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Paramedics Providing Palliative Care at Home was launched in two provinces, including a new clinical practice guideline, database, and paramedic training. The aim of this study was to evaluate patient/family satisfaction and paramedic comfort and confidence.
In Part A, we gathered perspectives of patients/families via surveys mailed at enrolment and telephone interviews after an encounter. Responses were reported descriptively and by thematic analysis. In Part B, we surveyed paramedics online pre- and 18 months post-launch. Comfort and confidence were scored on a 4-point Likert scale, and attitudes on a 7-point Likert scale, reported as the median (interquartile range [IQR]); analysis with Wilcoxon ranked sum/thematic analysis of free text.
In Part A, 67/255 (30%) enrolment surveys were returned. Three themes emerged: fulfilling wishes, peace of mind, and feeling prepared for emergencies. In 18 post-encounter interviews, four themes emerged: 24/7 availability, paramedic professionalism and compassion, symptom relief, and a plea for program continuation. Thematic saturation was reached with little divergence. In Part B, 235/1255 (18.9%) pre- and 267 (21.3%) post-surveys were completed. Comfort with providing palliative care without transport improved post launch (p = < 0.001) as did confidence in palliative care without transport (p = < 0.001). Respondents strongly agreed that all paramedics should be able to provide basic palliative care.
After implementation of the multifaceted Paramedics Providing Palliative Care at Home Program, paramedics describe palliative care as important and rewarding. The program resulted in high patient/family satisfaction; simply registering provides peace of mind. After an encounter, families particularly noted the compassion and professionalism of the paramedics.
4H-SiC was selectively etched in a Reactive Ion Etch (RIE) system using a nickel mask. The power, pressure, and electrode spacing were varied within a RF generated SF6:O2 (1:2) plasma. Peak etch rates of up to 2600 Aring;/min. were obtained at a pressure of 350 mT, power of 90 W (2 W/cm2), and electrode spacing of 3.180 cm. Etches were all residue-free, although power levels above 60 W (1.36 W/cm2) resulted in the SiC surface being roughened, which limited smooth surface etch capability to 2000 Aring;/min. When comparing electrode spacing from 3.180 cm to 1.270 cm, the 3.180 cm spacing was found to have the highest etch rate at pressures ranging from 250 mT to 500 mT.
The synthesis of aluminum nitride thin films by pulsed-laser ablation is demonstrated. The films were formed on single-crystal sapphire and graphite substrates. A number of techniques were used to characterize the films: transmission and scanning electron microscopy, Rutherford backscattering spectrometry and x-ray diffraction.
Thin, calcium magnesium silicate glass films have been deposited onto (001)
-oriented single-crystal MgO substrates by pulsed-laser deposition (PLD).
The substrates were thinned to electron transparency and characterized in
the transmission electron Microscope (TEM) before and after the deposition
and following different heat treatments. Energy Dispersive X-ray
Spectroscopy (EDS) was used in the TEM to characterize the chemistry of the
films. The heat treatments were performed both in situ and ex situ. Direct
evidence for crystallization was obtained by in-situ experiments at 950°C.
Subsequent heat treatments were performed for longer times in air between
950°C and 1100°C. The crystallized phase was found to be Monticellite
(CaMgSiO4) and the crystallites show moderate epitaxy with the
underlying substrate. Films contaminated with aluminum resulted in the
growth of magnesium aluminate spinel (MgAl2O4)
epitaxially from the substrate. These observations of epitaxy indicated that
crystallization initiated at the surface of MgO.
Anorthite-glass films have been grown by pulsed-laser deposition on
single-crystal α-Al2O3 substrates which were
pre-thinned to electron transparency. The glass films were crystallized in
the transmission electron Microscope (TEM), which allowed direct observation
and video-recording of the crystallization process. Crystallization of these
films in the TEM resulted in the formation of hexagonal and orthorhombic
anorthite. The orthorhombic phase was the predominant product of glass films
grown at elevated substrate temperatures and displayed strong epitaxy with
the underlying substrate. In contrast, the hexagonal phase was the major
constituent of films grown at ambient substrate temperature and displayed no
clear epitaxy with the substrate. The differences in degree of epitaxy and
phase structure may be evidence of ordering at the original glass/oxide
This paper presents an advanced design and fabrication concept for a solid oxide fuel cell (SOFC). The concept is based on a laminate repeat unit comprised of a thin electrolyte, cermet anode, metallic gas flow fields, and a metallic bipolar plate. The laminate is sintered in a singlestep process in a controlled atmosphere, and the cathode is applied and sintered in situ during the initial heating of the cell (or stack). Observations about the types of cracks that formed in the electrolyte during the sintering process guided the development of the sintering protocol to yield the desired product. Cells with power densities exceeding 250 mW/cm2 have been tested.
Presacral neurectomy is useful in the treatment of severe, disabling dysmenorrhea secondary to endometriosis and pelvic pain associated with pelvic inflammatory disease. The efficacy of presacral neurectomy for the relief of midline dysmenorrhea was confirmed by a randomized study performed at the Johns Hopkins University School of Medicine. Tjaden used the surgical technique first described in 1899 by Jaboulay and Ruggi. Black estimated a 75% to 80% success in 9937 cases of presacral neurectomy. Laparoscopic techniques for presacral neurectomy have been described by Perez, Biggerstaff, Carter, Chen, and Nezhat. Kwok reviewed laparoscopic presacral neurectomy and concluded that patients for whom this operation is recommended should be carefully selected. They should have midline dysmenorrhea as the main symptom and should have failed or not tolerated medical therapy. Presacral neurectomy has been shown to have long-run effectiveness for the treatment of severe dysmenorrhea due to endometriosis. As has been pointed out by Stones and Jacobson, a percentage of women with chronic pelvic pain and/or dysmenorrhea do not respond or respond poorly to medical treatment. Surgery may represent the final therapeutic option for these patients. In a prospective double-blind randomized, controlled study, Zullo et al. demonstrated the effectiveness of presacral neurectomy for women with severe dysmenorrhea due to endometriosis who had been treated with conservative laparoscopic surgical intervention.
Retropubic Burch colposuspension has been considered by many to be the “gold standard” procedure for the treatment of female stress urinary incontinence for almost 40 years. Vancaillie and Schuessler introduced the laparoscopic approach to retropubic colposuspension in 1991. Numerous reports followed in subsequent years describing laparoscopic colposuspensions and their efficacy. Analysis of the outcomes of these various laparoscopic “Burch” colposuspensions is difficult because many of the techniques are not true Burch procedures but rather other modified retropubic colposuspensions. In this section, we describe the laparoscopic Burch colposuspension, including patient selection, preoperative evaluation, operative technique, possible complications, and efficacy. We review the efficacy of the laparoscopic Burch colposuspension studies that use the Burch—Tanagho procedure and compare these techniques to other popular anti-incontinence procedures. The many modified laparoscopic retropubic procedures are not addressed.
BURCH COLPOSUSPENSION: THE EVOLUTION OF A PROCEDURE
In 1961, Burch published the description of a new female anti-incontinence procedure, based on a technique started in 1958. The technique involved entering the space of Retzius via a paramedian incision. After clearing the periurethral tissue of its overlying fat and areolar tissue, three 2-0 chromic sutures were placed at the mid-urethra and the bladder neck and then fixed to Cooper's ligament. Burch reported a subjective cure rate of 92% in 143 patients with 10 to 60 months of followup.
Let p be a prime number and let k be a field of characteristic not equal to p. Assuming k contains the appropriate roots of unity, we characterise the non-cyclic Galois extensions of k of degree p3. Concrete examples of such extensions are given for each possible case which can occur, up to isomorphism.