Dying in hospital in Ireland: an assessment of the quality of care in the last week of life: National audit of end-of-life care in hospitals in Ireland, 2008/9

The context of this report is set by the fact that most people die in a hospital or similar setting, outside the home. When you consider that most people are also born in hospital, and may spend some time there over the course of a lifetime, it becomes clear that hospitals are central to our passage into life and out of it, touching people at the most important and intimate moments of their lives. In this sense, the work of hospitals mirrors the cycle of life and the expectations of society about its role at each stage of the life cycle. The report assesses the quality of care provided by Irish hospitals in the last week of life. The word ‘hospital’ shares a common linguistic root with words like hospice and hospitality. Hospitality – understood as being welcomed and cared for with kindness and attentiveness - is still what everyone seeks when they come to hospital, including patients and their families who are going through the journey of dying, death and bereavement. That is why the Hospice Friendly Hospitals Programme (2007-2012) commissioned this first ever national audit of endof-life care in Irish hospitals. This report contributes to the growing practice within the Irish hospital system of auditing performance against standards in order to ensure that every aspect of its work meets, and even exceeds, the highest standards of care and excellence. Given that end-of-life care standards did not exist at the time the audit – but have since been published as Quality Standards for End-of-Life Care in Hospitals1 – it may be more appropriate to regard this report as a ‘pre-audit’ or ‘baseline-audit’. It is Government policy, since February 2009, to introduce a mandatory licensing system whereby each hospital will only be allowed to practice if, on the basis of audited performance, it meets acceptable quality standards of service

Assessing the regional impact of Indonesian biomass burning emissions based on organic molecular tracers and chemical mass balance modeling

Biomass burning activities commonly occur in Southeast Asia (SEA), and are particularly intense in Indonesia during the dry seasons. The effect of biomass smoke emissions on air quality in the city state of Singapore was investigated during a haze episode in October 2006. Substantially increased levels of airborne particulate matter (PM) and associated chemical species were observed during the haze period. Specifically, the enhancement in the concentration of molecular tracers for biomass combustion such as levoglucosan by as much as two orders of magnitude and the diagnostic ratios of individual organic compounds indicated that biomass burning emissions caused a regional smoke haze episode due to their long-range transport by prevailing winds. With the aid of air mass backward trajectories and chemical mass balance modeling, large-scale forest and peat fires in Sumatra and Kalimantan were identified as the sources of the smoke aerosol, exerting a significant impact on air quality in downwind areas, such as Singapore

Trace gas and particle emissions from domestic and industrial biofuel use and garbage burning in central Mexico

In central Mexico during the spring of 2007 we measured the initial emissions of 12 gases and the aerosol speciation for elemental and organic carbon (EC, OC), anhydrosugars, Cl−, NO[subscript 3]−, and 20 metals from 10 cooking fires, four garbage fires, three brick making kilns, three charcoal making kilns, and two crop residue fires. Global biofuel use has been estimated at over 2600 Tg/y. With several simple case studies we show that cooking fires can be a major, or the major, source of several gases and fine particles in developing countries. Insulated cook stoves with chimneys were earlier shown to reduce indoor air pollution and the fuel use per cooking task. We confirm that they also reduce the emissions of VOC pollutants per mass of fuel burned by about half. We did not detect HCN emissions from cooking fires in Mexico or Africa. Thus, if regional source attribution is based on HCN emissions typical for other types of biomass burning (BB), then biofuel use and total BB will be underestimated in much of the developing world. This is also significant because cooking fires are not detected from space. We estimate that ~2000 Tg/y of garbage are generated globally and about half may be burned, making this a commonly overlooked major global source of emissions. We estimate a fine particle emission factor (EFPM2.5) for garbage burning of ~10.5±8.8 g/kg, which is in reasonable agreement with very limited previous work. We observe large HCl emission factors in the range 2–10 g/kg. Consideration of the Cl content of the global waste stream suggests that garbage burning may generate as much as 6–9 Tg/yr of HCl, which would make it a major source of this compound. HCl generated by garbage burning in dry environments may have a relatively greater atmospheric impact than HCl generated in humid areas. Garbage burning PM[subscript 2.5] was found to contain levoglucosan and K in concentrations similar to those for biomass burning, so it could be a source of interference in some areas when using these tracers to estimate BB. Galactosan was the anhydrosugar most closely correlated with BB in this study. Fine particle antimony (Sb) shows initial promise as a garbage burning tracer and suggests that this source could contribute a significant amount of the PM2.5 in the Mexico City metropolitan area. The fuel consumption and emissions due to industrial biofuel use are difficult to characterize regionally. This is partly because of the diverse range of fuels used and the very small profit margins of typical micro-enterprises. Brick making kilns produced low total EFPM[subscript 2.5] (~1.6 g/kg), but very high EC/OC ratios (6.72). Previous literature on brick kilns is scarce but does document some severe local impacts. Coupling data from Mexico, Brazil, and Zambia, we find that charcoal making kilns can exhibit an 8-fold increase in VOC/CO over their approximately one-week lifetime. Acetic acid emission factors for charcoal kilns were much higher in Mexico than elsewhere. Our dirt charcoal kiln EFPM2.5 emission factor was ~1.1 g/kg, which is lower than previous recommendations intended for all types of kilns. We speculate that some PM[subscript 2.5] is scavenged in the walls of dirt kilns.National Science Foundation (U.S.) (Grant ATM-0513055)United States. Dept. of Defense (Strategic Environmental Research and Development Program (SERDP))United States. Dept. of Agriculture (Agreement 07-JV-11221649-060)United States. Dept. of Agriculture (Agreement 08-JV-11272166-039)United States. Forest ServiceRocky Mountain Research Station (Fort Collins, Colo.)Pacific Southwest Research Statio

Implications of regional surface ozone increases on visibility degradation in southeast China

Long-term visibility (1968–2010) and air pollutant (1984–2010) data records in Hong Kong reveal that the occurrence of reduced visibility (RV, defined as the percentage of hours per month with visibility below 8 km in the absence of rain, fog, mist or relative humidity above 95%) in southeast China has increased significantly in the last four decades. The most pronounced rate of increase was observed after 1990 (nine times higher than that before 1990), when notable increases in surface ozone (O3) levels were simultaneously observed (1.06 µg m−3 per yr). The greatest increases in RV, and in O3, NO2 and SO2 concentrations are coincident in the autumn (1.47, 0.20 and 0.45 µg m−3 per yr respectively), when southeast China is strongly influenced by regional O3 formation and accumulation due to continental outflow of pollution from the east China coast under favourable meteorological conditions. Multiple regression revealed that the RV percentage correlated well (p<0.05) with NO2 and NO x in the 1980s, and with NO2, SO2 and O3 after the 1990s, suggesting that there have been changes in the predominant factors causing visibility degradation. In order to elucidate the reasons for these changes, the results were integrated with data from previous research. Possible impacts of elevated O3 on secondary particle formation and their effects on visibility degradation and aerosol radiative forcing in an oxidant-enhanced southeast China are highlighted. Other factors potentially leading to visibility degradation, such as ship emissions and biomass burning, are also discussed

Seasonal variations of anhydrosugars in PM2.5 in the Pearl River Delta Region, China

Anhydrosugars including levoglucosan and mannosan are the most effective organic tracers for biomass burning aerosol in the atmosphere. In this study, to investigate the contribution of biomass burning emissions to the aerosol burden in the Pearl River Delta (PRD) region, China, 24-hour integrated PM2.5 samples were collected simultaneously at four locations, (i) Guangzhou (GZ), (ii) Zhaoqing (ZQ) in Guangdong province, (iii) Hok Tsui (HT) and (iv) Hong Kong Polytechnic University (PU) in Hong Kong, in four seasons between 2006 and 2007. Levoglucosan and mannosan, together with water-soluble inorganic ions and water-soluble organic carbon (WSOC), were determined to elucidate the seasonal and spatial variations in biomass burning contributions. The concentrations of levoglucosan and mannosan were on average 82.4±123 and 5.8±8.6 ng m−3, respectively. The WSOC concentrations ranged from 0.2 to 9.4 µg m−3, with an average of 2.1±1.6 µg m−3. The relative contributions of biomass burning emissions to OC were 33% in QZ, 12% in GZ, 4% at PU and 5% at HT, respectively, estimated by the measured levoglucosan to organic carbon ratio (LG/OC) relative to literature-derived LG/OC values. The contributions from biomass burning emissions were in general 1.7–2.8 times higher in winter than those in other seasons. Further, it was inferred from diagnostic tracer ratios that a significant fraction of biomass burning emissions was derived from burning of hard wood and likely also from field burning of agricultural residues, such as rice straw, in the PRD region. Our results highlight the contributions from biomass/biofuel burning activities on the regional aerosol budget in South China

Organic compounds in PM2.5 emitted from fireplace and woodstove combustion of typical Portuguese wood species

The aim of this study is the further characterisation of PM2.5 emissions from the residential wood combustion of common woods grown in Portugal. This new research extends to eight the number of biomass fuels studied and tries to understand the differences that the burning appliance (fireplace versus woodstove) and the combustion temperature (cold and hot start) have on emissions. Pinus pinaster (Maritime pine), Eucalyptus globulus (eucalypt), Quercus suber (cork oak), Acacia longifolia (Golden wattle), Quercus faginea (Portuguese oak), Olea europea (Olive), Quercus ilex rotundifolia (Holm oak) and briquettes produced from forest biomass waste were used in the combustion tests. Determinations included fine particle emission factors, carbonaceous content (OC and EC) by a thermaleoptical transmission technique and detailed identification and quantification of organic compounds by gas chromatographyemass spectrometry. Fine particle emission factors from the woodstove were lower than those from the fireplace. For both combustion appliances, the OC/EC ratio was higher in “cold start” tests (1.56 0.95 for woodstove and 2.03 1.34 for fireplace). These “cold start” OC/EC values were, respectively, for the woodstove and the fireplace, 51% and 69% higher than those obtained in “hot start” experiments. The chromatographically resolved organics included n-alkanes, n-alkenes, PAHs, n-alkanals, ketones, n-alkanols, terpenoids, triterpenoids, phenolic compounds, phytosterols, alcohols, n-alkanoic acids, n-di-acids, unsaturated acids and alkyl esters of acids. The smoke emission rate and composition varied widely depending on fuel type, burning appliance and combustion temperature

Mutational Analysis of the Export Targeting Motif of Fibroblast Growth Factor 2, a Mediator of Tumor-Induced Angiogenesis

The majority of secretory proteins is exported from mammalian cells by the classical secretory pathway involving subcellular compartments such as the endoplasmic reticulum (ER) and the Golgi apparatus. However, basic fibroblast growth factor (FGF2), a potent mediator of tumor-induced angiogenesis, has been shown to be secreted by a non-classical pathway that does not depend on the functions of the ER and the Golgi apparatus. The molecular characterization of the FGF2 export mechanism is not only a fundamental problem in cell biology but also of great interest for biomedical research since it may pave the way for the development of a novel class of anti-angiogenic drugs. In this thesis, a robust model system designed to quantitatively assess FGF2 secretion under various experimental conditions was developed. A retroviral expression system was established in CHO cells that allows for a stable integration of reporter constructs whose expression can be induced by doxicycline. In order to monitor expression of FGF2 reporter molecules they were constructed as GFP fusion proteins. Based on this experimental system, secretion of FGF2-GFP can be quantified by flow cytometry, confocal microscopy and biochemical methods since exported FGF2-GFP binds to cell surface heparan sulfate proteoglycans and, therefore, is accessible by membrane-impermeable tools such as antibodies and biotinylation reagents. In the second part of this thesis, a systematic mutational analysis of the FGF2 open reading frame was conducted in order to identify cis elements that direct FGF2 to its export machinery. Initial experiments revealed the identification of FGF2 mutants that are defective in binding to heparan sulfate proteoglycans. Such mutants were neither detectable on the cell surface nor in the medium of cells suggesting that the interaction of FGF2 with heparan sulfate proteoglycans does not only play a role in FGF2 signaling but also in the overall process of FGF2 externalization from mammalian cells. A collection of more than a hundred FGF2 mutants and corresponding stable cell lines described in this thesis now provide a basis for future studies in order to conduct a detailed analysis of determinants required for FGF2 secretion