End of life person’s evaluation criteria in the decision making regarding artificial nutrition

Background: Artificial nutrition at the end of life is assumed as a medical intervention, however for a large percentage of person’s and families is considered as basic care [1]. Thinking about artificial nutrition and the end of life person, such as the person with advanced, incurable and progressive disease, with a survival expectancy between 3 to 6 months [2] is often reflected on a set of issues. This is a controversial discussion, about the quality of life resulting of one of these means and ethical questioning [3]. It’s relevant to look to the user/family as one, which motivates the urgent intervention of the nurses in decision-making support. Objective: Identify scientific evidence regarding the end-of-life evaluation criteria, to be considered in the nurses’ decision-making about artificial nutrition. Methods: Literature Review (15-06-2017) with PRISMA guidelines for reviews [4]. It’s relevant to look to the user/family as one, which motivates the urgent intervention of the nurses in decision-making support. Objective: Identify scientific evidence regarding the end-of-life evaluation criteria, to be considered in the nurses’ decision-making about artificial nutrition. Methods: Literature Review (15-06-2017) with PRISMA guidelines for reviews [4 in Academic Search Complete, Complementary Index, CINAHL Plus with Full Text®, Psychology and Behavioural Sciences Collection, ScieELO, MEDLINE®, Directory of Open Access Journals, Supplemental Index, ScienceDirect, Education Source, Business Source Complete and MedicLatina. Inclusion/exclusion criteria: nurses who care for adult/elderly persons at the end of life, excluding nurses who care for children; articles about nurses’ intervention in nutrition care to the person at the end of life and the person’s evaluation criteria; full text; in French/Spanish/English/Portuguese; peer-reviewed; published between 2000-2017. A sample of 11 articles was selected. Results: The evaluation criteria to be considered when making decisions on artificial nutrition are: the evaluation of symptoms/problems; emotional value of food; the meaning of the diet for the person at the end of life and definition of prognosis [3,5-6]. In every decision-making, it should be considered the existence of a clinical indication/treatment, a therapeutic objective and the informed consent of a user or legal guardian. Conclusions: It is concluded that the decision on artificial nutrition should integrate the person at the end of life and family, be taken by an interdisciplinary team, considering the definition of the prognosis and the effectiveness of the treatment applied [3]. The intervention of the nurse is understood as a primordial one, based on the best evidence, in relation of proximity [5] considered, simultaneously, the principle of autonomy, beneficence, non-maleficence and justice. There is little evidence of end-of-life nutrition and new studies on the role of nurses within the interdisciplinary team are suggested.info:eu-repo/semantics/publishedVersio

Nurse’s intervention – end of life nutrition approach protocol

Background: To know that nutrition in the present society is increasingly associated with life maintenance and comfort, helps us to understand the complexity of this subject when approached the end of life. Artificial nutrition remains controversial in a palliative context, given the questioning about the quality of life that offers [1]. Protocols help nurses in the decision-making process and increasing their competences. Objective: To present an end-of-life nutrition approach protocol for palliative care. Methods: This study is the result of three integrative literature reviews that intended to measure: which nursing interventions promote end of life nutrition in people without artificial nutrition criteria?; what are the evaluation criteria for the end-of-life person for the nurse’s decision-making of start, don’t start or suspending artificial nutrition?; does the nurse’s interventions towards the end-of-life reduce the risk of therapeutic obstinacy associated with artificial nutrition? Based in Buckman & Spikes Communication Protocol [2], the results were integrated in a protocol form and submitted to the opinion of 13 experts, from 18th October to 6th November 2017, and the respective changes were made. Inclusion criteria of experts were: being health professionals; palliative care experience and/or work development in nutrition subjects. Results: Our experts have on average 37 years old; 10 carry out their activity in Palliative settings, 8 of these have advanced training in Palliative Care. Our protocol considers: I) setting - preparing the environment; II) perception - prior knowledge of the person/family information about nutrition, preferences and considerations regarding the future commitment of feeding and active listening, understanding what the person/family wants to know, especially as to the meaning of nutrition, what that moment represents and invite them to address the subject; III) knowledge - provide adequate information in phases, contextualizing the present symptoms in the disease process (prognosis) and discuss the evaluation criteria before starting artificial nutrition; IV) emotions – attend to the emotions and provide realistic hope; V) strategy – interventions from the patient’s needs are presented in an algorithm form, promoting oral feeding as long as possible. In all process, the person and family autonomy in decision making is preserved. At each step, we identified an element to avoid in the communication process [1,2]. Conclusions: The set of nurse’s interventions in end-of-life nutrition approach systematizes the elements to be considered in decision-making and guarantees the importance of nurses' contribution in risk reduction of therapeutic obstinacy.info:eu-repo/semantics/publishedVersio

Seasonal variations in air concentrations of 27 organochlorine pesticides (OCPs) and 25 current-use pesticides (CUPs) across three agricultural areas of South Africa

For decades pesticides have been used in agriculture, however, the occurrence of legacy organochlorine pesticides (OCPs) and current-use pesticides (CUPs) is poorly understood in Africa. This study investigates air concentrations of OCPs and CUPs in three South African agricultural areas, their spatial/seasonal variations and mixture profiles. Between 2017 and 2018, 54 polyurethane foam-disks passive air-samplers (PUF-PAS) were positioned in three agricultural areas of the Western Cape, producing mainly apples, table grapes and wheat. Within areas, 25 CUPs were measured at two sites (farm and village), and 27 OCPs at one site (farm). Kruskal-Wallis tests investigated area differences in OCPs concentrations, and linear mixed-effect models studied differences in CUPs concentrations between areas, sites and sampling rounds. In total, 20 OCPs and 16 CUPs were detected. A median of 16 OCPs and 10 CUPs were detected per sample, making a total of 11 OCPs and 24 CUPs combinations. Eight OCPs (trans-chlordane, o,p'-/p,p'-dichlorodiphenyldichloroethylene (DDE)/dichlorodiphenyltrichloroethane (DDT), endosulfan sulfate, γ-hexachlorocyclohexane and mirex) and two CUPs (carbaryl and chlorpyrifos) were quantified in all samples. p,p'-DDE (median 0.14 ng/m(3)) and chlorpyrifos (median 0.70 ng/m(3)) showed the highest concentrations throughout the study. Several OCPs and CUPs showed different concentrations between areas and seasons, although CUPs concentrations did not differ between sites. OCPs ratios suggest ongoing chlordane use in the region, while DDT and endosulfan contamination result from past-use. Our study revealed spatial and seasonal variations of different OCPs and CUPs combinations detected in air. Further studies are needed to investigate the potential cumulative or synergistic risks of the detected pesticides

Means-end analysis of consumers’ perceptions of virtual world affordances for e-commerce

Virtual worlds are three-dimensional (3D) persistent multi-user online environments where users interact through avatars. The affordances of virtual worlds can be useful for business-to-consumer e-commerce. Moreover, affordances of virtual worlds can complement affordances of websites to provide consumers with an enhanced e-commerce experience. We investigated which affordances of virtual worlds can enhance consumers‟ experiences on e-commerce websites. We conducted laddering interviews with 30 virtual world consumers to understand their perceptions of virtual world affordances. A means-end analysis was then applied to the interview data. The results suggest co-presence, product discovery, 3D product experience, greater interactivity with products and sociability are some of the key virtual world affordances for consumers. We discuss theoretical implications of the research using dimensions from the Technology Acceptance Model. We also discuss practical implications, such as how virtual world affordances can be incorporated into the design of e-commerce websites

Interventions to reduce pesticide exposure from the agricultural sector in Africa: a workshop report

Despite the fact that several cases of unsafe pesticide use among farmers in different parts of Africa have been documented, there is limited evidence regarding which specific interventions are effective in reducing pesticide exposure and associated risks to human health and ecology. The overall goal of the African Pesticide Intervention Project (APsent) study is to better understand ongoing research and public health activities related to interventions in Africa through the implementation of suitable target-specific situations or use contexts. A systematic review of the scientific literature on pesticide intervention studies with a focus on Africa was conducted. This was followed by a qualitative survey among stakeholders involved in pesticide research or management in the African region to learn about barriers to and promoters of successful interventions. The project was concluded with an international workshop in November 2021, where a broad range of topics relevant to occupational and environmental health risks were discussed such as acute poisoning, street pesticides, switching to alternatives, or disposal of empty pesticide containers. Key areas of improvement identified were training on pesticide usage techniques, research on the effectiveness of interventions targeted at exposure reduction and/or behavioral changes, awareness raising, implementation of adequate policies, and enforcement of regulations and processes

Laddered motivations of external whistleblowers: The truth about attributes, consequences, and values

The purpose of this study was to explore the motivational structures of external whistleblowers involved in the decision to blow the whistle by applying MEC theory and the laddering technique. Using both soft and hard laddering methods, data were collected from 37 Korean external whistleblowers. Results revealed that the means-end chain of external whistleblow-ers was the hierarchical linkage among two concrete attributes (the power of external whistleblowing to make changes and its warning about the seriousness of wrongdoing to the public), two functional consequences (correcting a wrongdoing and making those who violated laws admit their offenses), and one terminal value (the truth). The extant whistleblowing literature has either made assumptions about whistleblowers’ motivations when developing models or has drawn indirect inferences from measures of other variables. Our study is the first with an explicit and empirical focus on whistleblowers’ motivations. The findings provide evidence of the motivational structures of external whistleblowers that consist of a set of complex paths linked by multi-layered motivators. This research will be helpful in designing and reviewing whistleblowing programs for organizations, regulatory agencies, and journalists

Crustal Seismic Structure beneath Portugal (Western Iberia) and the role of Variscan Inheritance

Mainland Portugal comprises most of theWestern portion of the Iberian Peninsula, in a geodynamic setting associated with the Africa-Eurasia plate boundary. The crustal structure in Portugal is the result of a complex assemblage history of continental collision and extension with most of the surface is covered by rocks dating to the Variscan orogeny, the coastal ranges dominated by Mesozoic structures and Mesocenozoic basins covering partially the mainland. The impact and extension of this complex tectonic in the structure of the Iberian Lithosphere is still a matter of discussion, especially in its western part beneath Portugal. The existing knowledge relating the observed surface geology and lithospheric structures is sparse and sometimes incoherent, the relation between shallow and deep structures and their lateral extension still widely undetermined. Some questions still pertinent are the role and influence of the several tectonic units and their contacts in the present tectonic regime and in the stress field observed today, and the relation between the anomalous seismicity and associated crustal deformation rates with the inherited structure from past orogenies. In this study we present the results of a local earthquake tomographic study, performed to image this complex crustal structure down to 20 km depth. The relocation of the onshore seismicity recorded in the period 2000-2014 with the new 3D model allows cleansing some of the alignments and their correlation with some of the main active structures in Portugal enabling for the first time to correlate a large number of tectonic features to the small magnitude seismicity pattern. The seismicity distribution also displays a complex pattern, mainly reflecting the interaction between inherited Variscan structures with more recent fault systems created during the rifting stages of the Atlantic and diapir magmatic intrusions. The complex history of the assemblage of the crust beneathWestern Iberia is well-marked in the final models. The arcuate shape of the Ibero-Armorican Arc can be perceived over the general pattern of the Vp and Vp/Vs anomalies and the heterogeneity observed on the surface geology are clearly marked in the tomograms. Other significant features are the low Vp values associated with the Mesocenozoic rocks outcropping in the Lusitanian and Algarve basins, and the low Vp and high Vp/Vs values of the sedimentary cover of the Lower-Tagus and Sado Basin.Publication supported by FCT- project UID/GEO/50019/2013 - Instituto Dom LuizPeer Reviewe