A Preliminary Model of Dignity Management in Hospice

This study aims to develop a preliminary model of dignity management (MDM) in hospice describing the social process used by the interdisciplinary team to support the dignity of the patient-family unit in hospice. A qualitative, grounded theory methodology was used to achieve this goal. Research samples, including dying patients, their families and hospice staff, were recruited from a residential hospice in North Amherst, Massachusetts. Data collection methods included interview, observation, and document review. Symbolic interactionism and pragmatism provided the philosophical basis for this study. Thematic analysis was used to explore the definitions of dignity; and grounded theory analytic techniques for theory discovery, including constant comparison, opening, axial and selective coding, process, and the conditional matrix, were used to produce theoretical models. Definitions of dignity for patients and families, which were synthesized based on data from patients, families, and staff in hospice, were presented. The model of dignity in hospice (MDH) was developed by referring to the conditional matrix to elaborate the phenomenon of dignity in hospice. In this model, dignity was placed in the context of hospice with an extension to the community that patients and families belonged to. Resources and social support from community are located in the community level; agency policies and missions, environment of the residential hospice, and services and resources from the residential hospice are agency-level factors to support dignity. The interdisciplinary team locates in the group individual level of the model. Incidents in the interactional level and the core actions refer to the process of dignity management. The preliminary model of dignity management (MDM) was proposed to describe the process the interdisciplinary team used to manage dignity in hospice. The four modules in the model refer to the steps to manage dignity in hospice, flowing from “acknowledge,” “define” to “prepare” and “manage” to formalize the process of dignity management in hospice. Themes and subthemes within each module indicated the ways to complete each step. Finally, two cases were used to describe and tentatively verify the preliminary model of dignity management in hospice

Development and evaluation of the Dignity Talk question framework for palliative patients and their families: A mixed-methods study

Background: Effective patient–family communication can reduce patients’ psychosocial distress and relieve family members’ current suffering and their subsequent grief. However, terminally ill patients and their family members often experience great difficulty in communicating their true feelings, concerns, and needs to each other. Aim: To develop a novel means of facilitating meaningful conversations for palliative patients and family members, coined Dignity Talk, explore anticipated benefits and challenges of using Dignity Talk, and solicit suggestions for protocol improvement. Design: A convergent parallel mixed-methods design. Dignity Talk, a self-administered question list, was designed to prompt end-of-life conversations, adapted from the Dignity Therapy question framework. Participants were surveyed to evaluate the Dignity Talk question framework. Data were analyzed using qualitative and quantitative methods. Setting/participants: A total of 20 palliative patients, 20 family members, and 34 healthcare providers were recruited from two inpatient palliative care units in Winnipeg, Canada. Results: Most Dignity Talk questions were endorsed by the majority of patients and families (>70%). Dignity Talk was revised to be convenient and flexible to use, broadly accessible, clearly stated, and sensitively worded. Participants felt Dignity Talk would be valuable in promoting conversations, enhancing family connections and relationships, enhancing patient sense of value and dignity, promoting effective interaction, and attending to unfinished business. Participants suggested that patients and family members be given latitude to respond only to questions that are meaningful to them and within their emotional capacity to broach. Conclusion: Dignity Talk may provide a gentle means of facilitating important end-of-life conversations

Effectiveness of oseltamivir on disease progression and viral RNA shedding in patients with mild pandemic 2009 influenza A H1N1: opportunistic retrospective study of medical charts in China

Objective To describe the clinical features and effectiveness of oseltamivir on disease progression and viral RNA shedding in patients with mild pandemic 2009 influenza A(H1N1) virus infection

The experiences of health-care providers during the COVID-19 crisis in China: a qualitative study

Background In the early stages of the outbreak of coronavirus disease 2019 (COVID-19) in Hubei, China, the local health-care system was overwhelmed. Physicians and nurses who had no infectious disease expertise were recruited to provide care to patients with COVID-19. To our knowledge, no studies on their experiences of combating COVID-19 have been published. We aimed to describe the experiences of these health-care providers in the early stages of the outbreak. Methods We did a qualitative study using an empirical phenomenological approach. Nurses and physicians were recruited from five COVID-19-designated hospitals in Hubei province using purposive and snowball sampling. They participated in semi-structured, in-depth interviews by telephone from Feb 10 to Feb 15, 2020. Interviews were transcribed verbatim and analysed using Haase's adaptation of Colaizzi's phenomenological method. Findings We recruited nine nurses and four physicians. Three theme categories emerged from data analysis. The first was “being fully responsible for patients' wellbeing—‘this is my duty’”. Health-care providers volunteered and tried their best to provide care for patients. Nurses had a crucial role in providing intensive care and assisting with activities of daily living. The second category was “challenges of working on COVID-19 wards”. Health-care providers were challenged by working in a totally new context, exhaustion due to heavy workloads and protective gear, the fear of becoming infected and infecting others, feeling powerless to handle patients' conditions, and managing relationships in this stressful situation. The third category was “resilience amid challenges”. Health-care providers identified many sources of social support and used self-management strategies to cope with the situation. They also achieved transcendence from this unique experience. Interpretation The intensive work drained health-care providers physically and emotionally. Health-care providers showed their resilience and the spirit of professional dedication to overcome difficulties. Comprehensive support should be provided to safeguard the wellbeing of health-care providers. Regular and intensive training for all health-care providers is necessary to promote preparedness and efficacy in crisis management. Funding National Key R&D Program of China, Project of Humanities and Social Sciences of the Ministry of Education in China

Effects of Large-Diameter Shield Tunneling on the Pile Foundations of High-Speed Railway Bridge and Soil Reinforcement Schemes

In order to study the effects induced by large-diameter shield tunneling on the internal force and displacement of adjacent high-speed railway bridge pile foundations, symmetrical element analysis models for the whole process of large-diameter shield tunneling through the high-speed railway bridge were established. The protective effects of various soil reinforcement schemes such as isolation piles’ protection, Metro Jet System (MJS) reinforcement, and the addition of isolated piles’ crown beams were investigated. The numerical results show that the maximum bending moment and the maximum lateral displacement of the bridge piles appear at the piles’ body of the central elevation of the tunnel and the piles’ top, respectively. Without any soil reinforcement measures, the maximum lateral displacement and settlement of the piers top were 7.1 mm and −7.2 mm respectively, which could not meet the displacement control requirements of ±2 mm for the piers of the existing bridge under the condition of the normal operation of high-speed trains. The isolation piles’ protection effect was better than that of MJS reinforcement alone. Two or more soil reinforcement measures could be adopted simultaneously to further control the displacement of piers within ±1 mm. The validity of the numerical simulation results was verified by comparing them with the field monitoring results

Effects of Large-Diameter Shield Tunneling on the Pile Foundations of High-Speed Railway Bridge and Soil Reinforcement Schemes

In order to study the effects induced by large-diameter shield tunneling on the internal force and displacement of adjacent high-speed railway bridge pile foundations, symmetrical element analysis models for the whole process of large-diameter shield tunneling through the high-speed railway bridge were established. The protective effects of various soil reinforcement schemes such as isolation piles’ protection, Metro Jet System (MJS) reinforcement, and the addition of isolated piles’ crown beams were investigated. The numerical results show that the maximum bending moment and the maximum lateral displacement of the bridge piles appear at the piles’ body of the central elevation of the tunnel and the piles’ top, respectively. Without any soil reinforcement measures, the maximum lateral displacement and settlement of the piers top were 7.1 mm and −7.2 mm respectively, which could not meet the displacement control requirements of ±2 mm for the piers of the existing bridge under the condition of the normal operation of high-speed trains. The isolation piles’ protection effect was better than that of MJS reinforcement alone. Two or more soil reinforcement measures could be adopted simultaneously to further control the displacement of piers within ±1 mm. The validity of the numerical simulation results was verified by comparing them with the field monitoring results

Effect of plant-based carbon sources on denitrifying microorganisms in a vertical flow constructed wetland

The effects of supplementing plant-based carbon sources, fermented tissues of Arundo donax and Pontederia cordata, and a combination of the two plants, on the nitrogen removal efficiency and microbial composition in a vertical flow constructed wetland (VFCW) were examined. The results showed that the addition of the composite carbon source produced the highest removal efficiencies of NH41-N 91.5%, NO3-N 94.5% and TN 92.8% in VFCW. The detected abundance of amoA, nirS, and nxrA genes indicated that ammonia oxidation bacteria and denitrifying bacteria were more abundant than the nitrite oxidation bacteria. Furthermore, the addition of the composite carbon source significantly promoted the growth of the denitrifying bacteria in VFCW. The results indicated that supplementing the system with plant-based carbon sources achieved partial nitrification and denitrification, as well as classic denitrification in VFCWs. The study suggested that multiple nitrogen removal pathways were required to feasibly and efficiently remove nitrogen. (C) 2016 Elsevier Ltd. All rights reserved.</p

PGPR Promotes the Recovery of Submerged Macrophytes via Indigenous Microbiome Modulations under Combined Abiotic Stress

The restoration of submerged macrophytes is commonly limited by abiotic stress. Here, we isolated PGPR strains from the rhizosphere of submerged macrophytes using ACC deaminase selective medium, and evaluated their growth promoting effects on Vallisneria natans (V. natans) under low light intensity and (or) high sediment organic matter load, and also explored the indigenous microbiome response of V. natans seedlings to PGPR inoculants. Ten isolates were chosen from the 252 isolated strains based on the ACC deaminase activity and the production of IAA and siderophore. M1 (Pseudomonas vancouverensis) and E15 (Enterobacter ludwigii) had the best growth promoting effects under low light stress and under double stress of low light and high sediment organic matter load, and the shoot height increased by 36% and 46%, respectively. The results of indigenous microbiome analysis showed that PGPR inoculants could regulate the relative abundance of unclassified_f_Enterobacteriaceae and improve the &alpha;-diversity of the rhizosphere bacterial community. Under high sediment organic matter load, inoculation of PGPR obviously shifted the &beta;-diversity of rhizosphere bacterial communities to promote the early growth of V. natans. This study expands the application of plant&ndash;microbe interaction in the field of freshwater ecological restoration