Serious life-threatening and life-limiting illnesses place an enormous burden on society and health systems. Understanding how this burden will evolve in the future is essential to inform policies ...that alleviate suffering and prevent health system weakening. We aimed to project the global burden of serious health-related suffering requiring palliative care until 2060 by world regions, age groups, and health conditions.
We projected the future burden of serious health-related suffering as defined by the Lancet Commission on Palliative Care and Pain Relief, by combining WHO mortality projections (2016–60) with estimates of physical and psychological symptom prevalence in 20 conditions most often associated with symptoms requiring palliative care. Projections were described in terms of absolute numbers and proportional change compared with the 2016 baseline data. Results were stratified by World Bank income regions and WHO geographical regions.
By 2060, an estimated 48 million people (47% of all deaths globally) will die with serious health-related suffering, which represents an 87% increase from 26 million people in 2016. 83% of these deaths will occur in low-income and middle-income countries. Serious health-related suffering will increase in all regions, with the largest proportional rise in low-income countries (155% increase between 2016 and 2060). Globally, serious health-related suffering will increase most rapidly among people aged 70 years or older (183% increase between 2016 and 2060). In absolute terms, it will be driven by rises in cancer deaths (16 million people, 109% increase between 2016 and 2060). The condition with the highest proportional increase in serious-related suffering will be dementia (6 million people, 264% increase between 2016 and 2060).
The burden of serious health-related suffering will almost double by 2060, with the fastest increases occurring in low-income countries, among older people, and people with dementia. Immediate global action to integrate palliative care into health systems is an ethical and economic imperative.
Research Challenge Fund, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London.
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The optoelectronic properties of gallium arsenide (GaAs) hold great promise in biosensing applications, currently being held back by the lack of methodologies reporting the spatially ...selective functionalisation of this material with multiple biomolecules. Here, we exploit the use of a photoreactive crosslinker - a diazirine derivative - for spatially selective covalent immobilisation of multiple bioreceptors on the GaAs surface. As a proof of principle we show the immobilisation of two proteins: neutravidin and endosulfine alpha protein. X-ray photoelectron spectroscopy results showed the presence of the biomolecules on the GaAs regions selectively exposed to ultraviolet light. The approach presented here is applicable to the covalent attachment of other biomolecules, paving the way for using GaAs as a platform for multiplexed biosensing.
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Resumo Seguindo uma cena do atletismo nos Jogos Olímpicos de 2016, no Rio de Janeiro, iremos esmiuçar relações institucionais, científicas e morais que permeiam a regulação esportiva da elegibilidade ...feminina no alto rendimento, observando com atenção as imbricações multissituadas da categoria integridade. Nesse contexto analisado, o corpo sexuado aparece como lugar privilegiado de inscrição social, especialmente o corpo feminino que apresenta alguma variação de intersexualidade. Acompanharemos parte dessa experiência esportiva, que envolveu a vitória da sul-africana Caster Semenya nos 800 metros feminino, para refletir sobre um modo particular e efetivo de gestão dos corpos e das populações na vida contemporânea. Utilizando cada vez mais recursos técnicos e saberes hormonais, sem abandonar memórias e estratégias de um passado colonial, as entidades esportivas atuais legitimam ou debilitam atletas para proteger a categoria feminina. Com isso, tecem os próprios limites que esses corpos - sexuados e atléticos - conseguem pertencer ao movimento olímpico, materializar virilidade e visibilizar masculinidade feminina.
Resumen Siguiendo una escena del atletismo en los Juegos Olímpicos de 2016, en Río de Janeiro, escudriñaremos relaciones institucionales, científicas y morales que permean la regulación deportiva de la elegibilidad femenina en alto rendimiento, acompañando las imbricaciones multisituadas de la categoría integridad. En este contexto analizado, el cuerpo sexuado aparece como un lugar privilegiado de inscripción social, especialmente el cuerpo femenino que presenta alguna variante de intersexualidad. Seguiremos parte de esta experiencia deportiva, que supuso la victoria de la sudafricana Caster Semenya en los 800 metros femeninos, con el objetivo de comprender un modo particular y eficaz de gestión de los cuerpos y las poblaciones en la vida contemporánea. Utilizando cada vez más recursos técnicos y conocimientos hormonales, sin abandonar memorias y estrategias de un pasado colonial, las entidades deportivas legitiman o debilitan a las atletas para proteger la categoría femenina. Con ello, trazan los propios limites que estos cuerpos - sexuados y atléticos - logran para pertenecer al movimiento olímpico, materializar virilidad y visibilizar la masculinidad femenina.
Abstract Taking as our point of analysis the Olympic Games in Rio de Janeiro in 2016, we will scrutinize the institutional, scientific and moral relations that permeated the regulation of female eligibility in elite sports, looking closely at integrity as a multi-situated, imbricated category. In the context under analysis, the sexed body appears as a privileged place of social inscription, with the female body that presents some variation of intersexuality being seen as especially problematic. We follow part of the Olympic sporting experience involving the victory of Caster Semenya (South Africa) in the women’s 800 meter race. We seek to reflect upon a particular and effective mode of management of bodies and populations in contemporary life. With the increasing use of technical resources and hormonal knowledge -- and without abandoning the memories and strategies of a colonial past -- sport entities legitimate or exclude athletes participation in the name of protecting women’s sports. Ultimately, they weave the limits that these sexed and athletic bodies must stay within in order to belong to the Olympic movement, materializing virility and making female masculinity visible.
Background:
Ageing nations have growing needs for end of life care, but these have never
been projected in detail. We analysed past trends in place of death (1974—2003)
and projected likely trends to ...2030 in England and Wales and from these need for
care.
Methods:
Mortality trends and forecasts were obtained from official statistics. Future
scenarios were modelled using recent five-year trends in age and gender specific
home death proportions to estimate numbers of deaths by place to 2030, accounting
for future changes in the age and gender distribution of deaths.
Results:
Annual numbers of deaths fell by 8% from 1974 to 2003, but are expected to
rise by 17% from 2012 to 2030. People will die increasingly at older ages, with
the percentage of deaths among those aged 85 and expected to rise from 32% in 2003
to 44% in 2030. Home death proportions fell from 31% to 18% overall, and at an
even higher rate for people aged 65 and over, women and noncancer deaths. If
recent trends continue, numbers of home deaths could reduce by 42% and fewer than
1 in 10 will die at home in 2030. Annual numbers of institutional deaths
(currently 440936) will be 530409 by 2030 (20% increase).
Conclusions:
In England and Wales home deaths have been decreasing. The projections
underline the urgent need for planning care to accommodate a large increase of
ageing and deaths. Either inpatient facilities must increase substantially, or
many more people will need community end of life care from 2012 onwards.
Palliative Medicine 2008;
22
: 33—41
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In nature, interfacial molecular interactions are at the heart of all biological processes and are mediated by diverse stimuli. Inspired by nature's responsive mechanisms and our increased capability ...to manipulate matter at the molecular level, new bio-interface materials are being developed that respond efficiently to a variety of external stimuli. In this Review, we discuss emerging methods for imparting surfaces with dynamic properties and how this, in turn, is leading to increased functional complexity at the bio-interface. We examine how recent advances are becoming important in providing new insights into cell behaviour and spurring substantial progress in the fields of regenerative medicine and tissue engineering. These advances provide new opportunities to address the complex issues associated with biofouling and facilitate the production of implantable on-demand sensing devices and highly effective delivery, bioseparation and bioelectrocatalytic systems. Although progress is being made, we also highlight that current methods are still limited in their capability to impart complex functionality onto the bio-interface to fully address the current challenges in biotechnology and biomedicine. Exciting prospects include the incorporation of full reversibility of interactions, a broad repertoire of multi-responsiveness and bidirectional actuation at the bio-interface, as well as the capability to incorporate the developed systems in practical applications.Bio-interface materials inspired by natural systems that respond efficiently to various external stimuli can dynamically regulate molecular interactions between biological entities and material surfaces. In this Review, Gomes and colleagues describe advances in bio-interface materials that may provide insights into cell behaviour, biofouling and the production of on-demand devices with medical applications, among others.
Background: Increased attention is being paid to the place where people die with a view to providing choice and adequately planning care for terminally ill patients. Secular trends towards an ...institutionalised dying have been reported in Britain and other developed world regions.
Aim: This study aimed to examine British national trends in place of death from 2004 to 2010.
Design and setting: Descriptive analysis of death registration data from the Office for National Statistics, representing all 3,525,564 decedents in England and Wales from 2004 to 2010.
Results: There was a slow but steady increase in the proportion of deaths at home, from 18.3% in 2004 to 20.8% in 2010. Absolute numbers of home deaths increased by 9.1%, whilst overall numbers of deaths decreased by 3.8%. The rise in home deaths was more pronounced in cancer, happened for both genders and across all age groups, except for those younger than 14 years and for those aged 65–84, but only up to 2006. The rise was more evident when ageing was accounted for (age–gender standardised proportions of home deaths increased from 20.6% to 23.5%).
Conclusions: Following trends in the USA and Canada, dying is also shifting to people’s homes in Britain. Home deaths increased for the first time since 1974 amongst people aged 85 years and over. There is an urgent need across nations for comparative evidence on the outcomes and the costs of dying at home.
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Gallium arsenide (GaAs) is a promising candidate as a platform for optical biosensing devices due to its enabling optoelectronic properties. However, the biofunctionalisation of the ...GaAs surface has not received much attention compared to gold, carbon and silicon surfaces. Here we report a study presenting a physicochemical surface characterisation of the GaAs surface along the functionalisation with a high-affinity bioconjugation pair widely explored in the life sciences – biotin and neutravidin. Combined X-ray photoelectron spectroscopy (XPS), wettability measurements and spectroscopic ellipsometry were used for a reliable characterisation of the surface functionalisation process. The results suggest that a film with a thickness lower than 10 nm was formed, with a neutravidin to biotin ratio of 1:25 on the GaAs surface. Reduction of non-specific binding of the protein to the surface was achieved by optimising the protein buffer and rinsing steps. This study shows the feasibility of using GaAs as a platform for specific biomolecular recognition, paving the way to a new generation of optoelectronic biosensors.
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Little attention has been paid to the symptom management needs of patients with life-threatening diseases other than cancer. In this study, we aimed to determine to what extent patients with ...progressive chronic diseases have similar symptom profiles. A systematic search of medical databases (MEDLINE, EMBASE, and PsycINFO) and textbooks identified 64 original studies reporting the prevalence of 11 common symptoms among end-stage patients with cancer, acquired immunodeficiency syndrome (AIDS), heart disease, chronic obstructive pulmonary disease, or renal disease. Analyzing the data in a comparative table (a grid), we found that the prevalence of the 11 symptoms was often widely but homogeneously spread across the five diseases. Three symptoms—pain, breathlessness, and fatigue—were found among more than 50% of patients, for all five diseases. There appears to be a common pathway toward death for malignant and nonmalignant diseases. The designs of symptom prevalence studies need to be improved because of methodological disparities in symptom assessment and designs.
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Este artigo apresenta uma revisão documental e bibliográfica de parte do histórico de gestão da feminilidade no esporte de alto rendimento. Nesse sentido, é preciso acompanhar como nasce o movimento ...olímpico. Uma recapitulação necessária para saber de onde vem e como se estrutura a necessidade de controle dos corpos atléticos das mulheres. Com a defesa de certos valores pautados no dimorfismo sexual, entenderemos como a ciência e a medicina auxiliaram na estabilização de fronteiras biológicas, sociais e esportivas. Contudo, à medida que esse conhecimento se transforma, todo um emaranhado regulatório também é atualizado em torno da elegibilidade das mulheres no esporte. A condução do artigo aposta na interpretação de que a proteção da categoria feminina no esporte se fez tanto por meio da suspeição quanto pela justiça, com a linguagem dos direitos sendo cada vez mais incorporada.
This article presents a documentary and bibliographic review of part of the history of femininity management in high-performance sport. In this sense, it is necessary to follow up how the Olympic movement is born. A necessary recap to know where it comes from and how the need to control women’s athletic bodies is structured. With the defense of certain values based on sexual dimorphism, we will understand how science and medicine helped to stabilize biological, social and sports boundaries. But as this knowledge changes, an entire regulatory meshwork is also updated around the eligibility of women in sport. The conduct of the article bets on the interpretation that the protection of the female category in sport was done both through suspicion and by justice, with the language of human rights being increasingly incorporated.
Este artículo presenta una revisión documental y bibliográfica de parte de la historia de la gestión de la feminidad en los deportes de alto rendimiento. En este sentido, es necesario monitorear cómo nace el movimiento olímpico. Una recapitulación necesaria para saber de dónde viene y cómo se estructura la necesidad de controlar los cuerpos atléticos de las mujeres. Con la defensa de ciertos valores basados en el dimorfismo sexual, entenderemos cómo la ciencia y la medicina ayudaron a estabilizar los límites biológicos, sociales y deportivos. Pero a medida que este conocimiento cambie, todo un enredo regulatorio también se actualiza en torno a la elegibilidad de las mujeres en el deporte. La conducción del artículo apuesta por la interpretación de que la protección de la categoría femenina en el deporte se hizo tanto por la sospecha como por la justicia, incorporándose cada vez más el lenguaje de los derechos.
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