How can palliative care deal with overzealous treatment?

Palliative Care has an important role to play in preventing overzealous treatment. Active palliative care approach should be applied early in the disease and in all conditions, not only in cancer. Palliative Care specialists should be involved in the support and educating generalists, family members and general public. The holistic approach including the existential issues is able to foster new hope and stop patient and the family to insist on more treatments which may bring more harm than benefit. By gathering evidence through research and audit about the prevalence and costs of such iatrogenic activities, we may and advocate for a redesign of end-of-life care services so that patients can routinely access reliable care.Palliative Care has an important role to play in preventing overzealous treatment. Active palliative care approach should be applied early in the disease and in all conditions, not only in cancer. Palliative Care specialists should be involved in the support and educating generalists, family members and general public. The holistic approach including the existential issues is able to foster new hope and stop patient and the family to insist on more treatments which may bring more harm than benefit. By gathering evidence through research and audit about the prevalence and costs of such iatrogenic activities, we may and advocate for a redesign of end-of-life care services so that patients can routinely access reliable care

BIOFUELS, CLIMATE POLICY, AND WATER MANAGEMENT: ASSESSING POLICY-INDUCED SHIFTS ON AGRICULTURE’S EXTENSIVE AND INTENSIVE MARGINS

Biofuel expansion efforts and climate mitigation policy could fundamentally alter land management trends in U.S. agriculture and forestry (AF) by mandating biofuel feedstock production and providing incentives for greenhouse gas (GHG) emissions reduction and carbon sequestration from terrestrial sources. Research has shown that biofuel expansion can alter commodity markets, induce agricultural land expansion, and intensify production. Meanwhile, GHG mitigation efforts could limit agricultural expansion, reduce current cultivation, and lower management intensity by incentivizing GHG emissions reduction and carbon sequestration within AF. To date, little work has attempted to quantify biofuel and climate policy-induced shifts together along the extensive and intensive agricultural production margins within a systems-based framework, though such shifts could have resounding implications on agricultural water consumption and quality. This study uses a comprehensive and detailed economic model of the U.S. AF sectors to simulate land management responses to biofuel expansion and GHG policies. While bioenergy production and altered AF management practices are found to significantly reduce GHG emissions, additional water consumption and nutrient use are possible policy outcomes. Specifically, we find that policies that influence shifts to the extensive margin will increase aggregate water use and nutrient application, but lead to lower intensity per-unit area. Conversely, when combined with biofuel mandates climate mitigation incentives lower agricultural land expansion, but lead to higher levels of management intensity. Somewhat contrary to expectations, GHG mitigation incentives cause water and nutrient use intensity to grow at an increasing rate due to the greater level of land use competition. Additionally, important regional trends emerge, as water use and quality concerns grow with the CO2 price in areas with limited GHG mitigation possibilities. This suggests that “water leakage” is possible whereby emissions reduction activities decrease output in one region and stimulate management intensity elsewhere. The potential indirect consequences of combined biofuel and climate mitigation incentives on water resource systems warrant further attention in policy design and future research.Greenhouse gas mitigation, biofuels, water resource management, Environmental Economics and Policy, Production Economics, Resource /Energy Economics and Policy,

Scale-Free topologies and Activatory-Inhibitory interactions

A simple model of activatory-inhibitory interactions controlling the activity of agents (substrates) through a "saturated response" dynamical rule in a scale-free network is thoroughly studied. After discussing the most remarkable dynamical features of the model, namely fragmentation and multistability, we present a characterization of the temporal (periodic and chaotic) fluctuations of the quasi-stasis asymptotic states of network activity. The double (both structural and dynamical) source of entangled complexity of the system temporal fluctuations, as an important partial aspect of the Correlation Structure-Function problem, is further discussed to the light of the numerical results, with a view on potential applications of these general results.Comment: Revtex style, 12 pages and 12 figures. Enlarged manuscript with major revision and new results incorporated. To appear in Chaos (2006

Pupil-led biomedical lessons for primary school children : a pilot study

Peer reviewedPublisher PD

Integrating palliative care into the community:the role of hospices and schools

Objectives: Palliative care services have, up to now, paid insufficient attention to social aspects of dying and bereavement and this has affected how patients and their families experience end of life and bereavement within their communities. New public health approaches to palliative care offer a different way forward by seeking to develop communities that support death and bereavement. Such approaches are now a priority for the majority of hospices in the UK and work with schools has been identified as a key area of work. Practice that engages schools and children on issues concerning end-of-life care is, however, underdeveloped and underdocumented. This research explored the role of hospices in working with schools to promote education and support around end-of-life and bereavement experiences. Methods: Action research was used to explore the potential for hospices to work with schools and engage participants in change processes. The research was conducted in 1 hospice and 2 primary schools in Scotland. Participants included children, parents and school and hospice staff. Results: Seven innovations were identified that were found to be useful for the school curriculum and the relationship between hospices, school communities and wider society. A model for integrated practice between hospices and schools is suggested. Conclusions: This research adds to knowledge about how hospices might engage in community engagement activities that encourage school staff to develop greater openness and support around end-of-life and bereavement care for their children. This will require a rethinking of normal hospice services to also participate in community capacity building

W jaki sposób uniknąć uporczywej terapii w opiece paliatywnej?

Opieka paliatywna powinna odegrać ważną rolę w zapobieganiu uporczywej terapii. Powinna być stosowana we wczesnym stadium choroby i w odniesieniu do wszystkich schorzeń, nie tylko w chorobie nowotworowej. Specjaliści w zakresie opieki paliatywnej powinni się zaangażować we wspieranie oraz edukację lekarzy podstawowej opieki zdrowotnej, członków rodzin i całego społeczeństwa. Podejście holistyczne, uwzględniające zagadnienia natury egzystencjalnej, może wzbudzić nową nadzieję oraz powstrzymać pacjenta i jego rodzinę przed domaganiem się dalszego leczenia, które może przynieść więcej szkody niż pożytku. Dowody zgromadzone w trakcie badań oraz przeprowadzonych audytów dotyczących rozpowszechnienia i kosztów działań jatrogennych wskazują, że potrzebne są zmiany w opiece nad chorymi w schyłkowym okresie życia, dzięki którym pacjenci będą mieli stały dostęp do opieki na najwyższym poziomie. Medycyna Paliatywna w Praktyce 2010; 4, 2: 86-9