End-stage head and neck cancer: coping mechanism

Coping mechanisms are patients’ means of adapting to stressful situations and involve psychological and physical changes in behavior. Patients adapt to head and neck cancer in a variety of ways. Head and neck cancers are extremely debilitating, especially in advanced stages of the disease or in end-of-life situations. While an oncology team needs to address the needs of all oncology patients, the advanced terminal patients require special attention. Most of these patients do not cope well with their situation and have a tendency to cease social interactions. Pain is the most frequentlyexperienced medical disability in patients having an end-stage illness experience, and thus an important medical endeavor is to afford dignity to the dying patient facingan incurable disease. In such cases, the medical community should never refuse therapy or to assist a dying patient.In some instances, the patient and family may derive benefit from their religious beliefs

Right Heart Remodeling in Patients with End-Stage Alcoholic Liver Cirrhosis: Speckle Tracking Point of View

BACKGROUND: Data regarding cardiac remodeling in patients with alcoholic liver cirrhosis are scarce. We sought to investigate right atrial (RA) and right ventricular (RV) structure, function, and mechanics in patients with alcoholic liver cirrhosis. METHODS: This retrospective cross-sectional investigation included 67 end-stage cirrhotic patients, who were referred for evaluation for liver transplantation and 36 healthy controls. All participants underwent echocardiographic examination including strain analysis, which was performed offline. RESULTS: RV basal diameter and RV thickness were significantly higher in patients with cirrhosis. Conventional parameters of the RV systolic function were similar between the observed groups. Global, endocardial, and epicardial RV longitudinal strains were significantly lower in patients with cirrhosis. Active RA function was significantly higher in cirrhotic patients than in controls. The RA reservoir and conduit strains were significantly lower in cirrhotic patients, while there was no difference in the RA contractile strain. Early diastolic and systolic RA strain rates were significantly lower in cirrhotic patients than in controls, whereas there was no difference in the RA late diastolic strain rate between the two groups. Transaminases and bilirubin correlated negatively with RV global longitudinal strain and RV-free wall strain in patients with end-stage liver cirrhosis. The Model for End-stage Liver Disease (MELD) score, predictor of 3-month mortality, correlated with parameters of RV structure and systolic function, and RA active function in patients with end-stage liver cirrhosis. CONCLUSIONS: RA and RV remodeling is present in patients with end-stage liver cirrhosis even though RV systolic function is preserved. Liver enzymes, bilirubin, and the MELD score correlated with RV and RA remodeling

Nurse's Spiritual Care Competencies to Patient with End Stage Breast Cancer

Cancer has many side effects on patient's physic and mostly on mental which may affect on their quality of life. Physically most patients feel fatigue, insomnia, anorexia, nausea, and vomit while mentally they feel emotional disturbances such as anxiety, stress, or depression. One of the methods to that appropriate to overcome both of the conditions is spiritual care. Many research found that because spiritual care associated with better wellbeing, less emotional disturbance, less substance abuse, greater social support, better health behaviours, so it has impact to longer survival periods. This research aimed to investigate nurse's spiritual care competencies to patients with end stage cancer. This was descriptive study design employed Spiritual Care Competencies Scale (SCCS) instrument. A total sampling of 24 nurses working in Oncology department in Dr. Wahidin Sudirohusodo Hospital were recruited. This research found that there are 12 nurses (50 %) that work in oncology department have low competencies of spiritual care. Involving spiritual care is associated with better wellbeing and longer survival periods. Therefore, it is necessary to increase the competence of nurses on spiritual care in meeting the spiritual needs of patients with end stage breast cancer. A training of spiritual care can be an alternative for nurses to improve spiritual care in hospitals

An end-to-end framework for real-time automatic sleep stage classification.

Sleep staging is a fundamental but time consuming process in any sleep laboratory. To greatly speed up sleep staging without compromising accuracy, we developed a novel framework for performing real-time automatic sleep stage classification. The client-server architecture adopted here provides an end-to-end solution for anonymizing and efficiently transporting polysomnography data from the client to the server and for receiving sleep stages in an interoperable fashion. The framework intelligently partitions the sleep staging task between the client and server in a way that multiple low-end clients can work with one server, and can be deployed both locally as well as over the cloud. The framework was tested on four datasets comprising ≈1700 polysomnography records (≈12000 hr of recordings) collected from adolescents, young, and old adults, involving healthy persons as well as those with medical conditions. We used two independent validation datasets: one comprising patients from a sleep disorders clinic and the other incorporating patients with Parkinson's disease. Using this system, an entire night's sleep was staged with an accuracy on par with expert human scorers but much faster (≈5 s compared with 30-60 min). To illustrate the utility of such real-time sleep staging, we used it to facilitate the automatic delivery of acoustic stimuli at targeted phase of slow-sleep oscillations to enhance slow-wave sleep

End-wall boundary layer measurements in a two-stage fan

Detailed flow measurements made in the casing boundary layer of a two-stage transonic fan are summarized. These measurements were taken at a station upstream of the fan, between all blade rows, and downstream of the last row. Conventional boundary layer parameters were calculated from the measured data. A classical two dimensional casing boundary layer was measured at the fan inlet and extended inward to approximately 15 percent of span. A highly three dimensional boundary layer was measured at the exit of each blade row and extended inward to approximately 10 percent of span. The steep radial gradient of axial velocity noted at the exit of the rotors was reduced substantially as the flow passed through the stators. This reduced gradient is attributed to flow mixing. The amount of flow mixing was reflected in the radial redistribution of total temperature as the flow passed through the stators. The blockage factors calculated from the measured data show an increase in blockage across the rotors and a decrease across the stators. For this fan the calculated blockages for the second stage were essentially the same as those for the first stage

Guidance for students studying science

"Inspectors visited 45 secondary schools in February 2010 to find out how students at the end of Key Stage 3 and Key Stage 4 were guided to science courses. The schools were directing most students appropriately to suitable courses at the end of Key Stage 3 and very few students felt that they had been misdirected. Sixth form students chose science partly because of their particular career intentions, but mainly because of their interest in and enjoyment of the subject. They often cited good teaching as a factor that attracted them to science." - cover

Sensitivity of multi-product two-stage economic lotsizing models and their dependency on change-over and product cost ratio's

This study considers the production and inventory management problem of a two-stage semi-process production system. In case both production stages are physically connected it is obvious that materials are forced to flow. The economic lotsize depends on the holding cost of the end-product and the combined change-over cost of both production stages. On the other hand this 'flow shop' is forced to produce at the speed of the slowest stage. The benefit of this approach is the low amount of Work In Process inventory. When on the other hand, the involved stages are physically disconnected, a stock of intermediates acts as a decoupling point. Typically for the semi-process industry are high change-over costs for the process oriented first stage, which results in large lotsize differences for the different production stages. Using the stock of intermediates as a decoupling point avoids the complexity of synchronising operations but is an additional reason to augment the intermediate stock position. The disadvantage of this model is the high amount of Work-In-Process inventory. This paper proposes the 'synchronised planning model' realising a global optimum instead of the combination of two locally optimised settings. The mathematical model proves (for a two-stage single-product setting) that the optimal two-stage production frequency corresponds with the single EOQ solution for the first stage. A sensitivity study reveals, within these two-stage lotsizing models, the economical cost dependency on product and change-over cost ratio‟s. The purpose of this paper is to understand under which conditions the „joined setup‟ or the „two-stage individual eoq model‟ remain close to the optimal model. Numerical examples prove that the conclusions about the optimal settings remain valid when extending the model to a two-stage multi-product setting. The research reveals that two-stage individually optimized EOQ lotsizing should only be used when the end-product stage has a high added value and small change-over costs, compared to the first stage. Physically connected operations should be used when the end-product stage has a small added value and low change-over costs, or high added value and large change-over costs compared to the first production stage. The paper concludes with suggesting a practical common cycle approach to tackle a two-stage multi-product production and inventory management problem. The common cycle approach brings the benefit of a repetitive and predictable production schedule

Does Infall End Before the Class I Stage?

We have observed HCO+ J=3-2 toward 16 Class I sources and 18 Class 0 sources, many of which were selected from Mardones et al. (1997). Eight sources have profiles significantly skewed to the blue relative to optically thin lines. We suggest six sources as new infall candidates. We find an equal "blue excess" among Class 0 and Class I sources after combining this sample with that of Gregersen et al. (1997). We used a Monte Carlo code to simulate the temporal evolution of line profiles of optically thick lines of HCO+, CS and H2CO in a collapsing cloud and found that HCO+ had the strongest asymmetry at late times. If a blue-peaked line profile implies infall, then the dividing line between the two classes does not trace the end of the infall stage.Comment: 21 pages, 8 figures, accepted by ApJ for April 20, 2000, added acknowledgmen