what other professionals need to know about the counseling process. They are presented in this monograph for physicians, social workers, nurses, counselors, clergy, and students, and others in this field. To summarize the dilemmas these professionals have faced, the psychological and social problems of parents of defective newborns have been stated in the literature but suggestions for solving their problems have not been forthcoming . Parents of defective newborns have a greater separation and divorce rate than the average couple. Parents a r e often depressed and angry with little or no way to get help with these feelings. Problems with the couples\u27 intimate relationships and problems which include the siblings and extended family usually arise as well. Parents often go through a religious crisis which so far has not been discussed in the literature. In addition, little has been written about the moral and psychological problems felt by the physicians and nurses who care for these infants and their parents . There is a large turnover of nurses in the neonatal unit because of the severe psychological and physical pressure. The average life-span (job span actually) of a neonatologist is only four to five years. This pressure relates to what I call the humanization of the health care professional. Doctors and nurses must be in touch with their own human, emotional reality before they can effectively help parents in emotional situations . Doctors and nurses must be in touch with their own feelings about the entire situation--infant , parents, ethics, religion and society--before they can most effectively help parents deal with their feelings about these issues . Doctors and nurses must be in touch with their own mortality and have dealt with at least some of their feelings about their own death . Current medical training does not address this humanization\u27\u27 problem. For example, several doctors admitted that they feared their own death and that was one reason they were in medicine.* In this monograph I will share the ways we found to help parents suffering the crisis of a defective newborn . It is by no means meant as a rigid formula. Each hospital and staff are different and must make their own adaptations. All parents\u27 names are changed to protect their anonymity. The residents and nurses that I interviewed did not want their names used, therefore, are recognized only as resident or nurse. C. Dilworth, ** a poet, philosopher and friend, who taught me much about living and dying , wrote these words shortly before his death: ... There is one week of silence over our village ... For some few it may be a private silence forever ... Two births do not take the place of one who passes through our village ... in the loneliness of dying

« Tabee Insulinde… » Colonisation et décolonisation dans l’histoire des Pays-Bas

L’histoire coloniale des Pays-Bas est particulièrement riche et complexe. Cependant, la société néerlandaise actuelle semble avoir presque oublié son passé colonial. Le premier empire colonial date de l’époque de la Révolte (1568-1648). L’objectif en est double, à la fois commercial et stratégique. Il s’agit d’entamer la puissance ibérique en la frappant sur tous les points du globe, en Asie, en Afrique, et en Amérique. Ainsi, la fondation de la République néerlandaise et son empire colonial se confondent. Si les premières possessions au-delà des mers appartiennent aux compagnies de commerce privées (la VOC pour l’Asie et l’Afrique australe, la WIC pour l’Afrique occidentale et l’Amérique), l’État hérite de l’empire colonial après l’époque française et les guerres napoléoniennes. Le royaume des Pays-Bas, créé en 1815 et correspondant approximativement au Benelux actuel, c’est-à-dire à une nouvelle incarnation des Pays-Bas de Charles Quint, échoue rapidement. La sécession de la Belgique en 1830 amène les Pays-Bas à adopter une politique de neutralité en Europe. Le pays se concentre désormais sur son empire colonial, et notamment sur l’Indonésie, dans une forme de « splendid isolation » à la néerlandaise. Pendant le xixe siècle, le paradigme colonial change, à cause de la révolution industrielle et l’intervention de l’État. Les factoreries néerlandaises, globalement modestes au xviie siècle font office de points de départ d’une vaste conquête territoriale. La guerre d’Aceh (1873-1903) est un exemple à grande échelle de la politique coloniale contemporaine, tout comme le système de cultures obligatoires (Cultuurstelsel), employant à partir de 1830, au nom de la Compagnie néerlandaise de commerce (NHM), les terres et les paysans locaux dans un système de servage pour cultiver des productions destinées à l’exportation. La Seconde Guerre mondiale constitue une ligne de fracture dans l’histoire coloniale néerlandaise. En mai 1940, l’invasion allemande met brutalement un terme à plus d’un siècle de neutralité politique. En 1942, le Japon s’empare de l’Indonésie, mettant un terme à plusieurs siècles de supériorité militaire européenne. Dès que la guerre se termine avec la capitulation japonaise, une guerre coloniale commence. Cette guerre (1945-1949), appelée de manière euphémique « action de police », aboutit à l’indépendance de l’Indonésie. Pour l’Indonésie, la décolonisation néerlandaise est achevée rapidement. Trois siècles de présence néerlandaise prennent fin au lendemain de la Seconde Guerre mondiale. L’événement est escamoté par le traumatisme de la guerre en métropole. Le nombre de colons rentrant dans une métropole, que la plupart d’entre eux n’ont jamais connu, est relativement faible. Par conséquent, la mémoire coloniale s’estompe rapidement, au fur et à mesure que cette population s’intègre, voire disparaît. Les universitaires actuels abordent l’histoire coloniale avec une nouvelle perspective, détachée de l’expérience personnelle de l’ancienne société coloniale.The colonial past of the Netherlands is particularly rich and complex. However, the nowadays Dutch society seems so have almost forgotten its colonial past. The first colonial empire originates from the era of the Dutch Revolt (1568–1648). It has both a commercial and strategic aim, i.e. diminishing the Iberian power by striking it at every point of the globe, in Asia, Africa and America. Hence, the foundation of the Dutch Republic and its colonial empire are indistinctive. If the first possessions abroad belonged to privately owned trade companies (VOC in Asia and southern Africa, and WIC in western Africa and America), the State inherits the colonial empire after the Napoleonic Wars. The newly founded Kingdom of the Netherlands, a 1815 recreation of Charles V Netherlands (comprising roughly nowadays Benelux), fails rapidly. The secession of Belgium in 1830 causes the Netherlands to adopt a policy of neutrality in Europe. The country refocuses on its colonial empire, and notably on Indonesia, in a form of ‘splendid isolation’. During the 19th century, the colonial paradigm changes, as a result of the Industrial Revolution and the intervention of the State. The mainly modest Dutch factories in Asia dating from the 17th century are the starting points of a vast territorial conquest. The Aceh War (1873–1903) is a large-scale example of the contemporary colonial policy, as is the Cultivation System (Cultuurstelsel), using from 180 onwards local land and farmers in a form of serfage for cultivating cash crops on behalf of the Dutch trading company (NHM). The Second World War is a watershed in the Dutch colonial history. In May 1940, the German invasion brutally ends more than a century of political neutrality. In 1942, Japan seizes Indonesia, ending several centuries of European military superiority. As soon as the war ends with the Japanese capitulation, a colonial war breaks out. This war (1945–1949), elusively called ‘police actions’, leads to the independence of Indonesia. The Dutch decolonization is achieved, as for Indonesia, in a short period. Three centuries of Dutch presence come to an end in the aftermath of the Second World War. The event is overshadowed by the trauma of the war in the metropole. The number of colons returning to a ‘home’ most of them never experienced is relatively small. As a consequence, the colonial memory rapidly fades away with the integration, and the gradual disappearance, of this population. Present day scholars revisit colonial history with a new perspective, cut loose from the personal experiences of the former colonial society

Belite calcium sulfoaluminate cement early hydration: citric acid sensitivity.

Three buckets, corresponding to three selected samples, of the same type of belite calcium sulfoaluminate (BCSA) cements have been studied. These cements show very similar elemental and mineralogical compositions, and textural properties. Mortars, for mechanical strength characterisation at 3 and 24 hours, were prepared by two different methodologies: i) with w/c of 0.40 without citric acid and ii) with w/c=0.40 and adding 0.375 wt% by weight of cement (bwc) of citric acid used as a retarder. On the one hand, the mechanical strengths, at 24 hours, obtained by the three mortars prepared by both methodologies are almost coincident, 61(5) MPa without citric acid and 61(4) MPa for the mortars prepared with citric acid. On the other hand, the early mechanical strengths at 3 hours for the mortars prepared without citric acid are also almost coincident among the three cements, i.e. ~49(3) MPa. However, when the citric acid is added, the mechanical strengths at 3 hours are quite different among the three buckets, i.e. 34(1), 42(1) and 48(1) MPa, respectively. The main aim of this study is to understand the reasons causing the different early mechanical strengths. First of all, a full characterization of the three cements has been performed: textural properties, elemental composition by X-Ray Fluorescence (XRF) and mineralogical composition, including the amorphous content, by Laboratory X-Ray Powder Diffraction (LXRPD) combined with the Rietveld method. Moreover, the soluble sulphate contents within the first minutes of hydration are being determined. An isothermal calorimetry study at 20ºC for pastes without and with different amounts of citric acid will be presented as well as in situ X-Ray powder diffraction data analysis. The results will be discussed to give a picture of the early hydration behaviour of these BCSA cements.CTS cement corporation, CSA research Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Etiology of community-acquired pneumonia in hospitalized children based on WHO clinical guidelines

Community-acquired pneumonia (CAP) is a major cause of death in developing countries and of morbidity in developed countries. The objective of the study was to define the causative agents among children hospitalized for CAP defined by WHO guidelines and to correlate etiology with clinical severity and surrogate markers. Investigations included an extensive etiological workup. A potential causative agent was detected in 86% of the 99 enrolled patients, with evidence of bacterial (53%), viral (67%), and mixed (33%) infections. Streptococcus pneumoniae was accounted for in 46% of CAP. Dehydration was the only clinical sign associated with bacterial pneumonia. CRP and PCT were significantly higher in bacterial infections. Increasing the number of diagnostic tests identifies potential causes of CAP in up to 86% of children, indicating a high prevalence of viruses and frequent co-infections. The high proportion of pneumococcal infections re-emphasizes the importance of pneumococcal immunizatio

Effect of alkanolamines in kaolinitic calcined clays pozzolanic reactivity.

Five kaolinitic clays with different amounts of kaolinite, ranging between ~70 wt% and ~30 wt%, have been studied to unravel the possible activation effect of alkanolamines on the aluminate fraction of calcined clays. This is of interest for enhancing the reactivity of LC3 binders. These clays were calcinated at 860ºC for 4 h and ground to particle sizes of DV,50 ~10 μm. Three alkanolamines were selected: triisopropanolamine (TIPA), triethanolamine (TEA) and methyldiethanolamine (MDEOA), added in two dosages, 0.025 and 0.050 wt% (by weight of calcined clay, bwcc). The role of alkanolamines as activators in calcined clays was assessed following the ASTM c1897 standard bases on R3-tests. Concretely, first by measuring the heat evolved due to the pozzolanic reaction of the calcined clay and Ca(OH)2 (i.e. R3 mixture) by isothermal calorimetry at 40ºC during 7 days, and second, the bounded water by measuring the weight loss of R3 mixture after heating them at 350ºC.This study concludes that there is no significant activation of the pozzolanic activity of kaolinitic calcined clays just by adding alkanolamines. However, a mild activation was observed, i.e., higher heat evolved up to 7 days, by adding 0.05 wt% bwcc of TIPA, TEA and MDEOA to a high kaolinite content disordered metakaolin with high specific surface area calcined clay.PID2020-114650RB-I00 CTS cement corporation Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Bond of textile-reinforced belite calcium sulfoaluminate cement mortar to concrete substrate

The fast aging of existing building stock requires effective and sustainable strengthening solutions. Textile-reinforced mortars (TRM) have already proved to be very effective as well as versatile retrofitting solutions for reinforced concrete and masonry structures. TRMs can enhance the load bearing capacity of reinforced concrete structures; however, current TRM systems are based on standard Portland cement-based binders, which largely contribute to global human-induced CO2 emissions. This work, for the first time, explores the use of belite calcium sulfoaluminate (BCSA) binder for carbon textile reinforcement through a cross-disciplinary study combining structural engineering and materials science. An experimental study was carried out on concrete block members with externally bonded strips of carbon textile-reinforced mortars, similar to a typical TRM retrofitting system for concrete beams. The textiles were embedded in an ordinary Portland cement-based (OPC) binder or in a BCSA-based binder to compare the bond behaviour to the concrete substrate. The tests revealed a superior bond between the BCSA mortar and the concrete, as well as outstanding adhesion to the textiles achieved using the BCSA binder, with performance levels largely surpassing those measured in their counterparts that used the OPC-based binder. Scanning Electron Microscopy, X-ray diffraction, and thermogravimetric analyses were used to understand this behaviour difference and it was concluded that the ettringite phase is responsible for the enhanced performance in the studied system. The results of this study suggest that BCSA binders have the potential to be a more effective and “greener” alternative to the standard binders based on Portland cement in TRM strengthening applications

Датчик угла шарового гироскопа

При работе с гироскопическим прибором, важнейшим информационным параметром является угловое положение оси вращения ротора, относительно корпуса прибора. Существует много различных способов съема угловой информации, подходящих под ту или иную задачу. В первую очередь, для выбора принципа работы датчика, требуется изучить конструкцию прибора, на котором будет установлен датчик угла (ДУ), и установить требования, согласно которым будет разрабатываться датчик угла. В данной работе требуется рассмотреть всевозможные типа оптических датчиков, подобрать наиболее подходящий тип, и провести исследование по возможному использованию данного датчика на имеющейся конструкции гироскопического прибора с газодинамической подвесом шарового ротора.When working with a gyro instrument, the most important information parameter is the angular position of the axis of rotation of the rotor, relative to the body of the device. There are many different ways to remove the angular information, suitable for a particular task. First of all, to select the principle of the sensor, it is required to study the design of the device on which the angle sensor will be installed and establish the requirements according to which the angle sensor will be developed. In this paper, it is required to consider all possible types of optical sensors, to select the most suitable type, and to conduct a study on the possible use of this sensor on the existing design of a gyroscopic device with a gas-dynamic suspension of a spherical rotor

Microwave processing of cement and concrete materials - towards an industrial reality?

Each year a substantial body of literature is published on the use of microwaves to process cement and concrete materials. Yet to date, very few if any have lead the realisation of a commercial scale industrial system and is the context under which this review has been undertaken. The state-of the–art is evaluated for opportunities, and the key barriers to the development of new microwave-based processing techniques to enhance production, processing and recycling of cement and concrete materials. Applications reviewed include pyro-processing of cement clinker; accelerated curing, non-destructive testing and evaluation (NDT&E), and end-of-life processing including radionuclide decontamination