59 research outputs found
Shared decision-making with people with intellectual disabilities in the last phase of life : a scoping review
Shared decision-making (SDM) is the process in which healthcare professionals and patients jointly discuss and decide which care and treatment policy is to be followed. The importance of SDM is increasingly being recognised across health settings, including palliative care. Little is known about SDM with people with intellectual disabilities (IDs) in the last phase of life. This review aimed to explore to which extent and in which way people with ID in the last phase of life are involved in decision-making about their care and treatment. In this scoping review, we systematically searched in the Embase, Medline and PsycINFO databases for empirical studies on decision-making with people with ID in the last phase of life. Of a total of 281 identified titles and abstracts, 10 studies fulfilled the inclusion criteria. All focused on medical end-of-life decisions, such as foregoing life-sustaining treatment, do-not-attempt-resuscitation orders or palliative sedation. All studies emphasise the relevance of involving people with ID themselves, or at least their relatives, in making decisions at the end of life. Still, only two papers described processes of decision-making in which persons with ID actively participated. Furthermore, in only one paper, best practices and guidelines for decision-making in palliative care for people with ID were defined. Although the importance of involving people with ID in the decision-making process is emphasised, best practices or guidelines about what this should look like are lacking. We recommend developing aids that specifically support SDM with people with ID in the last phase of life
Anisotropy of Growth of the Close-Packed Surfaces of Silver
The growth morphology of clean silver exhibits a profound anisotropy: The
growing surface of Ag(111) is typically very rough while that of Ag(100) is
smooth and flat. This serious and important difference is unexpected, not
understood, and hitherto not observed for any other metal. Using density
functional theory calculations of self-diffusion on flat and stepped Ag(100) we
find, for example, that at flat regions a hopping mechanism is favored, while
across step edges diffusion proceeds by an exchange process. The calculated
microscopic parameters explain the experimentally reported growth properties.Comment: RevTeX, 4 pages, 3 figures in uufiles form, to appear in Phys. Rev.
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Shared decision making with frail people with intellectual disabilities in the palliative phase:A process evaluation of the use of the In-Dialogue conversation aid in practice
Background: This study reports the process evaluation of the In-Dialogue conversation aid to facilitate shared decision-making with people with intellectual disabilities in the palliative phase. Methods: Training for In-Dialogue was evaluated by 53 support staff members through questionnaires. The use of In-Dialogue in four residential care facilities for frail people with mild to severe intellectual disabilities was evaluated with semi-structured interviews with five relatives, nine support staff and three people with intellectual disabilities. Results: Most participants considered the training helpful to apply shared decision-making. Sixty-three people with intellectual disabilities participated in In-Dialogue conversations. Almost all interviewees stated that these conversations provided additional insight into people's concerns and preferences. Involvement of people with profound intellectual disabilities and their relatives appeared to be challenging.Conclusion: Conversations about illness and the end of life appeared to be feasible with the In-Dialogue conversation aid and provided insight into people's experiences and preferences.</p
Surfactant effect in heteroepitaxial growth. The Pb - Co/Cu(111) case
A MonteCarlo simulations study has been performed in order to study the
effect of Pb as surfactant on the initial growth stage of Co/Cu(111). The main
characteristics of Co growing over Cu(111) face, i.e. the decorated double
layer steps, the multiple layer islands and the pools of vacancies, disappear
with the pre-evaporation of a Pb monolayer. Through MC simulations, a full
picture of these complex processes is obtained. Co quickly diffuses through the
Pb monolayer exchanging place with Cu atoms at the substrate. The exchange
process diffusion inhibits the formation of pure Co islands, reducing the
surface stress and then the formation of multilayer islands and the pools of
vacancies. On the other hand, the random exchange also suppress the nucleation
preferential sites generated by Co atoms at Cu steps, responsible of the step
decoration.Comment: 4 pages, latex, 2 figures embedded in the tex
Consensus on a conversation aid for shared decision making with people with intellectual disabilities in the palliative phase
Background: Little is known about how to involve people with intellectual disabilities in making decisions about treatment and care in their palliative phase. We aimed to reach a consensus about a shared decision-making (SDM) conversation aid for people with intellectual disabilities, relatives, and healthcare professionals. Methods: In a Delphi process, an expert panel of 11 people with intellectual disabilities, 14 relatives, and 65 healthcare profe
Ab initio study of step formation and self-diffusion on Ag(100)
Using the plane wave pseudopotential method we performed density functional
theory calculations on the stability of steps and self-diffusion processes on
Ag(100). Our calculated step formation energies show that the {111}-faceted
step is more stable than the {110}-faceted step. In accordance with
experimental observations we find that the equilibrium island shape should be
octagonal very close to a square with predominately {111}-faceted steps. For
the (100) surface of fcc metals atomic migration proceeds by a hopping or an
exchange process. For Ag(100) we find that adatoms diffuse across flat surfaces
preferentially by hopping. Adatoms approaching the close-packed {111}-faceted
step edges descend from the upper terrace to the lower level by an atomic
exchange with an energy barrier almost identical to the diffusion barrier on
flat surface regions. Thus, within our numerical accuracy (approx +- 0.05 eV)
there is no additional step-edge barrier to descent. This provides a natural
explanation for the experimental observations of the smooth two-dimensional
growth in homoepitaxy of Ag(100). Inspection of experimental results of other
fcc crystal surfaces indicates that our result holds quite generally.Comment: 10 pages, 9 figures. Submitted to Phys. Rev B (October 31, 1996
Surface Kinetics and Generation of Different Terms in a Conservative Growth Equation
A method based on the kinetics of adatoms on a growing surface under
epitaxial growth at low temperature in (1+1) dimensions is proposed to obtain a
closed form of local growth equation. It can be generalized to any growth
problem as long as diffusion of adatoms govern the surface morphology. The
method can be easily extended to higher dimensions. The kinetic processes
contributing to various terms in the growth equation (GE) are identified from
the analysis of in-plane and downward hops. In particular, processes
corresponding to the (h -> -h) symmetry breaking term and curvature dependent
term are discussed. Consequence of these terms on the stable and unstable
transition in (1+1) dimensions is analyzed. In (2+1) dimensions it is shown
that an additional (h -> -h) symmetry breaking term is generated due to the
in-plane curvature associated with the mound like structures. This term is
independent of any diffusion barrier differences between in-plane and out
of-plane migration. It is argued that terms generated in the presence of
downward hops are the relevant terms in a GE. Growth equation in the closed
form is obtained for various growth models introduced to capture most of the
processes in experimental Molecular Beam Epitaxial growth. Effect of
dissociation is also considered and is seen to have stabilizing effect on the
growth. It is shown that for uphill current the GE approach fails to describe
the growth since a given GE is not valid over the entire substrate.Comment: 14 pages, 7 figure
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