Evolution and change in palliative care around the world

Palliative care developed in the later part of the 20th century as a social movement and medical speciality. Central to its modern development were the ideas of Dr Cicely Saunders, whose vision for improving the care of the dying encompassed the physical, psychological, social and spiritual domains while emphasizing the importance of rigorous clinical practice, training and research. St Christopher’s Hospice, which she founded, inspired generations of practitioners and influenced the expansion of hospices nationally and internationally. Terminal care evolved into the discipline of palliative care, which applied holistic principles to the care of those earlier in their disease trajectory and in different settings, such as hospitals and the community. Some countries now have national strategies for palliative care that are supported by government. Palliative care attracts increasing attention as an aspect of the public health system and there are calls for access to it to be recognized as a human right. Yet around the world, palliative care is not uniformly developed and it needs to press hard to secure full integration with prevailing health policies. Palliative care still reaches only a tiny proportion of those who could benefit from it, especially those with diseases other than cancer. The global challenge for palliative care in the 21st century is to develop models and coverage appropriate to those in need, whatever their diagnosis, income or setti

"If We Reintegrate Six Babies, Someone Else Will Institutionalise Eight": A Discourse Analysis of NGO Workers' Constructions of Alternative Care of Children in Cambodia

This thesis explored alternative care of children in Cambodia through the view of employees of non-governmental organisations. Preliminary research revealed a misappropriation of the word orphanage to describe a place, not for orphans, but where poor families in Cambodia take children for care. Thus, the language of alternative care became the topic of interest and was critically examined through discourse analysis. The research was guided by Personal Construct Theory, which provided a framework and method for inquiry. Using a combination of structured and semi-structured interviews, this thesis elicited and analysed the personal constructs of employees of non-governmental organisations across Cambodia and compared and contrasted these with the Royal Government of Cambodia’s policy and the United Nations guidelines on alternative care. The key finding was a pervasive discrepancy between discourse and on the ground reality, as evidenced by the respondents’ constructions. While some respondents criticized the government for weak implementation of alternative care standards, underlying many hindrances was the presence of hundreds of non-governmental organisations working outside the law and implementing fragmented and often contradictory alternative care programs. A longitudinal study was recommended to better examine the discourse, how it is changing, and how to close the gap between discourse and reality

A Process Model of Risk Communication: The Case of Global Climate Change

The authors describe a survey of public media use as it relates to different stages of awareness and concern regarding risk issues

New radiocarbon dates from the Bapot-1 site in Saipan and Neolithic dispersal by stratified diffusion

The colonisation of the Mariana Islands in Western Micronesia is likely to represent an early ocean dispersal of more than 2000 km. Establishing the date of human arrival in the archipelago is important for modelling Neolithic expansion in Island Southeast Asia and the Pacific, particularly the role of long-distance dispersals. This paper presents new ¹⁴C results and a ΔR estimate from the Bapot-1 site on Saipan Island, which indicate human arrival at ca. 3400-3200 cal. BP. Archaeological chronologies of long-distance dispersal to Western Micronesia and the Lapita expansion (Bismarcks to Samoa) show that the Neolithic dispersal rate was increasing during the period ca. 3400-2900 cal. BP. The range-versus-time relationship is similar to stratified diffusion whereby a period of relatively slow expansion is succeeded by long-distance movement. An increase in new colonies created by long-distance migrants results in accelerating range expansion

Ewe nutrition and lamb growth

1. The literature review initially describes foetal and placental growth and development. The following two sections present the effects of nutrition before mating and in early pregnancy, concentrating mainly on the effect on ovulation and lambing rate, and identify the lack of information on the effect on foetal lamb growth and birth weight.2. Aspects of nutrition, particularly during mid and late pregnancy are reviewed. The close relationship between energy and protein nutrition is recognised in relation to foetal growth.3. Finally, an account of nutritional effects on lactation is given and again emphasising the role protein and energy have to play. Methods of assessing milk yield are also described.4. The first experiment provided information on differences in maternal body composition, early foetal and placental growth and development brought about by high and low planes of feeding for ten weeks before mating and up till 90 days of gestation. The foetus weights were not different, but placenta and cotyledon weights were heavier ( p <0.05) for better nourished ewes. Liveweights of ewes differed by 27 kg, but energy contents differed by 479 MJ, or poorly fed ewes had half the reserves of well fed ewes.5. The second experiment provided information on changes in body composition as a result of high and low levels of nutrition before mating. Ewes received different amounts of protein and energy in late pregnancy. fiaternal body changes as well as thegrowth of foetuses and placentae were followed throughout this period. As in the first experiment the changes in energy were greater than would have been predicted from liveweight changes. Maternal composition was largely affected by treatment before mating. Lambs from ewes on high protein levels were approximately 1 kg heavier than lambs from ewes on low protein irrespective of energy level. Little effect was observed on the placenta as a result of treatment, but it increased in weight between 90 and 14-2 days of gestation.6. The third experiment provided information on the effect of increasing increments of fishmeal inclusion in the concentrate ration on ewe weight, milk yield and lamb birth weight and growth rate. The milk yield and growth rate recording ceased after four weeks of lactation. There was a significant difference of about 2 kg in the weight of twin lambs from ewes receiving concentrates with 0.15 and 0.2 fishmeal compared with those receiving barley alone. By weaning, after grazing on pasture, no differences in lamb weight were evident.7. The results are discussed, in the light of current research information and in relation to commercial practice

Likelihood of death within one year among a national cohort of hospital inpatients in Scotland

No abstract available

Suburban/Absurd: Subjects of Anxiety in the Fiction of John Cheever and Richard Ford.

One aspect of the common ground between the work of Richard Ford and John Cheever is their careful depiction of domestic life. It was this attention to the middle class suburbs of America that led some of Cheever's contemporary critics to dismiss his work, seeing his subject matter as inappropriate to serious critical enquiry. By altering the terms on which Cheever's work is approached, and reading Cheever's and Ford's suburban fiction in light of some of the tenets of existentialism, post-structuralism, and neo-pragmatism, it is possible to affirm their works as central to contemporary concerns surrounding subjectivity, identity, and agency

Comparison of Raman and near-infrared chemical mapping for the analysis of pharmaceutical tablets

Raman and near-infrared (NIR) chemical mapping are widely used methods in the pharmaceutical industry to understand the distribution of components within a drug product. Recent advancements in instrumentation have enabled the rapid acquisition of high-resolution images. The comparison of these techniques for the analysis of pharmaceutical tablets has not recently been explored and thus the relative performance of each technique is not currently well defined. Here, the differences in the chemical images obtained by each method are assessed and compared with scanning electron microscopy with energy dispersive X-ray microanalysis (SEM-EDX), as an alternative surface imaging technique to understand the ability of each technique to acquire a chemical image representative of the sample surface. It was found that the Raman data showed the best agreement with the spatial distribution of components observed in the SEM-EDX images. Quantitative and qualitative comparison of the Raman and NIR images revealed a very different spatial distribution of components with regards to domain size and shape. The Raman image exhibited sharper and better discriminated domains of each component, whereas the NIR image was heavily dominated by large pixelated domains. This study demonstrated the superiority of using Raman chemical mapping compared with NIR chemical mapping to produce a chemical image representative of the sample surface using routinely available instrumentation to obtain a better approximation of domain size and shape. This is fundamental for understanding knowledge gaps in current manufacturing processes; particularly relating the relationship between components in the formulation, processing condition, and final characteristics. By providing a means to more accurately visualize the components within a tablet matrix, these areas can all be further understood

Fibre tract segmentation for intraoperative diffusion MRI in neurosurgical patients using tract-specific orientation atlas and tumour deformation modelling

Purpose:: Intraoperative diffusion MRI could provide a means of visualising brain fibre tracts near a neurosurgical target after preoperative images have been invalidated by brain shift. We propose an atlas-based intraoperative tract segmentation method, as the standard preoperative method, streamline tractography, is unsuitable for intraoperative implementation. Methods:: A tract-specific voxel-wise fibre orientation atlas is constructed from healthy training data. After registration with a target image, a radial tumour deformation model is applied to the orientation atlas to account for displacement caused by lesions. The final tract map is obtained from the inner product of the atlas and target image fibre orientation data derived from intraoperative diffusion MRI. Results:: The simple tumour model takes only seconds to effectively deform the atlas into alignment with the target image. With minimal processing time and operator effort, maps of surgically relevant tracts can be achieved that are visually and qualitatively comparable with results obtained from streamline tractography. Conclusion:: Preliminary results demonstrate feasibility of intraoperative streamline-free tract segmentation in challenging neurosurgical cases. Demonstrated results in a small number of representative sample subjects are realistic despite the simplicity of the tumour deformation model employed. Following this proof of concept, future studies will focus on achieving robustness in a wide range of tumour types and clinical scenarios, as well as quantitative validation of segmentations