Search

Background: In end-of-life care hygiene, measures concerning multidrug-resistant bacterial microorganisms may contradict the palliative care approach of social inclusion and be burdensome for patients. Objectives: To integrate patients’ perspectives on handling multidrug-resistant bacterial microorganisms at their end of life, their quality of life, the impact of positive multidrug-resistant bacterial microorganisms’ diagnosis, protection and isolation measures on their well-being and patients’ wishes and needs regarding their care. Design: A mixed-methods convergent parallel design embedded quantitative data on the patients’ multidrug-resistant bacterial microorganisms’ trajectory and quality of life assessed by the Schedule for the Evaluation of Individual Quality of Life in qualitative data collection via interviews and focus groups. Data analysis was performed according to Grounded Theory and qualitative and quantitative results were interrelated. Setting/participants: Between March 2014 and September 2015 at two hospitals adult patients diagnosed with multidrug-resistant bacterial microorganisms and treated in a palliative care department or a geriatric ward were included in the sample group. Results: Patients in end-of-life and geriatric care reported emotional and social impact through multidrug-resistant bacterial microorganisms’ diagnosis itself, hygiene measures and lack of information. This impact affects aspects relevant to the patients’ quality of life. Patients’ wishes for comprehensive communication/information and reduction of social strain were identified from the focus group discussion. Conclusion: Patients would benefit from comprehensible information on multidrug-resistant bacterial microorganisms. Strategies minimizing social exclusion and emotional impact of multidrug-resistant bacterial microorganisms’ diagnosis in end-of-life care are needed as well as adaption or supplementation of standard multidrug-resistant bacterial microorganisms’ policies of hospitals.

There is a lack of research into how hospital staff and institutional stakeholders (i. e. institutional representatives from public health authorities, hospital hygiene, and the departments of microbiology, palliative care, and geriatrics) engage with patients who are carriers of multidrug-resistant organisms and receiving end-of-life care. Knowledge of their experiences, workload, and needs should be considered in dealing with hospitalized carriers of multidrug-resistant organisms as well as staff education. This study explored and compared staff members’ and stakeholders’ perspectives on multidrug-resistant organisms and on provision of end-of-life care to carrier patients. In this study four focus groups consisting of hospital staff members and institutional stakeholders were formed within a mixed-methods parent study in a palliative care unit at a university clinic and a geriatric ward of a Catholic and academic teaching hospital. Participants discussed results from staff and stakeholder interviews from a former study phase. Data were analyzed according to Grounded Theory and perspectives of staff members and institutional stakeholders were compared and contrasted. Key issues debated by staff members (N = 19) and institutional stakeholders (N = 10) were 1) the additional workload, 2) reasons for uncertainty about handling carrier patients, 3) the format of continuing education, and 4) the preferred management approach for dealing with multidrug-resistant organism carrier patients. Although similar barriers (e. g. colleagues’ ambiguous opinions) were identified, both groups drew different conclusions concerning the management of these barriers. While institutional stakeholders recommended making decisions on hygiene measures under consideration of the specific patient situation, staff members preferred the use of standardized hygiene measures which should be applied uniformly to all patients. Staff members and institutional stakeholders perceived similar barriers to practice caused by multidrug-resistant organisms and similar needs for continuing education. The staff members’ preferred management approach might originate from an uncertainty about the multidrug-resistant organism infection risk. Experiences and visions of both groups should be included in a specific recommendation for end-of-life care to ensure behavioral confidence.

AIMS AND OBJECTIVES To explore healthcare professionals' personal experiences, feelings and attitudes about caring for hospitalised patients with multidrug-resistant bacteria in palliative and geriatric care. BACKGROUND Working in end-of-life care involves at times burdening demands that affect not only healthcare professionals personally but also their actions. It is suggested that multidrug-resistant bacteria and their consequences for colonised or infected patients in hospitals are among the challenges for all professionals in end-of-life care. Little is known about the feelings and experiences of staff members during healthcare activities with regard to these bacteria. DESIGN A qualitative interview study in two German hospitals. METHODS We interviewed 35 staff members from a German palliative care unit and a geriatric unit about their experiences with multidrug-resistant bacteria in end-of-life care and the management of colonised or infected patients. Semistructured interviews were transcribed verbatim and analysed using grounded theory. RESULTS Interviewees represented two interdisciplinary teams with 40% nurses, 26% physicians and 34% other professionals. Salient themes that were identified included impact of multidrug-resistant bacteria on staff members' personal actions, feelings and attitudes towards the bacteria and the required isolation measures. Besides higher workload and consequences for working routines, the patients' palliative care needs were recognised, as well as the necessary protection measures to avoid contaminations in hospital. Healthcare professionals reported a dilemma that they experienced when facing these diverse demands. CONCLUSIONS Findings point to emotional and behavioural ambivalence in end-of-life care among staff members because necessary isolation measures and particular situation in end-of-life care create unsolvable conflicts for healthcare professionals. Possible strategies to cope with ambivalence are discussed. RELEVANCE TO CLINICAL PRACTICE Healthcare professionals in palliative and geriatric care have to deal with multidrug-resistant bacteria and have to face contradictory feelings while trying to fulfil patients' needs as well as isolation requirements.

Palliative care professionals are frequently confronted with patients colonized or infected with MDRO. One major challenge is how to balance necessary isolation measures and social inclusion as one of the main principles of palliative and end-of-life care. To date, MDRO-specific policies and protocols vary widely between institutions. Aim: provide empirical recommendations on how to deal with hospitalized MDRO patients in end-of-life care. Recommendations were developed based on (i) initial results of face-to-face interviews and focus groups, (ii) impartial experts’ comments and consensus on the draft via online survey and (iii) a face-to-face meeting with consortium members to finalize recommendations. Findings of 158 interviews and six focus groups (39 participants) with patients, family caregivers, staff members and institutional stakeholders contributed to the recommendations. The assessments of 17 experts were considered. In total, 21 recommendations were approved. The recommended strategy in dealing with MDRO at the end of life allows case-based application of protection and isolation measures. MDRO diagnostics and therapy involve screening at admission. The recommendations suggest consideration of required accommodation facilities, provided material as well as staff and time resources. The recommendations further highlight the importance of providing for strategies enabling the patient’s social inclusion and provision of verbal and written information about MDRO for patients and family caregivers, transparent medical documentation, and staff member training. The recommendations summarize the perspectives of individuals and groups affected by MDRO at the end of life and provide practical guidance for clinical routine. Further dissemination and implementation requirements are discussed and should contain the evaluation of the knowledge, views, worries, and anxieties of the target groups.

The period 1984–1985 has seen a dramatic improvement in the quality of the ECMWF operational forecasts for tropical regions. This improvement is discussed in terms of the model changes during this period. Revisions include the introduction of a parametrization of shallow cumulus convection, modifications to the parametrization of deep cumulus convection, a new cloud scheme, and an increase in horizontal resolution with a change in spectral truncation from T63 to T106. Impact of the various model changes is assessed through a set of forecast experiments and through parallel 10-day forecasts over a 20-day period. The results show that the improvements in tropical forecasts are mainly through the reduction of systematic errors in response to a more realistic tropical diabatic forcing. The impact of these changes on the analyses is also assessed. This is shown to be substantial, particularly for the thermal state.

Current climate and forecast models treat clouds as plane-uniform, ignoring subgrid-scale variations of cloud water content in radiative transfer calculations. The plane-uniform assumption is relaxed in a new cloud-radiation parameterization that considers cloud inhomogeneities and heterogeneities associated with convective and stratiform cloudiness. Convective cloudiness is diagnosed from the assumption that the ensemble of convective clouds within a model grid column is in a quasi-steady state. Global forecast experiments with the new parameterization show that the introduction of cloud inhomogeneities and heterogeneities leads to substantially increased and more realistic net downward shortwave radiative fluxes at the top of the atmosphere; over the tropical and subtropical oceans (30°S–30°N) the increase by inhomogeneities and heterogeneities is on average 9 and 7 W m−2, respectively.

A prognostic scheme for stratiform and convective clouds is developed for large-scale models. The time evolution of clouds is defined through the large-scale budget equations for cloud water content and cloud air (which is converted into a prognostic equation for fractional cloud cover). The scheme considers the formation of clouds in connection with large-scale ascent diabatic cooling, boundary-layer turbulence, and horizontal transport of cloud water from convective updrafts. Clouds dissipate through adiabatic and diabatic heating, turbulent mixing of cloud air with unsaturated environmental air, and depletion of cloud water by precipitation. The scheme differs from conventional schemes in its approach, which is fully prognostic and model consistent, and in the larger degree of complexity as the formation of anvil and circus clouds originating by cumulus updrafts and boundary-layer clouds is included. The scheme has been tested in the European Centre for Medium-Range Weather Forecasts (ECMWF) g...

The HIRS instrument on the NOAA polar orbiting satellites is used to obtain coverage of outward-going longwave radiation across the global tropics and subtropics four times a day. Fractional coverage of cold cloud is obtained from this, which is then interpreted as rainfall rates. This information is introduced into the ECMWF data assimilation system as diabatic heating through the nonlinear normal-mode initialization scheme. Substantial impact on the analyses is found.

The HIRS instrument on the NOAA polar orbiting satellites is used to obtain coverage of outward-going longwave radiation across the global tropics and subtropics four times a day. Fractional coverage of cold cloud is obtained from this, which is then interpreted as rainfall rates. This information is introduced into the ECMWF data assimilation system as diabatic heating through the nonlinear normal-mode initialization scheme. Substantial impact on the analyses is found.

The superionic conductor Ag3SI was studied by129I-Mossbauer spectroscopy in the rhombohedral γ-phase and in the cubic β-phase at temperatures between 4.2 K and 180 K. In the low-temperature γ-phase, one observes well below the γ-β phase transition at 157 K a motional-narrowing-like decrease of the electric-quadrupole interaction, roughly linear with temperature, which points to a diffusional motion of the Ag+ ions already in the γ-phase. Diffusional effects are also reflected by anomalous decrease of thef-factor in the same temperature region, which originates from a restricted short-range diffusional displacement of the iodide ions induced by the hopping Ag+ ions.

The127I- and129I-Mossbauer resonances are applied to study the chemical nature of the interhalogen molecules ICI and IBr in stage-1 and stage-2 graphite intercalation compounds (GICs) and, for sake of comparison, in their solid molecular modifications. For both GIC systems one observes, in support of a model for the intercalate structure derived from recent X-ray absorption studies, two sites with an intensity ratio 1∶1 and with similar isomer shifts and electric-quadrupole splittings. The charge transfer mechanisms are discussed in conjunction with complementary X-ray absorption and photoemission studies.

Experiments have been conducted to evaluate the feasibility of conducting pointing stability measurements with a relatively low cost stand alone apparatus. These experiments also aimed at collecting beam wandering data for pointing stability measurement system engineering purposes. The system consists of two dual-axes position sensing detectors (PSDs) that simultaneously measure variations of the beam position in two different planes. Sample-and-hold circuits are used to synchronize measurements taken by both PSDs. Detector signals are amplified and processed analogically in order to obtain voltage outputs directly related to beam position. The output signals are then A/D converted for computations. Software allows pointing stability calculations as well as frequency spectrum analysis of position fluctuations.© (1996) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

A prognostic scheme for stratiform and convective clouds is developed for the model The time evolution of clouds is defined through the large-scale budget equations for cloud water and cloud air. The scheme has been tested in the ECMWF global model and compared with the current operational scheme. The representation of the cloud process has a strong effect on the hydrological cycle and the maintenance of the tropospheric water vapour cycle.

This paper describes the impact on the tropical simulation in the ECMWF model of various changes to the treatment of physical processes, with particular emphasis on the onset of the Asian summer monsoon. A series of 10-day forecasts were carried out, each integration starting from 1200 UTC 11 June 1979 and covering the rapid intensification of the monsoon over the Arabian Sea and Southern India. The changes to the physical processes involved modifications to the radiation and Kuo penetrative convective schemes and the introduction of a shallow convection scheme. The changes to the treatment of convection, particularly the introduction of the shallow convection scheme, are found to have a large impact on the tropical circulation and precipitation. In addition to an overall beneficial effect on the simulated large-scale flow (e.g., tradewind boundary layer structure, tradewinds, ITCZ) there is a significant improvement of the monsoon simulation. It is found that only when the radiation changes are ...

We present the results of a series of forecasts on seven weather situations from February 1976 using two models which differ only in their physical parameterizations. One set of parameterizations was developed at the Geophysical Fluid Dynamics Laboratory (GFDL) some years ago, the other more recently at the European Centre for Medium Range Forcasts (ECMWF). The resolution of the model (N48, 15 levels) was that which ECMWF has used in the first phase of operations, which began in August 1979. The particular aim of the experiments was to study the importance of the differences in the parameterization schemes for the model; in addition, we obtained a general view of the forecast results that might be available in the first phase of operations. Both sets of parameterizations gave similar results in terms of forecast quality. When measured by the standard objective methods, the range of predictability was 5–6 days. A study of the systematic errors in the forecasts showed that these were mainly associa...

Bei 41 Patienten mit peripheren Fazialisparesen und sieben gesunden Kontrollpersonen wurden nach Pilocarpinstimulation speichelchemische Analysen im Seitenvergleich durchgefuhrt. Dabei zeigten sich die Elektrolyte Natrium und Calcium sowie das Ferment Amylase im Speichel der paretischen Seite erhoht. Die Natriumkonzentrationserhohungen werden nach entsprechenden Modellvorstellungen als Storung der physiologischen Natriumruckresorption (zellulare Natriumpumpe) des Drusengangepithels interpretiert. Die Natriumkonzentrationserhohungen waren abhangig vom Schweregrad der Parese und bildeten sich wahrend der Ausheilung zuruck. Es liegen noch nicht genugend Befunde im Fruhstadium einer Fazialisparese vor, um die Zuverlassigkeit dieses Parameters zur Fazialisdiagnostik beurteilen zu konnen.

The problem of cumulus parameterization in large-scale models is discussed. Several popular current schemes for penetrative and shallow convection are described and verified in semi-prognostic tests and in a full global forecast model. The results from the global experiments, in particular, indicate uncertainties in the parameterizations of penetrative and shallow convection, as well as in the interaction of cumulus cloud fields with radiation.

The chemistry of the saliva produced by the submaxillary glands after pilocarpin stimulation has been investigated in normal cases and cases of peripheral facial paralysis.