Systemic Factors Impacting Mortality and End-of-Life Issues in Critical Care

This chapter reviews issues related to mortality in the intensive care setting. Relevant literature is summarized and emphasizes the common need patients have for more frequent assessment, dependency on technology support, and psychosocial intervention. The authors stress the importance of interdisciplinary teams and the unique staffing and workforce challenges they encounter. Despite agreement on its importance, the authors maintain that end-of-life care is associated with a lack of consensus around its implementation at the bedside. The diversity within patient groups, diseases and conditions, and health care providers results in an environment in which the interplay of a growing number of variables influences the engagement of patients and families in discussions about end-of-life planning and care, futility, palliation, or withdrawal of support.

Social Support Experiences of Spousally Bereaved Individuals in a South African Township Community: The Botho/Ubuntu Perspective

Bereavement is a deeply personal experience that is also shaped by one’s socio-cultural context. This qualitative study explored the social support experiences and needs of spousally bereaved individuals in a South African township. The botho/ubuntu philosophical framework was used to interpret participants’ experiences in this regard. Six ethnically diverse, bereaved spouses aged 55–67years, residing in a predominantly Setswana-speaking township in the North West Province of South Africa, were interviewed. Thematic analysis was used to analyze the data. An indigenous knowledge consultant was interviewed to situate participant experiences pertaining to mourning rites and traditions within the indigenous socio-historical and contemporary cultural context. The following themes were identified: (i) Sources of social support during bereavement; (ii) Inadequate social support after spousal death; (iii) The need for grief counseling; and (iv) Social restrictions and systematic isolation during the traditional mourning period: “It is as if you smell.” Broadly, bereaved spouses drew on their support networks at various stages of their bereavement, which included family members, in-laws, friends, burial societies, their surrounding communities, and religious communities and figures. However, some experienced ostracization and stigmatization during the mourning period, which was invariably longer for the widows in this study, in line with conventions across Black South African cultures. Some participants reported withdrawal of support by their in-laws and harmful attitudes and assumptions rooted in patriarchal ideology by family members and in-laws. As pertaining to botho/ubuntu, the study also showed that communality or relationality entailed both positive and negative aspects, including support, co-operation, care, lack of support, stigmatization, and ostracization. Unlike conventional conceptualizations of botho/ubuntu, the study findings illustrate the human experience as comprising varying dimensions of relationality, ranging from harmony to disharmony. Findings regarding the negative aspects of communality are compatible with those relating to relational interdependence in African and East Asian settings. The findings also expand our understanding of the nature of disharmony alongside harmony in interdependent socio-cultural contexts.

Attitudes Toward End-Of-Life Decisions Other Than Assisted Death Amongst Doctors in Northern Portugal

Background Doctors often deal with end-of-life issues other than assisted death, such as incompetent patients and treatment withdrawal, including food and fluids. Methods A link to a questionnaire was sent by email three times, at intervals of one week, to the doctors registered in the Northern Section of the Portuguese Medical Association. Results The questionnaire was returned by 1148 (9%) physicians. This study shows that only a minority of Portuguese doctors were willing to give one or more drugs in lethal doses to cognitively incompetent patients with an incurable, advanced, and progressive disease at the request of a family member or other close person, and even less would do it on their own initiative. Concerning the withdrawal of support of life measures in advanced and progressive diseases at the patient’s request, most doctors were in favor, but much fewer doctors agreed with the suspension of supportive life measures at the request of a family member, another close person, or by their own unilateral decision. However, concerning the suspension of food and fluids, fewer agreed with that action. Portuguese doctors favor the administration of drugs for suffering control, even foreseeing they could shorten life, Conclusion Most doctors in this study respect patients’ autonomy, but do not agree with measures decided by others that have an impact on patients’ survival. They also agree with the administration of drugs for suffering control, even considering the possibility of shortening life.

Religious Diversity and Equality in Interwar Yugoslavia

This paper explores the relationship between religion and state- and nation-building in interwar Yugoslavia. In the current scholarship, the relationship between religion and nationalism in interwar Yugoslavia has been assessed primarily in terms of its contribution to the Croat-Serbian tension and exacerbating political crisis leading to the collapse of the state (Ekmečić, 1989; Radić, 2000, 2003). This approach continues the historiographical tradition of studying the positive link between religion and national identity in the Balkans, where indeed since the 19th century religion has played an important role in the development of national ideologies and national movements (Jelavich, 1983; Kitromilides, 1994). This articles provides a more detailed exploration of the dynamic behind the religious communities’ shift from initial support of Yugoslavia in 1918 to disenchantment with the Yugoslav idea and withdrawal of support. I argue that the reasons for this shift are closely linked to how Yugoslav authorities approached the question of religious diversity and attempted to secure religious equality in the context of establishing new state structures; and to what assumptions were made about the role and place of religion in relation to both the new state and the Yugoslav nation. The article thus questions the presumption that religion was inevitably a destabilizing factor in the interwar period.

Interview with the Guest Editor – Derek Walsh

ABSTRACT Derek Walsh obtained his PhD in cell biology at Dublin City University (DCU), Ireland, in 2000. After a brief stint as a postdoc at Columbia University, he then joined Ian Mohr's lab for a postdoc at New York University (NYU) School of Medicine to study translational regulation in herpesviruses and poxviruses. He received a Science Foundation Ireland (SFI) Investigator Award to move back to Ireland and establish his own research group in 2006. However, the financial crisis and withdrawal of support systems from SFI forced him to close his lab in 2011. He returned to New York where his former mentor, Ian Mohr, took him back under his wing and helped him rebuild his career over the next 3 years. Despite Hurricane Sandy devastating the lab at NYU in 2012, just like the herpesviruses he studies, Derek is not that easy to get rid of. In 2014, he was recruited to Northwestern University, Chicago, where he reestablished his own research program and became Professor in 2019. His research has revealed mechanisms by which poxviruses regulate translation, taking control of the ribosomes and signalling pathways of the host. Another line of research in his lab has shown how herpesviruses use microtubules to control cellular architecture.

Experiences of children with special educational needs and disabilities and their families in the United Kingdom during the coronavirus pandemic

Purpose The purpose of this paper is to outline the experiences of children with special educational needs and disabilities (SEND) and their families during the coronavirus pandemic. Design/methodology/approach This paper draws on research gathered and collated by three different organisations working with families of children and young people with SEND. Findings There were a number of common findings across all three surveys. In particular: the rapid collapse of external support for children and families; the reduction/withdrawal of support exacerbated the stress and exhaustion already experienced by many families; it proved very difficult to establish home learning and get adequate support from schools; there was little government recognition of families’ vulnerability and need for support; and, paradoxically, a significant minority of children and families reported increased well-being. Originality/value Findings carry clear implications both for the provision of child and family support during any further lockdowns and, more generally, in respect of government policy and funding of family support.

Factors Affecting Sustainability of Donor Funded Food Security Projects in Tharaka South Sub-County, Tharaka Nithi County, Kenya

Project activities have been used to solve food insecurity problems. However, despite efforts made by the Government and other development partners to implement food security projects in areas of need project activities collapse after the withdrawal of support by donors limiting sustainability these projects. Therefore, this study sought to fill this gap by investigating factors which affect sustainability of donor funded food security projects in Tharaka South Sub-County, Tharaka Nithi County using there source based and stakeholder theories. The study was exploratory and was executed through a descriptive survey and targeted donor funded food security projects which included Njaa Marufuku, National Agriculture Sector Extension Policy, Food for Asset and Mount Kenya East Pilot Project for Natural Resource Management (MKEPP). The study used both simple random and purposive sampling methods in a population of 400 community project beneficiaries, Social Development Officer, project officers and opinion leaders and a sample of 238 respondents was adopted. Questionnaires with both closed ended and open-ended questions were used as the main research instruments to solicit information and the data obtained was coded and subjected to analysis using both descriptive and inferential statistics. Out of sample of 238, 227 respondents filled in and submitted the questionnaires making a response rate of 95% respectively. It was observed that community involvement and sustainability of donor funded food security projects correlated positively and significantly (r=0.548, p=0.000); Institution capacity and sustainability of donor funded food security projects correlated positively and significantly (r=0.521, p=0.000) and roles of donors and sustainability of donor funded food security projects correlated positively (r=0.534, p=0.000). Finally, the study established that donors play a very important role in ensuring sustainability of donor funded food security projects.

‘The Going Out of the Voluntary and the Coming in of the Compulsory’: The Impact of the 1838 Irish Poor Law on Voluntary Charitable Societies in Dublin City

The introduction of the workhouse-centred Poor Law system into Ireland on the eve of the Great Famine transformed the provision of poor assistance in the country. Throughout various urban centres, the plethora of charitable societies that had been prominent in the provision of corporate assistance to the poor faced an increasingly uncertain future, fearing that the levying of compulsory poor rates would result in a withdrawal of support from subscribers and donors. This article analyses the impact of the Poor Law system on charitable societies in Dublin city, covering the fifteen-year period between the 1830 Select Committee on the State of the Poor in Ireland to the eve of the Great Famine in 1845. The article outlines how the establishment of the statutory Poor Law system resulted in confusion among the managers of existing welfare institutions and demonstrates that the opening of Poor Law Union workhouses greatly affected charitable societies’ pauper lists and income levels; yet the impact on the many charities that dotted Dublin’s crowded welfare landscape was not uniform.

Support optimization for additive manufacturing: application to FDM

Purpose This paper aims to present a new methodology to optimize the support generation within the fused deposition modeling process. Design/methodology/approach Different methods of support generation exist, but they are limited with regards to complex parts. This paper proposes a method dedicated to support generation, integrated into CAD software. The objective is to minimize the volume of support and its impact on a part’s surface finish. Two case studies illustrate the methodology. The support generation is based on an octree’s discretization of the part. Findings The method represents a first solid step in the support optimization for a reasonable calculation time. It has the advantage of being virtually automatic. The only tasks to be performed by the designer are to place the part to be studied with respect to the CAD reference and to give the ratio between the desired support volume and the maximum volume of support. Research limitations/implications In the case studies, a low gain in manufacturing time was observed. This is explained by the honeycomb structure of the support generated by a common slicing software, whereas the proposed method uses a “full” structure. It would be interesting to study the feasibility of an optimized support, with a honeycomb structure but with a preservation of the surface which is in contact with the part. Originality/value This solution best fits the needs of the designer and manufacturer already taking advantage of existing solutions. It is adaptable to any part if the withdrawal of support is taken into account. It also allows the designer to validate the generation of support throughout the CAD without breaking the digital chain.