Ethical decisions in endof- life care

No Abstract

Sexuality in patients with human immunodeficiency virus at Embhuleni Hospital in Mpumalanga province

Objectives: This study explored issues of sexuality in people living with AIDS who were on highly active antiretroviral therapy (HAART).Design: This was a descriptive quantitative study. Data were collected with an administered questionnaire and entered in Excel®. Statistical analysis included frequency tables, summary statistics and 95% confidence intervals.Setting and subjects: The respondents were purposively sampled from the 850 patients attending the antiretroviral clinic at Embhuleni Hospital in Mpumalanga province.Outcome measures: The questionnaire included questions on sexual practices, number of partners, sexual experience and fertility wishes, comparing respondents’ experience before and after HAART.Results: There was a response rate of 100%, with 102 questionnaires completed. There was a significant difference between the responses to questions on sexual desire, sexual performance, sexual enjoyment and satisfaction regarding frequency of intercourse before and after HAART. Respondents reported a better sexual experience before HAART (t = 2.4387, p-value = 0.0165). There was a statistically significant difference between the number of partners before and after initiation of HAART (p-value = 0.000). Although 96% of respondents rated  condom use as being very important, 11% never used condoms during sex and 21% indicated that they had had unprotected sex in the previous six months. Eighteen per cent of respondents said it was very important for them to have a child and 20% were planning to have a child in the future. A quarter of respondents had not disclosed their HIV status to their partners. The majority (95%) of respondents indicated that it was very important to them that health workers discussed their sexual needs with them.Conclusion: Sexuality in HIV is complex, with components described as the “Ps” of sexuality: practices, partners, pleasure, pressure and pain, procreation and power. In this study, participants reported a better sexual experience before HAART. Healthcare professionals need to develop the skills to discuss sexuality, intimacy and fertility wishes with patients. Thisdiscussion will enhance healthcare professionals’ understanding of  atients’ experiences of their illness and should allow for a more effective patient-centred approach to care.Keywords: sexuality, sexual experience, HIV, HAART, reproductive health, rura

Sexuality in patients with human immunodeficiency virus at Embhuleni hospital in Mpumalanga province

Objectives: This study explored issues of sexuality in people living with AIDS who were on highly active antiretroviral therapy (HAART). Design: This was a descriptive quantitative study. Data were collected with an administered questionnaire and entered in Excel®. Statistical analysis included frequency tables, summary statistics and 95% confidence intervals. Setting and subjects: The respondents were purposively sampled from the 850 patients attending the antiretroviral clinic at Embhuleni Hospital in Mpumalanga province. Outcome measures: The questionnaire included questions on sexual practices, number of partners, sexual experience and fertility wishes, comparing respondents’ experience before and after HAART. Results: There was a response rate of 100%, with 102 questionnaires completed. There was a significant difference between the responses to questions on sexual desire, sexual performance, sexual enjoyment and satisfaction regarding frequency of intercourse before and after HAART. Respondents reported a better sexual experience before HAART (t = 2.4387, p-value = 0.0165). There was a statistically significant difference between the number of partners before and after initiation of HAART (p-value = 0.000). Although 96% of respondents rated condom use as being very important, 11% never used condoms during sex and 21% indicated that they had had unprotected sex in the previous six months. Eighteen per cent of respondents said it was very important for them to have a child and 20% were planning to have a child in the future. A quarter of respondents had not disclosed their HIV status to their partners. The majority (95%) of respondents indicated that it was very important to them that health workers discussed their sexual needs with them. Conclusion: Sexuality in HIV is complex, with components described as the “Ps” of sexuality: practices, partners, pleasure, pressure and pain, procreation and power. In this study, participants reported a better sexual experience before HAART. Healthcare professionals need to develop the skills to discuss sexuality, intimacy and fertility wishes with patients. This discussion will enhance healthcare professionals’ understanding of patients’ experiences of their illness and should allow for a more effective patient-centred approach to care

The Whole Antarctic Ocean Model (WAOM v1.0): Development and evaluation

The Regional Ocean Modeling System (ROMS), including an ice shelf component, has been applied on a circum-Antarctic domain to derive estimates of ice shelf basal melting. Significant improvements made compared to previous models of this scale are the inclusion of tides and a horizontal spatial resolution of 2 km, which is sufficient to resolve on-shelf heat transport by bathymetric troughs and eddy-scale circulation. We run the model with ocean–atmosphere–sea ice conditions from the year 2007 to represent nominal present-day climate. We force the ocean surface with buoyancy fluxes derived from sea ice concentration observations and wind stress from ERA-Interim atmospheric reanalysis. Boundary conditions are derived from the ECCO2 ocean state estimate; tides are incorporated as sea surface height and barotropic currents at the open boundary. We evaluate model results using satellite-derived estimates of ice shelf melting and established compilations of ocean hydrography. The Whole Antarctic Ocean Model (WAOM v1.0) qualitatively captures the broad scale difference between warm and cold regimes as well as many of the known characteristics of regional ice–ocean interaction. We identify a cold bias for some warm-water ice shelves and a lack of high-salinity shelf water (HSSW) formation. We conclude that further calibration and development of our approach are justified. At its current state, the model is ideal for addressing specific, process-oriented questions, e.g. related to tide-driven ice shelf melting at large scales

Vertical Processes and Resolution Impact Ice Shelf Basal Melting: A Multi-Model Study

Understanding ice shelf–ocean interaction is fundamental to projecting the Antarctic ice sheet response to a warming climate. Numerical ice shelf–ocean models are a powerful tool for simulating this interaction, yet are limited by inherent model weaknesses and scarce observations, leading to parameterisations that are unverified and unvalidated below ice shelves. We explore how different models simulate ice shelf–ocean interaction using the 2nd Ice Shelf–Ocean Model Intercomparison Project (ISOMIP+) framework. Vertical discretisation and resolution of the ocean model are shown to have a significant effect on ice shelf basal melt rate, through differences in the distribution of meltwater fluxes and the calculation of thermal driving. Z-coordinate models, which generally have coarser vertical resolution in ice shelf cavities, may simulate higher melt rates compared to terrain-following coordinate models. This is due to the typically higher resolution of the ice–ocean boundary layer region in terrain following models, which allows better representation of a thin meltwater layer, increased stratification, and as a result, better insulation of the ice from water below. We show that a terrain-following model, a z-level coordinate model and a hybrid approach give similar results when the effective vertical resolution adjacent to the ice shelf base is similar, despite each model employing different paradigms for distributing meltwater fluxes and sampling tracers for melting. We provide a benchmark for thermodynamic ice shelf–ocean interaction with different model vertical coordinates and vertical resolutions, and suggest a framework for any future ice shelf–ocean thermodynamic parameterisations

Vertical processes and resolution impact ice shelf basal melting: A multi-model study

Understanding ice shelf–ocean interaction is fundamental to projecting the Antarctic ice sheet response to a warming climate. Numerical ice shelf–ocean models are a powerful tool for simulating this interaction, yet are limited by inherent model weaknesses and scarce observations, leading to parameterisations that are unverified and unvalidated below ice shelves. We explore how different models simulate ice shelf–ocean interaction using the 2nd Ice Shelf–Ocean Model Intercomparison Project (ISOMIP+) framework. Vertical discretisation and resolution of the ocean model are shown to have a significant effect on ice shelf basal melt rate, through differences in the distribution of meltwater fluxes and the calculation of thermal driving. Z-coordinate models, which generally have coarser vertical resolution in ice shelf cavities, may simulate higher melt rates compared to terrain-following coordinate models. This is due to the typically higher resolution of the ice–ocean boundary layer region in terrain following models, which allows better representation of a thin meltwater layer, increased stratification, and as a result, better insulation of the ice from water below. We show that a terrain-following model, a z-level coordinate model and a hybrid approach give similar results when the effective vertical resolution adjacent to the ice shelf base is similar, despite each model employing different paradigms for distributing meltwater fluxes and sampling tracers for melting. We provide a benchmark for thermodynamic ice shelf–ocean interaction with different model vertical coordinates and vertical resolutions, and suggest a framework for any future ice shelf–ocean thermodynamic parameterisations. © 2020 The Author

Seasonality of warm water intrusions onto the continental shelf near the Totten Glacier

Warm Modified Circumpolar Deep Water (MCDW) from the Southern Ocean drives rapid basal melt of the Totten Ice Shelf on the Sabrina Coast (East Antarctica), affecting the mass balance of the grounded Totten Glacier. Recent observations show that MCDW intrudes onto the continental shelf through a depression at the shelf break. Here we investigate such intrusions by combining (1) new oceanographic and bathymetric observations collected for two consecutive years by profiling floats in the depression south of the shelf break, (2) oceanographic measurements collected by conductivity‐temperature‐depth‐instrumented seals on continental slope, and (3) an ocean model. The depression provides a pathway for persistent inflow of warm (0‐1°C) MCDW to the inner shelf. In austral autumn and early winter MCDW intrusions were up to 0.5°C warmer and were are ~75 m thicker than in spring and summer. The seasonality of the flow on the continental slope explains the seasonality of the intrusions. The MCDW layer on the continental slope is warmer and thicker to the east of the depression than to the west. In autumn and early winter a strong, top‐to‐bottom westward current (Antarctic Slope Current) transports the warmer and thicker MCDW layer along the slope and is diverted poleward at the eastern entrance of the depression. A bottom‐intensified eastward current (Antarctic Slope Undercurrent) develops in other months, allowing cooler and thinner intrusions to enter the depression from the west. Our study illustrates how circulation on the Antarctic slope regulates the ocean heat delivery to the continental shelf and ultimately to the ice shelves

EVALUATION OF PREHOSPITAL BLOOD PRODUCTS TO ATTENUATE ACUTE COAGULOPATHY OF TRAUMA IN A MODEL OF SEVERE INJURY AND SHOCK IN ANESTHETIZED PIGS

This material is licensed under the terms of the Open Government Licence except where otherwise statedUK Ministry of Defence

Modelling the Response of Ice Shelf Basal Melting to Different Ocean Cavity Environmental Regimes

We present simulation results from a version of the Regional Ocean Modeling System modified for ice shelf/ocean interaction, including the parameterisation of basal melting by molecular diffusion alone. Simulations investigate the differences in melting for an idealised ice shelf experiencing a range of cold to hot ocean cavity conditions. Both the pattern of melt and the location of maximum melt shift due to changes in the buoyancy-driven circulation, in a different way to previous studies. Tidal forcing increases both the circulation strength and melting, with the strongest impact on the cold cavity case. Our results highlight the importance of including a complete melt parameterisation and tidal forcing. In response to the 2.4 degrees C ocean warming initially applied to a cold cavity ice shelf, we find that melting will increase by about an order of magnitude (24 x with tides and 41 x without tides)