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In today's world where people are increasingly lonely, the need to support people going through difficult and troublesome processes via professional means has emerged. Especially in situations when death or an illness is faced, people may experience various psychological, social and spiritual problems. When the individual cannot cope with the happening he/she experiences, a psycho-social crisis is experienced. Psycho-social crisis refers to the deterioration of the spiritual harmony of the person. The struggle of individuals to regain their balance in the face of these unexpected events is called the psycho-social adjustment process. Patients need to receive support from psychological, social and spiritual resources in their struggle to reach a state of balance while their physical treatment is being carried out. As a requirement for holistic care, there are various service branches that take part in meeting the psychological, social and spiritual support that patients need during the treatment process, providing morale and motivation. One of these service areas is the application of moral support. Spiritual support service, which is a new field of application in Turkey, aims to accompany patients with religious/spiritual references in various problems experienced during the disease process. The psycho-social reactions of the patients to their illness can be grouped under three main headings. Factors affecting the adaptation of patients to their illness are classified as; factors related to the patient's illness, personal characteristics and environmental factors. Within the scope of this study, individual and illness-related factors affecting the adaptation processes of patients were examined. Therefore, the findings are presented under two main headings as individual factors and illness-related factors. In this study, the psycho-social adaptation processes of the patients to the illness were examined in the context of individual and illness-related factors, and the role and effect of the moral support service in the adaptation processes of the patients were tried to be revealed. The research consists of two parts: theoretical and field research. In the first chapter, general information about religion, spirituality and spiritual support services in hospitals is given, and the concept of psycho-social harmony is explained and its relationship with spirituality is emphasized. In the second part, a field research was conducted with 24 moral support specialists working in hospitals in Ankara, Adana, Antalya, Bursa, Eskişehir, Istanbul, and it was tried to determine to what extent the moral support service has an effect on the adaptation processes of the patients. The findings are summarized in the conclusion section., İnsanların giderek yalnızlaştığı günümüzde zor ve sıkıntılı süreçlerden geçerken, duyulan desteğin profesyonel yollarla sağlanması ihtiyacı hasıl olmuştur. Özellikle hastalık gibi ölümle yüz yüze gelinen bir süreçte kişiler; psikolojik, sosyal ve manevi olarak çeşitli problemler yaşayabilmektedirler. Birey, yaşadığı olumsuz durumun üstesinden gelemediği zaman psiko-sosyal kriz hali yaşamaktadır. Psiko-sosyal kriz, kişideki ruhsal ahengin bozulması durumunu ifade etmektedir. Bireylerin bu beklenmedik olaylar karşısında yeniden denge sağlama mücadelesine psiko-sosyal uyum süreci denilmektedir. Hastalar, yeniden denge haline ulaşmak için verdikleri mücadelede fiziksel tedavileri gerçekleşirken psikolojik, sosyal ve manevi kaynaklardan destek alma ihtiyacı duymaktadırlar. Bütüncül bakımın bir gereği olarak hastaların tedavisi sürecinde ihtiyaç duyduğu psikolojik, sosyal ve manevi desteğin karşılanmasında moral ve motivasyon sağlanmasında görev alan çeşitli hizmet kolları bulunmaktadır. Bu hizmet alanlarından biri de manevi destek uygulamasıdır. Ülkemizde henüz yeni bir uygulama sahası olan manevi destek hizmeti, hastalık sürecinde yaşanan çeşitli problemlerde dini/manevi referanslarla hastalara eşlik etmeyi amaçlamaktadır. Hastaların, hastalık süreci esnasında gösterdikleri psiko-sosyal tepkiler üç ana başlıkta toplanabilmektedir. Bireylerin hastalıklarına uyumunu etkileyen faktörler; hastalığa bağlı olan faktörler, kişisel özellikleri ve çevreyle ilgili faktörler olarak tasnif edilmektedir. Bu araştırma kapsamında hastaların uyum süreçlerine etki eden bireysel ve hastalık kaynaklı etkenler incelenmiştir. Bundan dolayı bulgular bireysel etkenler, hastalıkla ilgili etkenler olarak iki ana başlık altında sunulmuştur. Bu çalışmada bireysel ve hastalık kaynaklı faktörler bağlamında hastaların süreçteki psiko-sosyal uyumları incelenmiş olup hastaların uyum dönemlerinde manevi destek hizmetinin rolü ve etkisi ortaya konulmaya çalışılmıştır. Araştırma, teorik ve alan araştırması olmak üzere iki bölümden oluşmaktadır. Birinci bölümde din, maneviyat ve hastanelerdeki manevi destek hizmeti hakkında genel bilgiler verilmiş olup psiko-sosyal uyum kavramı açıklanarak maneviyatla ilişkisi üzerinde durulmuştur. İkinci bölümde mülakat tekniği kullanılarak Ankara, Adana, Antalya, Bursa, Eskişehir, İstanbul illerindeki hastanelerde görev yapan 24 manevi destek uzmanıyla görüşülerek alan araştırması yapılmıştır. Manevi destek hizmetinin hastaların sürece uyumlarına ne ölçüde etkisi olduğu tespit edilmeye çalışılmıştır. Sonuç bölümünde ise elde edilen bulgular özetlenmiştir.

Background Missing data are common in end-of-life care studies, but there is still relatively little exploration of which is the best method to deal with them, and, in particular, if the missing at random (MAR) assumption is valid or missing not at random (MNAR) mechanisms should be assumed. In this paper we investigated this issue through a sensitivity analysis within the ACTION study, a multicenter cluster randomized controlled trial testing advance care planning in patients with advanced lung or colorectal cancer. Methods Multiple imputation procedures under MAR and MNAR assumptions were implemented. Possible violation of the MAR assumption was addressed with reference to variables measuring quality of life and symptoms. The MNAR model assumed that patients with worse health were more likely to have missing questionnaires, making a distinction between single missing items, which were assumed to satisfy the MAR assumption, and missing values due to completely missing questionnaire for which a MNAR mechanism was hypothesized. We explored the sensitivity to possible departures from MAR on gender differences between key indicators and on simple correlations. Results Up to 39% of follow-up data were missing. Results under MAR reflected that missingness was related to poorer health status. Correlations between variables, although very small, changed according to the imputation method, as well as the differences in scores by gender, indicating a certain sensitivity of the results to the violation of the MAR assumption. Conclusions The findings confirmed the importance of undertaking this kind of analysis in end-of-life care studies.

Understanding the locus of fluid flow along thrust and splay faults is important to understand the hydraulic properties of accretionary systems and fault mechanics. Here, we use rock magnetic techniques in combination with backscattered electron imaging to depict the locus of enhanced magnetic mineral alteration within the Pāpaku fault, an active splay fault of the subduction interface at the northern Hikurangi Margin. The Pāpaku fault was cored at Site U1518 during Expedition 375 of the International Ocean Discovery Program and we report room temperature magnetic parameters, complemented by first-order reversal and thermomagnetic curves in the depth interval 250–400 m below seafloor (mbsf). The ∼60-m wide Pāpaku fault zone comprises two main slip zones, referred to as the upper main brittle (304–321 mbsf) and lower subsidiary (351–361 mbsf) fault zones, and an intervening zoned, termed the lower ductile deformation zone. Two narrow zones, at the top of the main brittle fault zone, and one in a sand-rich interval above the subsidiary fault zone, experienced enhanced magnetic mineral diagenesis, which resulted in the recrystallization of ferrimagnetic greigite to paramagnetic pyrite. We propose that secondary magnetic mineral diagenesis was driven by anaerobic methane oxidation within these intervals, which occurs in the presence of methane and sulfate. We relate the observed changes to the fault parallel transport of fluids which is restricted to two damage zones. Overlying compacted and clay-rich sediments likely act as a barrier to upward advective flow through the fault zone and into the hanging wall.

PURPOSE: Writing an Advance Directive (AD) is often seen as a part of Advance Care Planning (ACP). ADs may include specific preferences regarding future care and treatment and information that provides a context for healthcare professionals and relatives in case they have to make decisions for the patient. The aim of this study was to get insight into the content of ADs as completed by patients with advanced cancer who participated in ACP conversations. METHODS: A mixed methods study involving content analysis and descriptive statistics was used to describe the content of completed My Preferences forms, an AD used in the intervention arm of the ACTION trial, testing the effectiveness of the ACTION Respecting Choices ACP intervention. RESULTS: In total, 33% of 442 patients who received the ACTION RC ACP intervention completed a My Preferences form. Document completion varied per country: 10.4% (United Kingdom), 20.6% (Denmark), 29.2% (Belgium), 41.7% (the Netherlands), 61.3% (Italy) and 63.9% (Slovenia). Content analysis showed that 'maintaining normal life' and 'experiencing meaningful relationships' were important for patients to live well. Fears and worries mainly concerned disease progression, pain or becoming dependent. Patients hoped for prolongation of life and to be looked after by healthcare professionals. Most patients preferred to be resuscitated and 44% of the patients expressed maximizing comfort as their goal of future care. Most patients preferred 'home' as final place of care. CONCLUSIONS: My Preferences forms provide some insights into patients' perspectives and preferences. However, understanding the reasoning behind preferences requires conversations with patients.

JW Hoefnagels,1 MC Kars,2 K Fischer,1 REG Schutgens,1 LH Schrijvers1,3 1Van Creveldkliniek, University Medical Center Utrecht, Utrecht, the Netherlands; 2Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; 3Institute of Nursing Studies, University of Applied Sciences, Utrecht, the NetherlandsCorrespondence: JW HoefnagelsVan Creveldkliniek, Division Internal Medicine and Dermatology, University Medical Center Utrecht, Room C01.409, PO Box 85500, Utrecht 3508, GA, the NetherlandsTel +31 88 75 584 50Fax +31 88755438Email j.w.hoefnagels@umcutrecht.nlPurpose: Adolescents and young adults (AYAs) with severe hemophilia use prophylaxis that requires a high level of adherence. The present study aimed to explore the underlying reason for adherence and non-adherence to prophylaxis in hemophilia from the perspective of AYAs.Patients and Methods: A qualitative study in Dutch AYAs with hemophilia (14– 25 years) using prophylaxis was executed. Focus group interviews and individual interviews were recorded, transcribed, coded and analyzed using an iterative process. Member checking in three respondents was used to validate the potential model.Results: A total of 21 interviews were performed. Parental support decreased when AYAs gained more treatment responsibilities, which resulted in a higher risk for non-adherence. AYAs were weighing their potential bleeding risk per activity based on the wish to do what they prefer while also wanting to simultaneously feel safe. When bleeding with low impact on their daily life occurred, or when bleeding remained absent, AYAs felt safe and the perceived need for prophylaxis decreased.Conclusion: The level of treatment responsibility per AYA and estimated risks per activity were the two main underlying reasons for (non-)adherence.Clinical implications: We suggest using a conversation technique to discuss adherence, especially during bleeding assessment visits.Keywords: hemophilia, compliance, qualitative study, barrier, facilitator, self-management

International Ocean Discovery Program (IODP) Expedition 385 drilled organic-rich sediments with sill intrusions on the flanking regions and in the northern axial graben in Guaymas Basin, a young marginal rift basin in the Gulf of California. Guaymas Basin is characterized by a widely distributed, intense heat flow and widespread off-axis magmatism expressed by a dense network of sill intrusions across the flanking regions, which is in contrast to classical mid-ocean ridge spreading centers. The numerous off-axis sills provide multiple transient heat sources that mobilize buried sedimentary carbon, in part as methane and other hydrocarbons, and drive hydrothermal circulation. The resulting thermal and geochemical gradients shape abundance, composition, and activity of the deep subsurface biosphere of the basin. Drill sites extend over the flanking regions of Guaymas Basin, covering a distance of ~81 km from the from the northwest to the southeast. Adjacent Sites U1545 and U1546 recovered the oldest and thickest sediment successions (to ~540 meters below seafloor [mbsf]; equivalent to the core depth below seafloor, Method A [CSF-A] scale), one with a thin sill (a few meters in thickness) near the drilled bottom (Site U1545), and one with a massive, deeply buried sill (~356–430 mbsf) that chemically and physically affects the surrounding sediments (Site U1546). Sites U1547 and U1548, located in the central part of the northern Guaymas Basin segment, were drilled to investigate a 600 m wide circular mound (bathymetric high) and its periphery. The dome-like structure is outlined by a ring of active vent sites called Ringvent. It is underlain by a remarkably thick sill at shallow depth (Site U1547). Hydrothermal gradients steepen at the Ringvent periphery (Holes U1548A–U1548C), which in turn shifts the zones of authigenic carbonate precipitation and of highest microbial cell abundance toward shallower depths. The Ringvent sill was drilled several times and yielded remarkably diverse igneous rock textures, sediment–sill interfaces, and hydrothermal alteration, reflected by various secondary minerals in veins and vesicles. Thus, the Ringvent sill became the target of an integrated sampling and interdisciplinary research effort that included geological, geochemical, and microbiological specialties. The thermal, lithologic, geochemical, and microbiological contrasts between the two deep northwestern sites (U1545 and U1546) and the Ringvent sites (U1547 and U1548) form the scientific centerpiece of the expedition. These observations are supplemented by results from sites that represent attenuated cold seepage conditions in the central basin (Site U1549), complex and disturbed sediments overlying sills in the northern axial trough (Site U1550), terrigenous sedimentation events on the southeastern flanking regions (Site U1551), and hydrate occurrence in shallow sediments proximal to the Sonora margin (Site U1552). The scientific outcomes of Expedition 385 will (1) revise long-held assumptions about the role of sill emplacement in subsurface carbon mobilization versus carbon retention, (2) comprehensively examine the subsurface biosphere of Guaymas Basin and its responses and adaptations to hydrothermal conditions, (3) redefine hydrothermal controls of authigenic mineral formation in sediments, and (4) yield new insights into many geochemical and geophysical aspects of both architecture and sill–sediment interaction in a nascent spreading center. The generally high quality and high degree of completeness of the shipboard datasets present opportunities for interdisciplinary and multidisciplinary collaborations during shore-based studies. In comparison to Deep Sea Drilling Project Leg 64 to Guaymas Basin in 1979, sophisticated drilling strategies (for example, the advanced piston corer [APC] and half-length APC systems) and numerous analytical innovations have greatly improved sample recovery and scientific yield, particularly in the areas of organic geochemistry and microbiology. For example, microbial genomics did not exist 40 y ago. However, these technical refinements do not change the fact that Expedition 385 will in many respects build on the foundations laid by Leg 64 for understanding Guaymas Basin, regardless of whether adjustments are required in the near future.

Background In oncology, Health Care Professionals often experience conducting Advance Care Planning (ACP) conversations as difficult and are hesitant to start them. A structured approach could help to overcome this. In the ACTION trial, a Phase III multi-center cluster-randomized clinical trial in six European countries (Belgium, Denmark, Italy, the Netherlands, Slovenia, United Kingdom), patients with advanced lung or colorectal cancer are invited to have one or two structured ACP conversations with a trained facilitator. It is unclear how trained facilitators experience conducting structured ACP conversations. This study aims to understand how facilitators experience delivering the ACTION Respecting Choices (RC) ACP conversation. Methods A qualitative study involving focus groups with RC facilitators. Focus group interviews were recorded, transcribed, anonymized, translated into English, and thematically analysed, supported by NVivo 11. The international research team was involved in data analysis from initial coding and discussion towards final themes. Results Seven focus groups were conducted, involving 28 of in total 39 trained facilitators, with different professional backgrounds from all participating countries. Alongside some cultural differences, six themes were identified. These reflect that most facilitators welcomed the opportunity to participate in the ACTION trial, seeing it as a means of learning new skills in an important area. The RC script was seen as supportive to ask questions, including those perceived as difficult to ask, but was also experienced as a barrier to a spontaneous conversation. Facilitators noticed that most patients were positive about their ACTION RC ACP conversation, which had prompted them to become aware of their wishes and to share these with others. The facilitators observed that it took patients substantial effort to have these conversations. In response, facilitators took responsibility for enabling patients to experience a conversation from which they could benefit. Facilitators emphasized the need for training, support and advanced communication skills to be able to work with the script. Conclusions Facilitators experienced benefits and challenges in conducting scripted ACP conversations. They mentioned the importance of being skilled and experienced in carrying out ACP conversations in order to be able to explore the patients’ preferences while staying attuned to patients’ needs. Trial registration International Standard Randomised Controlled Trial Number registry 63110516 (ISRCTN63110516) per 10/3/2014.

International audience; Single crystals of Ge-doped TiS2 polytypes, 1T, (4H)2, 12R, and their corresponding new a√3 × a√3 superstructure were grown by chemical vapor transport method. The crystals were characterized by combining X-ray diffraction and transmission electron microscopy techniques. The structures of these polytypes are all based on close packing layers of sulfur of CdI2-type structure. Except in the 1T polytype, the germanium atoms are observed to be equally distributed over both partial and complete occupancy layers. A significant distortion of the metal–sulfur distances is observed in the superstructure polytypes, as a consequence of metal–metal corrugated layers. The 12R-a√3 × a√3 superstructure is revealed by both electron diffraction and X-ray diffraction by the presence of satellite reflections. Electron diffraction patterns from the 12R polytype show highly structured diffuse scattering surrounding the main spots. These diffuse segments, which are arranged in triangles sharing vertices, correspond to a 2a* × 2a* superstructure and are attributed to the short-range order of metal atoms in the partially filled layers.