End Of Life (Medical Law)

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End of Life Care in Patients With Heart Failure

End of Life Care in Patients With Heart Failure

Stage D heart failure (HF) is associated with poor prognosis, yet little consensus exists on the care of pa- tients with HF approaching the end of life. Treatment options for end-stage HF range from continuation of guideline-directed medical therapy to device interventions and cardiac transplantation. However, patients approaching the end of life may elect to forego therapies or procedures perceived as burdensome, or to deactivate devices that were implanted earlier in the disease course. Although discussing end-of-life issues such as advance directives, palliative care, or hospice can be difficult, such conversations are critical to understanding patient and family expectations and to developing mutually agreed-on goals of care. Because patients with HF are at risk for rapid clinical deterioration or sudden cardiac death, end-of-life issues should be discussed early in the course of management. As patients progress to advanced HF, the need for such discussions increases, especially among patients who have declined, failed, or been deemed to be ineligible for advanced HF therapies. Communication to define goals of care for the indi- vidual patient and then to design therapy concordant with these goals is fundamental to patient-centered care. The objectives of this white paper are to highlight key end-of-life considerations in patients with HF, to provide direction for clinicians on strategies for addressing end-of-life issues and providing optimal pa- tient care, and to draw attention to the need for more research focusing on end-of-life care for the HF pop- ulation. (J Cardiac Fail 2014;20:121 e 134)
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To study the end of life coastal boat using design sustainability method.

To study the end of life coastal boat using design sustainability method.

Eco Design is known as ecology or environmental based design method to emphasize the importance of green sustainability. It is also known by other names as Design for Environment (DFE), Green Design, Sustainable Design, Environment Concious Design, Life Cycle Design, Life Cycle Engineering and Clean Design have same goals and objective. It can be defined as approach that consider all the environmental impacts of a product right from the earliest stage of its design and throughout product development process by systematic way and encountered with other traditional approach such as function, safety, ergonomic, endurance, quality, and cost. This is stated in ISO 14062, that integrating environmental aspects into product development is able to minimize the total environmental impact in a life cycle perspective from raw material extraction, production, packaging, distribution, use, recovery and recycling
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Estimating life cycle cost for a product family design: The challenges - Ubaya Repository

Estimating life cycle cost for a product family design: The challenges - Ubaya Repository

Manufacturing companies are now under pressure to provide a variety of products in a shorter lead- time and in a cost effective way, without sacrificing product quality and environmental considerations, to be competitive in the market. Simpson (as cited in [1]) proposes that an effective means of fulfilling the requirements, to provide a variety of products in a cost effective way, is through a product family design. The implementation of a product family design is not only beneficial at the manufacturing and supply chain stages but also at the end of life stage. In general, a product family is defined as “a group of related products that is derived from a product platform to satisfy a variety of market niches” [2]. Derived from various definitions of a product platform as cited by Simpson et al., the groups of products are related because they share common functions, features, components, technologies, processes, knowledge, people and/or relationships, which form a product platform [2].
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Manajemen | Fakultas Ekonomi Universitas Maritim Raja Ali Haji 191.full

Manajemen | Fakultas Ekonomi Universitas Maritim Raja Ali Haji 191.full

As discussed in Section IV, the magnitude of the difference in end-of-life transfers received by caregiving and noncaregiving siblings is of interest as a measure of the extent to which bequests compensate children for the large transfers of time they make to their elderly parents. It also provides an indication of how likely care- motivated end-of-life transfers are to exert meaningful influence on the eldercare sup- plied by families. In order to determine the difference in transfer dollars designated for caregiving and noncaregiving children of the same parent, I estimate a fixed- effects specification of the division of intended bequests and life insurance. This approach requires that the sample be narrowed to families in which parents have wills or life-insurance policies that treat their children differently. As reflected in Table 2, 252 unmarried parents with ongoing care needs, with a combined total of 1,002 chil- dren, report demographic information on two or more children and divide their end-of-life transfers unequally; 257 unmarried parents with multiple children and no current care needs, who combined have 924 children, meet the data requirements and divide end-of-life transfers unequally. I use data on these two family groups to esti- mate fixed-effect models of the estate-division choices of parents with and without care requirements.
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Last Will And Testament Considerations

Last Will And Testament Considerations

Title: Last Will And Testament Considerations Word Count: 251 Summary: Interest in a Last Will and Testament and other end of life planning documents skyrocketed during the coverage o[r]

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PENDAHULUAN  Analisis Cradle-To-Grave Produk Batik Cabut (Studi Kasus: Griya Batik Gress Tenan Laweyan).

PENDAHULUAN Analisis Cradle-To-Grave Produk Batik Cabut (Studi Kasus: Griya Batik Gress Tenan Laweyan).

dan ekosistem dari lingkungan hidup. Pada tahun 2015 Indonesia juga akan menghadapi MEA (Masyarakat Ekonomi ASEAN), dimana nantinya produk dari negara-negara anggota ASEAN bebas masuk ke Indonesia begitupun juga dengan produk dari Indonesia juga bebas masuk ke negara-negara anggota ASEAN, hal tersebut menyebabkan para produsen batik harus bisa bersaing dengan produk negara-negara anggota ASEAN tersebut, untuk bisa bersaing dengan produk dari luar negeri selain dinilai dari sisi kualitas, kesejahteraan pekerja, produk batik juga harus ramah lingkungan, tentu saja produk dikatakan ramah linkungan salah satunya adalah produk yang telah diberi sertifikat ecolable, secara sederhana produk batik yang telah dilabeli ecolable akan memiliki permintaan yang lebih tinggi dipasar Indonesia dan pasar internasional daripada produk tanpa ecolable. Dilihat dari proses siklus hidupnya yang berpotensi menimbulkan dampak pada lingkungan, maka perlu dilakukan penelitian cradle-to-grave (mulai dari material hingga end of life produk) batik cabut yang diproduksi oleh Griya Batik Gress Tenan agar dapat diketahui seberapa besar indeks dampak kerusakan lingkungan yang disebabkan produk batik cabut, sehingga setelah penilaian tersebut dilakukan, produsen dapat melakukan perbaikan pada prosesnya agar dapat mengurangi dampak kerusakan lingkungan.
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Suteja 2017 IOP Conf. Ser.  Mater. Sci. Eng. 273 012026

Suteja 2017 IOP Conf. Ser. Mater. Sci. Eng. 273 012026

Manufacturing companies are now under pressure to provide a variety of products in a shorter lead- time and in a cost effective way, without sacrificing product quality and environmental considerations, to be competitive in the market. Simpson (as cited in [1]) proposes that an effective means of fulfilling the requirements, to provide a variety of products in a cost effective way, is through a product family design. The implementation of a product family design is not only beneficial at the manufacturing and supply chain stages but also at the end of life stage. In general, a product family is defined as “a group of related products that is derived from a product platform to satisfy a variety of market niches” [2]. Derived from various definitions of a product platform as cited by Simpson et al., the groups of products are related because they share common functions, features, components, technologies, processes, knowledge, people and/or relationships, which form a product platform [2].
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T1 462009019 Daftar Pustaka

T1 462009019 Daftar Pustaka

Ishii, Y., Miyashita, M., Sato, K., & T.Ozawa. (2012). Family Difficult Scale in End of Life home Care: A New Measure of the Family's DIfficulties in Caring for Patients with cancer at the End of LIfe at Home from Bereaved Family's Perspective. Journal of Palliative Medicine Vol 15 no 2 . Jacono, B. J. (1993). Caring is loving. Journal of advanced nursing , 192-194.

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Effect of Treadmill Exercise Using 80% Intensity of Six Minute Walk Test on Walking Distance and Quality of Life in Moderate Stage Chronic Obstructive Pulmonary Disease Patients | Arisanti | Majalah Kedokteran Bandung 764 2917 1 PB

Effect of Treadmill Exercise Using 80% Intensity of Six Minute Walk Test on Walking Distance and Quality of Life in Moderate Stage Chronic Obstructive Pulmonary Disease Patients | Arisanti | Majalah Kedokteran Bandung 764 2917 1 PB

Skeletal muscle dysfunction poses as one of the systemic manifestation of chronic obstructive pulmonary disease (COPD) in the impact of inactivity and deconditioning from early fatigue to the end of declining quality of life (QoL). Giving pulmonary rehabilitation program of treadmill exercise will overcome the problem, but standard method for moderate stage of COPD is not yet available. This study aimed to evaluate the effect of treadmill exercise using 80% intensity of six minute walk test on walking distance and QoL in moderate stage COPD in order to overcome muscle dysfunction. Samples were taken from Physical Medicine and Rehabilitation and Respirology subdivision of Internal Medicine outpatient clinic of Dr. Hasan Sadikin General Hospital Bandung, from March 2012–April 2013. Data analysis was tested using t-test for comparison of two independent mean data. Otherwise, non parametric test of Mann Whitney and Wilcoxon Match Pair test. Thirty three subjects of moderate stage COPD were divided into 2 groups (intervention and control). Intervention group received treadmill exercise with 80% intensity from preliminary 6MWT for 30–60 minutes/session, 3 session/week for 6 weeks. Significant increase on walking distance was found in intervention group (70.66 m) compared to control group (7.43 m) after 6 weeks (p≤0.05). QoL using St. George Respiratory Questionnaire (SGRQ) showed significant decrease in intervention group for all components in the end of 6 weeks (total p=0.0038, symptoms p=0.0162, activities p=0.0043 and impact p=0.0057, p≤0.05). Eighty percent intensity of 6MWT in treadmill exercise for 6 weeks was well tolerated and could overcome skeletal muscle dysfunction in moderate stage COPD. It also revealed higher values in aerobic capacity and QoL compared to previous studies. In conclusion, treadmill exercise using 80% intensity of 6MWT provides further walking distance and higher QoL compared to control in moderate stage COPD. [MKB. 2016;48(2):105–11] Key words: Moderate stage COPD, quality of life, treadmill exercise, 6MWD
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Quality of Live of People with Mental Illness.

Quality of Live of People with Mental Illness.

There are two approach in measuring quality of life including subjective or objective orientation. A subjective orientation may emphasise the importance of „being‟ . This mean that the quality of life is determine by the experience of current happiness or pleasure, or self-fulfilment, and realisation or actualization. While a subjective approach asking individual to rate how satisfied them with their lives. An objective approach emphasis on meeting needs such as have sufficient income for food, satisfactory living conditions, well educated, have access to resources. A good quality of life is characterized by Feelings of wellbeing, control and autonomy, a positive self- perception, a sense of belonging, participation in enjoyable and meaningful activity, and a positive view of the future. In contrast, a poor quality of life is associated with Feelings of distress, lack of control over symptoms and life in general, a negative perception of self, stigmatization and rejection, diminished activity and difficulties with day to day functioning, and a negative outlook. (Connell, J., et al, 2012)
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End-to-End Coconut Harvesting Robot

End-to-End Coconut Harvesting Robot

Selection is an essential part of the natural evolution process and hence is an essential part of GA. The most com- monly known selection element is roulette-wheel selection. In roulette-wheel method, the candidate individuals are given a slice of the wheel proportional to their assigned probabilities obtained by scaling. Then the wheel is rotated N times where N is the number of individuals or parents needed for repro- duction. Thus, the best individuals have a higher probability of being chosen. However, undesired solutions also have a small chance of survival. More computation time effective way to select individuals from the wheel is to create one random number and from that point continue in increments of equal size (1/N). Another alternative for selection is tournament in which chromosomes are selected randomly and the best is chosen among the them. This procedure is again repeated N times. There can also be variations of this tournament where the best string does not always win but wins with a chance of certain threshold.
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ASM SNTTM VIII UNDIP 2009

ASM SNTTM VIII UNDIP 2009

Tool wear was measured using a Nikon tool makers’ microscope with γ0x magnification. The measurements of tool wear according to ISO 8688-2 were carried out for each cutting edge at initial cut and continuously after a particular length of cut (depend on wear progressive of each tool) until the end of tool life was achieved.

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Gauntlgrym Story Free download Free download ebook

Gauntlgrym Story Free download Free download ebook

The warlord shook himself from his wistful contemplation and moved his gaze to the Neverwinter River and the three ornate bridges crossing it. All were beautiful—the tradesmen of Neverwinter took great pride in their work —but one in particular, built with ornamental wings spread wide to either side, caught and held Alegni’s attention. Truly, of the three bridges connecting the halves of the city, north and south, it was the most impressive, for it was carved into the likeness of a wyvern taking wing, great and graceful. For many decades, the bridge had held strong and solid, its substructure supported by a metal grid forged by dwarves and continually reinforced. From a distance, it was beautiful to behold, and that feeling only grew on closer inspection. The bridge had been crafted to perfection in every facet—except for its name: the Winged Wyvern Bridge.
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Index of /papers/Finance Which One s for You

Index of /papers/Finance Which One s for You

There are mainly two types of life insurance, which is term life insurance and permanent life insurance Keywords: life insurance Article Body: What are the different types of life ins[r]

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AGAINST DOCTOR'S ORDERS BY RADCLYFFE

AGAINST DOCTOR'S ORDERS BY RADCLYFFE

And I don't get the whining about the ending... it wrapped up quickly but genuinely and not so perfect it was silly. Sometimes we only *think* we know what our dreams are or what's important until we come face to face with better options-- ones that truly fulfill us (as opposed to ones that fulfill our parents or mimic what they are). I didn't need an epilogue to clarify that or to find out what happened next. I wouldn't give her any awards for originality, but you could tell she breathed life into every scene. I got plenty of love left for Radclyffe when her work feels like this one.
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Perbandingan Teknik Steganografi Dengan Metode First-Of-File, End-Of-File Dan Kombinasi First-Of-File Dan End-Of-File Pada File Bitmap

Perbandingan Teknik Steganografi Dengan Metode First-Of-File, End-Of-File Dan Kombinasi First-Of-File Dan End-Of-File Pada File Bitmap

Berdasarkan tabel 4.7 terlihat bahwa semakin besar ukuran citra digital maka semakin besar waktu yang dibutuhkan untuk melakukan proses embedding. Pada penelitian ini, dari segi waktu eksekusi pelaksanaan proses embedding yang memiliki waktu paling cepat adalah metode kombinasi First-of-File dan End-of-File dan waktu paling lama adalah metode End-of-File. Hal yang sama juga terlihat pada proses extraction bahwa semakin besar ukuran citra digital maka waktu yang dibutuhkan untuk pengambilan pesan rahasia dalam stego image semakin besar. Dari segi waktu eksekusi pelaksanaan proses extraction yang memiliki waktu paling cepat adalah metode End-of-File dan waktu paling lama adalah metode First-of-File. Rata-rata nilai MSE dari semua ukuran citra digital adalah nol. Artinya tidak terjadi perubahan pixel saat proses pengambilan pesan rahasia.
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Influence of preload and afterload on st (1)

Influence of preload and afterload on st (1)

The FIESTA and PVC MR imaging sequences for the assessment of ventricular func- tion, flows and wall excursion, pulmonary and aortic flow were transferred to a work- station (Advantage Windows 4.1 GE) and elaborated by means of a commercially available software (Mass plus and CV Flow respectively, MR Analytical Software Sys- tems, version 4.0, Leiden, The Netherlands). Brie fl y, endocardial and epicardial con- tours were automatically traced in all the cine short axis images of all temporal phases. Manual correction of contours was performed when appropriate. The volumet- ric data of left and right ventricles were plotted against the time (in ms) in a volumet- ric time curve (Figs. 1 and 2) for left ventricle only. From these curves the end-diastolic
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BREATHTAKING Design Strategy 2008.08.04 ARNELL GROUP

BREATHTAKING Design Strategy 2008.08.04 ARNELL GROUP

Artists and architects have proportioned their works to approximate the Golden Ratio, especially in the form of the Golden Rectangle, in which the ratio of the longer side to the shorter is the Golden Ratio. They believe this proportion to be universally and aesthetically pleasing. The Golden Ratio plays an essential role in human perception of beauty.

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An Analysis of Moral in Jhon Ronald Reuel Tolkien’ Novel the Lord of the Rings

An Analysis of Moral in Jhon Ronald Reuel Tolkien’ Novel the Lord of the Rings

Aragorn looked at them, and there was pity in his eyes rather than wrath; for these were young men from Rohan, from Westfold far away, or husbandmen from Lossarnach, and to them Mordor had been from childhood a name of evil, and yet unreal, a legend that had no part in their simple life; and now they walked like men in a hideous dream made true, and they understood not this war nor why fate should lead them to such a pass. ‘Go!’ said Aragorn. ‘But keep what honour you may, and do not run! And there is a task which you may attempt and so be not wholly shamed. Then some being shamed by his mercy overcame their fear and went on, and the others took new hope.
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