Hospice and Palliative Care - Access for All

Published to coincide with World Hospice and Palliative Care Day 2006, this report showcases the success stories of how hospice and palliative care has been provided in the most difficult settings. It also explores how services can be made more accessible and reflects the diversity of our society and the different beliefs and attitudes to care that people have. It focuses on a number of barriers to good care provision including geography, complex needs, culture and perception, and social exclusion

A HETEROSKEDASTIC NESTED RUM OF FRESHWATER FISHING

Choice set definition can be viewed as a nesting issue. Although the behavioral basis for grouping sites into nests is not well understood, one reason for grouping alternatives into nests may be the likelihood that they are "in" or "out" of an individual's choice set. However, a problem with using nests to evaluate choice set issues is that the researcher typically needs to impose the same nesting structure on all individuals and trips. Such an approach assumes that the degree of correlation among the alternatives does not vary across the sample. This paper develops and tests a more flexible nesting structure that allows the parameters on the inclusive values to vary systematically based on the sample demographics.Resource /Energy Economics and Policy,

The serum treatment of erysipelas

The first attempt to produce an antistreptococcic serum for the treatment of erysipelas came from the hands of Charnn and Roger in 1895. cultures of streptococci isolated from cases of erysipelas were grown in bouillon for ten days and this was concentrated by evaporation to one tenth and placed in the autoclave at 115 degrees cent. Thus they believed that they had preserved the original bacterial substanc. e and its toxins. This was used to immunise a mule, giving 30 ccs. intravenously every second day. After about two weeks the mule was bled and the serum used in doses of about ten to fifteen ccs.. They reported good results, particularly in puerperal septicaemia without peritoneal localisation.Later Marmorek, Aronson, Moser, Savechenko and numerous other workers in this field reported favourable results with antistreptococcal serum in cases of erysipelas.More recently Goresco and Popesco reported very hopeful results in severe cases using a polyvalent antistreptococcal serum prepared by the Institute of Sero Vaccines, Bucarest.(hr J. cantacuzene ) Their report was on some eighty cases with a doseage of one cc. or more daily, the results being very satisfactory in nearly every case. The most marked feature was very often a great improvement in the general condition of the patient even if the temperature re-by lysis. The local lesion improved rapidly and relapses were rare, control cases treated with normal horse serum gave negative results

SampleQC: robust multivariate, multi-cell type, multi-sample quality control for single-cell data

Quality control (QC) is a critical component of single-cell RNA-seq (scRNA-seq) processing pipelines. Current approaches to QC implicitly assume that datasets are comprised of one cell type, potentially resulting in biased exclusion of rare cell types. We introduce SampleQC, which robustly fits a Gaussian mixture model across multiple samples, improves sensitivity, and reduces bias compared to current approaches. We show via simulations that SampleQC is less susceptible to exclusion of rarer cell types. We also demonstrate SampleQC on a complex real dataset (867k cells over 172 samples). SampleQC is general, is implemented in R, and could be applied to other data types

Linking marine mammal distribution and behavior to environment in three Arctic ecosystem case studies

O Ártico, uma região remota, árida e ecologicamente dinâmica da Terra, enfrenta mudanças sem precedentes. As tendências indicam que o planeta está aquecendo rapidamente, o que tem provocado uma redução dramática no gelo marinho do Ártico. Esta alteração estimulou um interesse renovado no desenvolvimento industrial e na expansão das rotas marítimas do Ártico, atividades que antes eram limitadas, tanto espacial quanto temporalmente. Prevê-se que a mudança climática, o declínio do gelo marinho e dos icebergues e o aumento das atividades antropogénicas determinarão mudanças dramáticas nos ecossistemas árticos. Os mamíferos marinhos, muitas vezes mencionados como indicadores de mudanças nas condições climáticas (Moore, 2008; Wolf et al., 2010), são considerados particularmente vulneráveis a mudanças físicas e podem ser os primeiros a sofrer modificações na distribuição e uso do habitat (Tynan & DeMaster, 1997; Wolf et al., 2010). Esta tese tem como objectivo investigar a ligação entre os mamíferos marinhos e seu ambiente, a partir de três conjuntos de dados respeitantes a três ecossistemas árticos geograficamente distintos. Cada um representa um tipo específico de ecossistema: o Fiorde Petermann, no noroeste da Groenlândia, representa um ambiente de fiorde alto do Ártico; o delta do rio Colville, no mar de Beaufort, representa um delta de rio próximo à costa; e o Mar de Chukchi, a nordeste, representa um ambiente pelágico offshore. Foi estudada a ocorrência, a distribuição, a adequação do habitat e a ecologia comportamental. Estes parâmetros foram relacionados com variáveis ambientais relevantes como, por exemplo, a temperatura da superfície do mar, a distância da costa ou da frente glacial, a cobertura de gelo e a profundidade. Adicionalmente, foram analisadas as respostas comportamentais aos efeitos antropogénicos específicos da região, como a presença de embarcações e de atividades industriais decorrentes da exploração de petróleo e de gás. O primeiro estudo de caso é do Fiorde Petermann, um fiorde situado no Alto Ártico com a língua de gelo flutuante, o glaciar de Petermann, no noroeste da Groenlândia. Durante 2010 e 2012, este glaciar perdeu partes substanciais de gelo. Os dados de ocorrência e distribuição de focas foram colhidos no Fiorde de Petermann e na região adjacente do Estreito de Nares durante a expedição científica multidisciplinar Petermann 2015 do navio Icebreaker Oden em agosto de 2015. Durante 239,4 horas de esforço de observação, um total de 312 focas representando quatro espécies foram identificadas: foca-barbuda (Erignathus barbatus), foca de-crista (Crystophora cristata), foca-da-Gronelândia (Pagophilus groenlandicus) e focaanelada (Pusa hispida). Os resultados indicaram uma diferença no comportamento entre espécies. A foca-barbuda foi a mais frequentemente encontrada fora de água enquanto os espécimes de foca-anelada permaneciam quase exclusivamente na água. Foram calculadas diferenças significativas na ocorrência de espécies por profundidade e cobertura de gelo; a foca-barbuda e a foca-da-Gronelândia foram encontradas em profundidades médias de água mais profundas e áreas de cobertura média de gelo mais espessa, enquanto a foca-de-crista e a foca-anelada foram encontradas em profundidades médias de água menos profundas e em áreas de cobertura média de gelo mais baixa. O segundo objetivo do estudo de caso do Fiorde Petermann foi investigar as respostas comportamentais potenciais de focas e ursos polares (Ursus maritimus) ao navio quebra-gelo. Estes navios, ferramentas importantes que permitem a pesquisa nas regiões polares, têm o potencial de se sobrepor aos habitats de mamíferos marinhos em áreas pouco estudadas. Foram registadas as respostas comportamentais relacionadas com a entrada na água, a partir das plataformas de descanso, como resposta à presença do navio quebra-gelo. Estas respostas foram menores para distâncias superiores a 600 m e inexistentes para distâncias superiores a 800 m. Adicionalmente, três ursos polares foram identificados durante o percurso e uma resposta comportamental (por exemplo, olhar, aproximar, afastar) foi registrada para os três avistamentos. O segundo estudo de caso é do delta do rio Colville, uma região estuarina e costeira localizada na encosta norte do Alasca, aproximadamente a 120 km a oeste de Prudhoe Bay e a 200 km a leste de Point Barrow dentro das ilhas barreira ao longo da costa do Mar de Beaufort. Durante agosto e setembro de 2014, um programa de aquisição sísmica para exploração de petróleo e gás decorreu próximo do delta do rio Colville. Foi registada informação sobre a ocorrência, a distribuição e a resposta de mamíferos marinhos às atividades sísmicas, usando uma combinação de métodos visuais, acústicos e ecológicos (TEK). O esforço visual por observadores a bordo de três pequenos navios de pesquisa totalizou 632 horas. Além disso, um observador Iñupiat e caçador de focas da aldeia de Nuiqsut conduziu uma pesquisa em pequenos navios para investigar a localização de locais de ocorrência de foca-manchada (Phoca largha). Um total de 102 indivíduos foram registados para um total de em cinco espécies: foca-manchada, foca-anelada, foca-barbuda, urso-polar, e beluga (Delphinapterus leucas). As taxas de avistamento foram mais de 13 vezes superiores durante a atividade não-sísmica do que durante a atividade sísmica, sugerindo os efeitos potenciais do “ruído” do canhão de ar na pesquisa sísmica sobre a presença/ausência de mamíferos marinhos. Este resultado está de acordo com informação publicada relativa à resposta comportamental que comprovam a ação dos efeitos sísmicos (Gordon et al., 2003; Harris et al., 2001; Richardson et al., 1986; Richardson et al., 1999). Foram registadas mais de 400 horas de dados acústicos usando Ecological Acoustics Recorders de segunda geração implantados no fundo do mar em três locais. Identificaram-se sons emitidos por beluga, por baleia-da-Gronelândia (Balaena mysticetus), por foca-barbuda e por foca-anelada. Os resultados mostraram uma diferença significativa entre as probabilidades de encontros acústicos na presença versus ausência de atividade sísmica apenas para beluga, sugerindo que estas aumentaram as taxas de vocalização em resposta à atividade sísmica. Os mamíferos marinhos são conhecidos por modificar seu comportamento vocal para compensar o ruído ambiente, aumentando a taxa de chamada, a intensidade do sinal e a duração (Scheifele et al., 2005; Tyak, 2008). A utilização de métodos visuais e acústicos combinados, juntamente com a inclusão de informação ecológica (TEK), permitiram uma cobertura e uma compreensão mais detalhadas da ocorrência de mamíferos marinhos nesta região. O terceiro estudo de caso corresponde a uma região offshore dos mares nordeste de Chukchi e de Southern Beaufort, Alasca. Esta região, antes remota, regista um aumento significativo na presença de navios devido a novas rotas de transporte transpolar, uma crescente indústria de turismo no Ártico e à exploração e desenvolvimento de prospeção de petróleo e gás offshore. Antes do início da exploração e do seu desenvolvimento, três empresas de petróleo e gás; ConocoPhillips, Shell e Statoil financiaram programas integrados de investigação (Chukchi Sea Environmental Studies Program [CSESP]). Os dados de ocorrência de mamíferos marinhos foram recolhidos a partir de embarcações durante o verão e outono de 2008-2014. O primeiro objetivo do estudo de caso do CSESP foi investigar a ocorrência de grandes baleias e dos habitats ocupados. Durante mais de 56.909 km de esforço de observação, as espécies de baleias grandes mais comumente registadas foram a baleia-da- Gronelândia e a baleia-cinzenta (Eschrichtius robustus). As grandes baleias subárticas registadas incluem a baleia-jubarte (Megaptera novaeangliae), a baleia-comum (Balaenoptera physalus) e a baleia-anã (Balaenoptera acutorostrata). Os registos dessas espécies durante o CSESP são paralelos a outros estudos que encontraram espécies subárticas que se tornaram mais comuns no Mar de Chukchi, devido à sua deslocação para águas mais quentes (Brower et al., 2018; Clarke et al., 2013a; Haley et al., 2010). Foi desenvolvido um modelo de adequação de habitat (HSM) para baleias-da-Gronelância e para baleia-cinzenta utilizando métodos de modelação Maxent e dados de presença e pseudo- ausência. Os HSM apresentaram diferenças indicando quais as variáveis ambientais que afetam o habitat; para a baleia-cinzenta, a distância até a costa constituiu a variável mais relevante, seguida pela profundidade. Os resultados indicam que a temperatura da água à superfície (SST) é a menos relevante, enquanto para as baleias-da-Groneândia, a distância até a costa e a SST foram considerados relevantes, enquanto que a profundidade foi menos importante. Essas diferenças, juntamente com as diferenças claras nos padrões de distribuição descritos nos mapas de previsão, sugerem que as baleias-da-Gronelândia e as baleias- cinzentas ocupam nichos ecológicos distintos durante o verão e o outono no mar de Chukchi. O segundo objetivo do estudo de caso do CSESP foi investigar a ocorrência de ursos polares e a resposta comportamental à presença de navios. Um total de 42 grupos (50 indivíduos) de ursos polares foram registados. Durante a estação de águas abertas no mar de Chukchi, acredita-se que os ursos polares migrem para o norte com o recuo do gelo ou se desloquem para zonas terrestres emersas. Os resultados deste estudo indicaram que alguns ursos polares permaneceram no ambiente offshore durante o verão e o outono. Mais de 50% dos grupos exibiram uma resposta comportamental (por exemplo, vigilância ou fuga), incluindo todos os grupos de mães com filhotes. A distância em que os ursos responderam aos navios era mais inferior à distância em que nenhuma resposta foi observada. Espera-se que as mudanças climáticas, a perda de gelo marinho e o aumento das atividades antrópicas alterem os habitats de muitas espécies de mamíferos marinhos do Ártico e, por sua vez, a sua ecologia comportamental. A capacidade de uma espécie se ajustar a essas mudanças é parcialmente determinada pela capacidade de ajustar as preferências de seleção de habitat às novas condições ambientais. A avaliação dos efeitos das alterações climáticas, a redução do gelo marinho e o aumento das atividades antrópicas sobre as espécies marinhas requerem uma compreensão das distribuições das espécies e a monitorização das mudanças potenciais no comportamento, na distribuição e no habitat. Adicionalmente, importa avaliar os impactos resultantes das atividades humanas, como a exploração de petróleo e de gás e o aumento da presença de embarcações, considerando a importância destes aspetos para a definição de estratégias de gestão e de conservação para estas e inúmeras outras espécies. À medida que as alterações climáticas e as atividades antrópicas no Ártico aumentam, a necessidade de avaliações de efeitos cumulativos será imperativa para a proteção futura dos mamíferos marinhos do Ártico.The Arctic, a remote, harsh, and ecologically dynamic region of the Earth, is facing unprecedented changes. Trends indicate the planet is rapidly warming and in response, sea ice and glaciers are disappearing. The dramatic reduction in Arctic sea-ice has spurred a renewed interest in industrial development and the expansion of Artic shipping routes, activities that were previously limited both spatially and temporally. The changing climate, the decline of sea ice and glaciers, and the increasing human activities are anticipated to result in dramatic shifts in Arctic ecosystems (Wassman et al., 2011). Marine mammals, often portrayed as indicators to changing climatic conditions (Moore, 2008; Moore & Huntington, 2008; Wolf et al., 2010), are considered particularly vulnerable to physical changes and may be the first to experience modifications in distribution and habitat use in response (Tynan & DeMaster, 1997; Wolf et al., 2010). Assessing the risk of anthropogenic activities on marine mammals requires an understanding of species distributions and monitoring potential shifts in range and suitable habitat. In addition, understanding what constitutes a species’ suitable habitat provides further insight into the ecological processes affecting these patterns. This thesis aims to investigate the link between marine mammals and their environment and potential region-specific anthropogenic threats from three data sets derived from three geographically distinct Arctic ecosystems. Each represents a specific ecosystem type; Petermann Fjord in Northwest Greenland represents a high Arctic ice-tongue fjord environment, the Colville River Delta in the Beaufort Sea, Alaska represents a nearshore, estuarine river delta, and the northeast Chukchi Sea represents an offshore pelagic environment. From these marine mammal occurrence, distribution, habitat suitability, and behavioral ecology was analyzed relative to relevant environmental variables (e.g. sea surface temperature, distance from shore or glacial front, ice cover, depth). Furthermore, behavioral responses to region-specific anthropogenic effects such as vessel presence and oil and gas industrial activities was investigated. The first case study is from the Petermann Fjord, a High Arctic fjord with the floating ice tongue, Petermann Glacier, in northwest Greenland. During 2010 and 2012 major calving events Petermann Glacier lost substantial sections of ice. Seal occurrence and distribution data were collected in Petermann Fjord and adjacent Nares Strait region during the multidisciplinary scientific Petermann 2015 Expedition on the icebreaker Oden in August 2015. During 239.4 hours of observation effort, a total of 312 seals representing four species of seals were recorded: bearded (Erignathus barbatus), hooded (Crystophora cristata), harp (Pagophilus groenlandicus), and ringed (Pusa hispida). Results indicated a difference in haul out behavior by species. Bearded seals were more frequently hauled out whereas ringed seals were almost exclusively in water. Significant differences in species occurrence by depth and ice coverage were recorded; harp and bearded seals were found in deeper mean water depths and areas of higher mean ice coverage while hooded and ringed seals were found in shallower mean water depths and areas of lower mean ice coverage. The second objective of the Petermann Fjord case study was to investigate potential behavioral responses by seals and polar bears (Ursus maritimus) to the icebreaker vessel. Icebreakers, important tools that enable research within the polar regions of the world, have the potential to overlap with marine mammal habitats in infrequently studied areas. To investigate seal “flush response” by distance (i.e., entering the water from the floating ice on which they were resting) relative to the icebreaker seal behavioral responses were recorded. There were fewer flush responses by seals at distances > 600 m and no flush responses by seals at distances > 800 m. In addition, three polar bears were recorded during the transit and a behavioral response (e.g. look, approach, move away) was recorded for all three sightings. The second case study is from the Colville River Delta, an estuarine and coastal region located on the North Slope of Alaska, approximately 120 km west of Prudhoe Bay and 200 km east of Point Barrow inside the barrier islands along the Beaufort Sea coast. During August and September 2014, a seismic acquisition program for oil and gas exploration occurred near the Colville River Delta. Data were collected on marine mammal occurrence, distribution, and response to seismic activities using a combination of visual, acoustic and traditional ecological knowledge (TEK) methods. Marine mammal visual effort totaled 632 hours by observers aboard three small survey vessels. Additionally, an Iñupiat observer and seal hunter from the village of Nuiqsut conducted a small-vessel survey to investigate locations of spotted seal (Phoca largha) haul-out sites. A total of 102 individual marine mammals were recorded from five species: spotted seal, ringed seal, polar bear, bearded seal, and beluga whale (Delphinapterus leucas). Sighting rates were over 13 times higher during non-seismic activity than during seismic activity, suggesting the potential effects from the airgun “noise” on the presence/absence of marine mammals. These findings correspond with previously published behavioral response studies indicating seismic effects (Gordon et al., 2003; Harris et al., 2001; Richardson et al., 1986; Richardson et al., 1999). Over 400 hours of acoustic data were recorded using second-generation Ecological Acoustic Recorders deployed on the seafloor at three locations. Calls were identified for beluga whale, bowhead whale (Balaena mysticetus), bearded seal and ringed seal. Results showed a significant difference between the probabilities of acoustic encounters in the presence versus absence of seismic activity only for beluga whales, suggesting beluga whales increased vocalization rates in response to seismic activity (i.e., a ‘noisier environment’). Marine mammals are known to modify their vocal behavior to compensate for ambient noise by increasing the call rate, signal intensity and duration (Scheifele et al., 2005; Tyak, 2008). Combined visual and acoustic methods along with the inclusion of knowledge (TEK) facilitated more complete coverage and understanding of marine mammal occurrence in this region. The third case study is an offshore region of the northeast Chukchi and Southern Beaufort seas, Alaska. This once remote region is experiencing a significant rise in vessel presence due to new transpolar shipping routes, a growing Arctic tourism industry, and offshore oil and gas exploration and development. Prior to the start of exploration and development, three oil abd gas companies; ConocoPhillips, Shell, and Statoil, funded integrative research programs (Chukchi Sea Environmental Studies Program [CSESP]). Marine mammal occurrence data were collected from vessel surveys during summer and fall 2008-2014. The first objective of the CSESP case study was to investigate large whale occurrence and suitable habitat. During over 56,909 km of observation effort the most commonly recorded large whale species were the bowhead and gray (Eschrichtius robustus) whales. Sub-Arctic large whales recorded included the humpback whale (Megaptera novaeangliae), fin whale (Balaenoptera physalus), and minke whale (Balaenoptera acutorostrata). Records of these species during CSESP parallel other studies finding sub-Arctic species becoming more common in the Chukchi Sea, potentially shifting northward with warmer waters (Brower et al., 2018; Clarke et al., 2013a; Haley et al., 2010). Using Maxent modeling methods with presence and pseudo-absence data a habitat suitability model (HSM) for bowhead and gray whales was developed. HSMs depicted differences in which environmental variables affect suitable habitat; for gray whales, distance to shore was most important, followed by depth. SST was found to be less important, whereas for bowhead whales, distance to shore and SST were found to be important and depth was found to be less important. These disparities, along with the clear differences in distribution patterns depicted in the prediction maps, suggest that bowhead and gray whales occupy separate ecological niches during summer and fall in the Chukchi Sea. The second objective of the CSESP case study was to investigate polar bear occurrence and behavioral response to vessel presence. A total of 42 groups (50 individuals) of polar bears were recorded. During the open water season in the Chukchi Sea, polar bears are thought to migrate north with the retreating ice or move onto land. Results from this study indicated that some polar bears do remain in the offshore environment during the summer and fall season. Over half of the groups exhibited a behavioral response (i.e., vigilance or flee) including all groups of mothers with cubs. Distance at which bears responded to vessels was closer than the distance at which no response was observed. Climate change, loss of sea ice and increasing human activities are expected to alter many Arctic marine mammal species’ habitats and in turn their behavioral ecology (Moore & Huntington, 2008). A species’ ability to adjust to these changes is partially determined by their ability to adjust habitat selection preferences to new environmental conditions. Evaluating the effects of the changing climate, loss of sea ice, and increasing human activities on marine species requires an understanding of species’ distributions and monitoring potential shifts in behavior, range, and suitable habitat. In addition, assessing the impacts of human activities such as oil and gas exploration and increasing vessel presence on Arctic wildlife is a key issue in current management and conservation strategies for many species. As climate change and human activities in the Arctic increase, the need for cumulative effects assessments will be imperative for the future protection of arctic marine mammals

PEACH PRICES IN CALIFORNIA IN THE PRESENCE OF TECHNOLOGICAL CHANGE IN THE AGRICULTURAL PESTICIDE INDUSTRY

The potentially adverse effects of pesticides in wide use are causing concern to grow in the agricultural community. Minimizing the risks to human health and the environment created by agricultural pesticides has become a very important issue. The United States Environmental Protection Agency (EPA) has set a high priority on registering safer pesticides. According to the EPA, more than 1 billion pounds of active pesticide ingredients are used in the United States each year. Americans are exposed to pesticides every day through food consumption, cleaning products, and home and work environments. The agricultural pesticide industry has experienced an influx of changes during the past decade. Two of the primary changes affecting the pesticide industry are the introduction of new technology and EPA regulatory changes. On the regulatory front, the EPA requires manufacturers to register and test pesticides before they appear on the market. By 2006, the EPA will review old pesticides to ensure that they meet new safety requirements. These regulatory initiatives have contributed to the industry drive to develop safer and more "environmentally friendly" products for use in agricultural pest control. Technological changes consist of the introduction of new pesticides that are considered to be safer for both humans and the environment. As new technologies and regulatory initiatives are undertaken to ensure an improvement in both the safety of human health and the environment, one must consider how these changes may affect consumers. Specifically, an analysis should be conducted to determine whether or not the technological and regulatory changes have an effect on consumer prices. The recent developments in the agricultural pesticide industry provide several reasons to believe structural change has been occurring in economic relationships that determine peach prices in California. Therefore, we use a vector autoregressive (VAR) model to forecast peach prices by allowing parameters to vary with time. VAR models differ from standard econometric analyses of structural relationships in that they do not apply the usual exclusion restrictions to specify a priori which variables appear in which equations. Instead, a set of distributed lag equations is used to model each variable as a function of other variables in the structural system (Bessler, 1984). The objective of this paper is to forecast peach prices and evaluate dynamic relationships in the peach industry in the presence of technological and regulatory change. A VAR model that explicitly recognizes structural change will be used to forecast peach prices in California. Changes in dynamic relationships between peach prices and relevant economic variables will be considered.Demand and Price Analysis,