Barriers to the development of palliative care in Western Europe

The Eurobarometer Survey of the <i>EAPC Task Force on the Development of Palliative Care in Europe</i> is part of a programme of work to produce comprehensive information on the provision of palliative care across Europe. Aim: To identify barriers to the development of palliative care in Western Europe. Method: A qualitative survey was undertaken amongst boards of national associations, eliciting opinions on opportunities for, and barriers to, palliative care development. By July 2006, 44/52 (85%) European countries had responded to the survey; we report here on the results from 22/25 (88%) countries in Western Europe. Analysis: Data from the Eurobarometer survey were analysed thematically by geographical region and by the degree of development of palliative care in each country. Results: From the data contained within the Eurobarometer, we identified six significant barriers to the development of palliative care in Western Europe: (i) Lack of palliative care education and training programmes (ii) Lack of awareness and recognition of palliative care (iii) Limited availability of/knowledge about opioid analgesics (iv) Limited funding (v) Lack of coordination amongst services (vi) Uneven palliative care coverage. Conclusion: Findings from the EAPC Eurobarometer survey suggest that barriers to the development of palliative care in Western Europe may differ substantially from each other in both their scope and context and that some may be considered to be of greater significance than others. A number of common barriers to the development of the discipline do exist and much work still remains to be done in the identified areas. This paper provides a road map of which barriers need to be addressed

Multi-layer study of wave propagation in sunspots

We analyze the propagation of waves in sunspots from the photosphere to the chromosphere using time series of co-spatial Ca II H intensity spectra (including its line blends) and polarimetric spectra of Si I 10827 and the He I 10830 multiplet. From the Doppler shifts of these lines we retrieve the variation of the velocity along the line-of-sight at several heights. Phase spectra are used to obtain the relation between the oscillatory signals. Our analysis reveals standing waves at frequencies lower than 4 mHz and a continuous propagation of waves at higher frequencies, which steepen into shocks in the chromosphere when approaching the formation height of the Ca II H core. The observed non-linearities are weaker in Ca II H than in He I lines. Our analysis suggests that the Ca II H core forms at a lower height than the He I 10830 line: a time delay of about 20 s is measured between the Doppler signal detected at both wavelengths. We fit a model of linear slow magnetoacoustic wave propagation in a stratified atmosphere with radiative losses according to Newton's cooling law to the phase spectra and derive the difference in the formation height of the spectral lines. We show that the linear model describes well the wave propagation up to the formation height of Ca II H, where non-linearities start to become very important.Comment: Accepted by The Astrophysical Journa

Dying with Dignity : Is This a Universal Concept?

Peer reviewedPublisher PD

Non-invasive Scanning Raman Spectroscopy and Tomography for Graphene Membrane Characterization

Graphene has extraordinary mechanical and electronic properties, making it a promising material for membrane based nanoelectromechanical systems (NEMS). Here, chemical-vapor-deposited graphene is transferred onto target substrates to suspend it over cavities and trenches for pressure-sensor applications. The development of such devices requires suitable metrology methods, i.e., large-scale characterization techniques, to confirm and analyze successful graphene transfer with intact suspended graphene membranes. We propose fast and noninvasive Raman spectroscopy mapping to distinguish between freestanding and substrate-supported graphene, utilizing the different strain and doping levels. The technique is expanded to combine two-dimensional area scans with cross-sectional Raman spectroscopy, resulting in three-dimensional Raman tomography of membrane-based graphene NEMS. The potential of Raman tomography for in-line monitoring is further demonstrated with a methodology for automated data analysis to spatially resolve the material composition in micrometer-scale integrated devices, including free-standing and substrate-supported graphene. Raman tomography may be applied to devices composed of other two-dimensional materials as well as silicon micro- and nanoelectromechanical systems.Comment: 23 pages, 5 figure

Global palliative care: from need to action

Katherine Sleeman and colleagues report the first worldwide projection of the future global burden of serious health-related suffering. The calculation followed the methods used by the Lancet Commission on Palliative Care and Pain Relief assessing global palliative care need. Combining these methods with WHO’s revised global and regional projections of mortality up to 2060,3 the authors estimate the global burden of serious health-related suffering requiring palliative care by world regions and age groups for 20 health conditions. The vision of the future delivered by this Article is alarming: “By 2060, an estimated 48 million people (47% of all deaths globally) will die each year with serious healthrelated suffering, and 83% of these deaths will occur in low-income and middle-income countries”.1 These numbers indicate that 130000 people worldwide will die every day with serious health-related suffering by 2060, the equivalent to twice the size of a Super Bowl stadium. The real burden of serious health-related suffering is even greater because the authors’ calculations are based on mortality data and do not include the burden of people living with serious health-related suffering who do not die in a given period

Desarrollo de formas superficiales en la Ciudad Encantada (Cuenca, España)

Resumen] La Ciudad Encantada, cerca de la ciudad de Cuenca, es morfológicamente un conjunto de rocas fungiformes, restos de platafórmas elongadas y arcos naturales modelados sobre dolomitas cretácicas de estructura subhorizontal. Su origen se atribuye a factores estructurales, presencia de estratos con diferente resistencia a la erosión, y ataque generalizado de la humedad primero subedáficamente y luego subaéreamente al pie de las formas actuales. Los factores que contribuyen a la estabilidad actual en la parte superior de estas formas, son los recubrimientos biológicos, la concentración de calcita o las variaciones locales en el régimen de humedad.Abstract] The Ciudad Encantada, near Cuenca, in east-central Spain, is a complex of mushroom-shaped rocks and elongate plateau remnants developed in flat-lying Cretaceous dolomite. Natural bridges are also presento The forms are attributed partly to structural factors, namely the presence of strata of contrasted resistance to weathering and erosion, but also to differential subsurface moisture attack beneath the plateau surface. Other factors contributing to the relative stability of the caprock include biotic coating, calcite concentration, and dryness at site scale

Palliative care in its own discourse: a focused ethnography of professional messaging in palliative care

Background Despite 50 years of modern palliative care (PC), a misunderstanding of its purpose persists. The original message that PC is focused on total care, helping to live until the person dies, is being replaced and linked to feelings of fear, anxiety and death, instead of compassion, support or appropriate care. Society is still afraid to speak its name, and specialized units are identified as “places of death” as opposed to “places of life” meant to treat suffering. This issue is prohibitive to the implementation and development of PC policies worldwide. It is imperative to identify what message PC professionals are relaying to patients and other health care specialists and how that message may condition understandings of the right to access PC. Methods A qualitative study, employing focused ethnography and participant observation (PO) of the daily interaction of PC professionals with patients and family members in three different PC services. Two researchers independently conducted a thematic analysis, followed by member checking with participants. Results A total of 242 h of participant observation revealed the following messages sent by PC professionals in their daily interaction with patients and families: i) We are focused on your wellbeing; ii) You matter: we want to get to know you; iii) Your family is important to us. Conclusion The complexity of PC discourses contributes to the difficulty of identifying a clear universal message between PC professionals, patients and families. The PC professionals observed transmit a simple message focused on their actions rather than their identity, which may perpetuate some social/cultural misunderstandings of PC. It seems there is a common culture, based on the same values and attitudes, within the messages that PC professionals transmit to patients and their families. PC teams are characterised by their availability