“You can’t die here”: an exploration of the barriers to dying-in-place for structurally vulnerable populations in an urban centre in British Columbia, Canada

Abstract Background One measure of quality in palliative care involves ensuring people approaching the end of life are able to receive care, and ultimately die, in the places they choose. Canadian palliative care policy directives stem from this tenet of autonomy, acknowledging that most people prefer to die at home, where they feel safe and comfortable. Limited research, however, considers the lack of ‘choice’ people positioned as structurally vulnerable (e.g., experiencing extreme poverty, homelessness, substance-use/criminalization, etc.) have in regard to places of care and death, with the option of dying-in-place most often denied. Methods Drawing from ethnographic and participatory action research data collected during two studies that took place from 2014 to 2019 in an urban centre in British Columbia, Canada, this analysis explores barriers preventing people who experience social and structural inequity the option to die-in-place. Participants include: (1) people positioned as structurally vulnerable on a palliative trajectory; (2) their informal support persons/family caregivers (e.g., street family); (3) community service providers (e.g., housing workers, medical professionals); and (4) key informants (e.g., managers, medical directors, executive directors). Data includes observational fieldnotes, focus group and interviews transcripts. Interpretive thematic analytic techniques were employed. Results Participants on a palliative trajectory lacked access to stable, affordable, or permanent housing, yet expressed their desire to stay ‘in-place’ at the end of life. Analysis reveals three main barriers impeding their ‘choice’ to remain in-place at the end of life: (1) Misaligned perceptions of risk and safety; (2) Challenges managing pain in the context of substance use, stigma, and discrimination; and (3) Gaps between protocols, policies, and procedures for health teams. Conclusions Findings demonstrate how the rhetoric of ‘choice’ in regard to preferred place of death is ethically problematic because experienced inequities are produced and constrained by socio-structural forces that reach beyond individuals’ control. Ultimately, our findings contribute suggestions for policy, programs and practice to enhance inclusiveness in palliative care. Re-defining ‘home’ within palliative care, enhancing supports, education, and training for community care workers, integrating palliative approaches to care into the everyday work of non-health care providers, and acknowledging, valuing, and building upon existing relations of care can help to overcome existing barriers to delivering palliative care in various settings and increase the opportunity for all to spend their end of life in the places that they prefer

Nivåbaserad åtkomstkontroll i distribuerade databaser

Detta arbete handlar om att ge riktlinjer för hur nivåbaserad åtkomstkontroll kan hanteras vid sammanslagning och replikering av distribuerade databaser. Dagens komplexa distribuerade databaser kräver hög säkerhet och det räcker ofta inte med lösenord för åtkomstkontroll. Nivåbaserad åtkomstkontroll ger möjlighet till att förbättra säkerheten genom att både användare och objekt klassas i olika säkererhetsklasser. Arbetet behandlar, utfrån specifika exempel, hantering av nivåbaserad åtkomstkontroll vid sammanslagning och replikering av distribuerade databaser. Metoden som används i arbetet är litteraturstudie. Material som används i arbetet är artiklar inom området. Efter att ha givit allmänna definitioner på begrepp som används i den senare delen av arbetet, diskuteras specifika fall med distribuerade databaser som slås samman och replikeras. Utifrån dessa fall och andra forskares teorier skapas det mer generella teorier enligt den problemställning som finns. Det ges även förslag på fortsatt arbete inom detta område

Analiza procesu zużycia narzędzi wykonanych ze stali 1.2344 oraz stopu MP159 w procesie zgrzewania tarciowego z przemieszaniem (FSW) blach ze stopu Aluminium 7075 T6

The study presents an analysis of wear of tools made of 1.2344 steel and MP159 alloy for the process of obtaining an overlap joint in 1.0 mm and 0.8 mm sheet metal made of 7075 T6 aluminum alloy using friction stir welding (FSW) technology. Tool geometry was designed at the Czestochowa University of Technology. Evaluation of tool wear was conducted based on the measurements of geometry of working area of tools by means of a multisensory meter system and based on the assessment of the working area by means of a stereoscope after individual stages of wear tests. Furthermore, based on the results of a static tensile strength test and metallographic examinations of the specimens sampled from the joints obtained during tool wear tests, the effect of the degree of tool wear on joint quality was also evaluated. Analysis of the results revealed that both the tool made of 1.2344 steel and that made of MP159 alloy were substantially worn, increasing the risk of further use of the tools for the joint material (7075-T6) after obtaining the joint with length of 200m, which suggests their low durability. Furthermore, modification of tool geometry caused by wear led to insignificant improvements in joint strength. Therefore, the results of wear measurement set directions for further modification of tool geometry, also due to the fact that despite a substantial wear, the tools continued to yield high-quality joints without defects. As demonstrated in the study, the type of tool material does not only impact on tool life but also, as it was the case in their geometry, has a significant effect on the quality of obtained joints. Although the tool made of MP159 alloy was worn more than the tool made of 1.2344 steel, it allowed for obtaining the joints with substantially better strength parameters.W pracy przedstawiono analizę procesu zużycia narzędzi wykonanych ze stali 1.2344 oraz stopu MP159 w procesie wykonywania złączy zakładkowych z blach ze stopu aluminium 7075 T6 o grubości 1,0mm i 0,8mm technologią zgrzewania tarciowego z przemieszaniem materiału (FSW). Geometrię narzędzi użytych do badań opracowano na Politechnice Częstochowskiej. Ocenę zużycia narzędzi przeprowadzono w oparciu o pomiary geometrii części roboczej narzędzi na maszynie multisensorycznej oraz na podstawie oględzin powierzchni roboczej przy użyciu stereoskopu po kolejnych etapach badań zużycia narzędzia. Dodatkowo, w oparciu o wyniki statycznej próby rozciągania oraz badania metalograficzne próbek pobranych ze złączy wykonywanych w trakcie badań zużycia narzędzi, przeprowadzono ocenę wpływu stopnia zużycia narzędzi na jakość wykonanych złączy. Na podstawie analizy wyników można stwierdzić, że zarówno narzędzie wykonane ze stali 1.2344 oraz ze stopu MP159 ulegają intensywnemu, zagrażającemu ich dalszej eksploatacji zużyciu, we współpracy z materiałem zgrzeiny (7075-T6) już po wykonaniu złącza o długości 200m, co świadczy o ich niskiej trwałości. Przy czym zmiany geometrii narzędzia spowodowane zużyciem pozwoliły na nieznaczną poprawę wytrzymałości złączy. Uzyskane wyniki pomiarów zużycia wyznaczają zatem kierunek w procesie dalszej modyfikacji geometrii badanych narzędzi, również z uwagi na fakt, iż pomimo znaczącego zużycia badanych narzędzi, pozwalały one w dalszym ciągu uzyskać dobre jakościowo złącza pozbawione wad. Jak wykazały badania, rodzaj materiału narzędzia wpływa nie tylko na trwałość narzędzi ale również, jak ma to miejsce w przypadku ich geometrii, ma on istotny wpływ na jakość uzyskanych połączeń. Pomimo tego, że narzędzie wykonane ze stopu MP159 uległo większemu zużyciu w porównaniu z narzędziem ze stali 1.2344, to pozwoliło ono uzyskać złącza o znacznie lepszych parametrach wytrzymałościowych

The Need to Recognize Conditions for River Crossing Operations in the Polish Lowlands by Military Vehicles in the Light of NATO Regulations

This paper presents the methods for obtaining the geomorphological information needed to determine the crossing conditions of river beds as well as requirements concerning its interpretation, both historical as well as currently binding and arising from NATO normative documents. The included procedures were analyzed in view of their usefulness in estimating the possibilities of crossing river beds in the Polish lowlands. Detecting the appropriate places to cross big rivers situated in the area of the so-called “eastern NATO flank” appears to be thoroughly essential, especially in the current geopolitical situation

Additional file 1 of “You can’t die here”: an exploration of the barriers to dying-in-place for structurally vulnerable populations in an urban centre in British Columbia, Canada

Supplementary Material 1: Observation and Focus Group Guide for Equitable Access to Care (EAC) stud