Abstract Context The need for children's palliative care (CPC) globally is unknown. In order to understand the scope of the need and to advocate to meet it, more accurate estimates are needed. ...Objectives To create an accurate global estimate of the worldwide need for CPC based on a representative sample of countries from all regions of the world and all World Bank income groups. Methods This work builds on previously published methods developed by the International Children's Palliative Care Network, UNICEF, and WHO and tested in three African countries. The study used a cross-sectional design with quantitative data obtained from primary and secondary data sources. Estimation of the need used prevalence data from the Institute for Health Metrics and Evaluation, mortality data from the WHO for the specific diseases known to require CPC, and UNAIDS data on HIV prevalence. Representative data were analyzed for twenty-three countries representing 59.5% of the world's population. Results The findings show estimated need for children's palliative care ranged from almost 120 per 10,000 children in Zimbabwe to slightly more than 20 per 10,000 in the United Kingdom. Overall, among the over 21 million with conditions that will benefit annually from a palliative care approach, more than 8 million need specialized children's palliative care worldwide. Conclusion The estimation of need for CPC is a critical step in meeting the needs of children with life-threatening conditions and provides a sound platform to advocate for closure of the unacceptably wide gaps in coverage.
Abstract Our purpose is to categorize palliative care development, country by country, throughout the world, showing changes over time. We adopt a multi-method approach. Development is categorized ...using a six-part typology: Group 1 (no known hospice-palliative care activity) and Group 2 (capacity-building activity) are the same as developed during a previous study (2006), but Groups 3 and 4 have been subdivided to produce two additional levels of categorization: 3a) Isolated palliative care provision, 3b) Generalized palliative care provision, 4a) Countries where hospice-palliative care services are at a stage of preliminary integration into mainstream service provision, and 4b) Countries where hospice-palliative care services are at a stage of advanced integration into mainstream service provision. In 2011, 136 of the world's 234 countries (58%) had at least one palliative care service—an increase of 21 (+9%) from 2006, with the most significant gains having been made in Africa. Advanced integration of palliative care has been achieved in only 20 countries (8.5%). Total countries in each category are as follows: Group 1, 75 (32%); Group 2, 23 (10%); Group 3a, 74 (31.6%); Group 3b, 17 (7.3%); Group 4a, 25 (10.7%); and Group 4b, 20 (8.5%). Ratio of services to population among Group 4a/4b countries ranges from 1:34,000 (in Austria) to 1:8.5 million (in China); among Group 3a/3b countries, from 1:1000 (in Niue) to 1:90 million (in Pakistan). Although more than half of the world's countries have a palliative care service, many countries still have no provision, and major increases are needed before palliative care is generally accessible worldwide.
The estimation of near surface air temperature (Ta) is useful for a wide range of applications such as agriculture, climate related diseases and climate change studies. Air temperature is commonly ...obtained from synoptic measurements in weather stations. In Africa, the spatial distribution of weather stations is often limited and the dissemination of temperature data is variable, therefore limiting their use for real-time applications. Compensation for this paucity of information may be obtained by using satellite-based methods. However, the derivation of near surface air temperature (Ta), from the land surface temperature (Ts) derived from satellite is far from straight forward. Some studies have tried to derive maximum Ta from satellites through regression analysis but the accuracy obtained is quite variable according to the study. The main objective of this study was to explore the possibility of retrieving high-resolution Ta data from the Moderate Resolution Imaging Spectroradiometer (MODIS) Ts products over different ecosystems in Africa. First, comparisons between night MODIS Ts data with minimum Ta showed that MODIS nighttime products provide a good estimation of minimum Ta over different ecosystems (with (ΔTs
−
Ta) centered at 0
°C, a mean absolute error (MAE)
=
1.73
°C and a standard deviation
=
2.4
°C). Secondly, comparisons between day MODIS Ts data with maximum Ta showed that (ΔTs
−
Ta) strongly varies according to the seasonality, the ecosystems, the solar radiation, and cloud-cover. Two factors proposed in the literature to retrieve maximum Ta from Ts,
i.e. the Normalized Difference Vegetation Index (NDVI) and the Solar Zenith Angle (SZA), were analyzed. No strong relationship between (ΔTs
−
Ta) and (i) NDVI and (ii) SZA was observed, therefore requiring further research on robust methods to retrieve maximum Ta.
Few efforts have attempted to quantify how well countries deliver end-of-life (EOL) care.
To score, grade, and rank countries (and Hong Kong and Taiwan) on the quality of EOL care based on ...assessments from country experts using a novel preference-based scoring algorithm.
We fielded a survey to country experts around the world, asking them to assess the performance of their country on 13 key indicators of EOL care. Results were combined with preference weights from caregiver-proxies of recently deceased patients to generate a preference-weighted summary score. The scores were then converted to grades (from A–F) and a ranking was created for all included countries.
The final sample included responses from 181 experts representing 81 countries with 2 or more experts reporting. The 6 countries who received the highest assessment scores and a grade of A were United Kingdom, Ireland, Taiwan, Australia, Republic of Korea, and Costa Rica. Only Costa Rica (upper middle) is not a high income country. Not until Uganda (ranked 31st) does a low-income country appear on the ranking. Based on the assessment scores, twenty-one countries received a failing grade, with only two – Czech Republic (66th), and Portugal (75th) – being high income countries.
This study provides an example of how a preference-based scoring algorithm and input from key stakeholders can be used to assess EOL health system performance. Results highlight the large disparities in assessments of the quality of EOL care across countries, and especially between the highest income countries and others.
Transparent conductive electrodes are important components of thin-film solar cells, light-emitting diodes, and many display technologies. Doped metal oxides are commonly used, but their optical ...transparency is limited for films with a low sheet resistance. Furthermore, they are prone to cracking when deposited on flexible substrates, are costly, and require a high-temperature step for the best performance. We demonstrate solution-processed transparent electrodes consisting of random meshes of metal nanowires that exhibit an optical transparency equivalent to or better than that of metal-oxide thin films for the same sheet resistance. Organic solar cells deposited on these electrodes show a performance equivalent to that of devices based on a conventional metal-oxide transparent electrode.
Different satellite rainfall products are used in different applications over different parts of the world. These products are particularly important over many parts of Africa, where they are used to ...augment the very sparse rain-gauge network. However, the quality of the different satellite products varies from one product to another and from one climatic region to another. The climate over eastern Africa varies from wet coastal and mountainous regions to dry arid regions. Significant variations could be observed within short distances. The different climates will pose different challenges to satellite rainfall retrieval over this region. This study explores the effect of mountainous and arid climates on four different satellite rainfall-estimation (RFE) algorithms. The mountainous climate is located over the Ethiopian highlands, while the arid region covers parts of Ethiopia, Djibouti and Somalia. One infrared-only product, African rainfall climatology (ARC), one passive-microwave-only product (the Climate Prediction Center morphing technique, CMORPH) and two products (the RFE algorithm and the tropical rainfall measuring mission (TRMM-3B42)), which combine both infrared and passive-microwave estimates, are used for this investigation. All the products exhibit moderate underestimation of rainfall over the highlands of Ethiopia, while the overestimation over the dry region is found to be very high. The underestimation over the mountainous region is ascribed to the warm orographic rain process, while the overestimation over the dry region may be because of sub-cloud evaporation. Local calibration of satellite algorithms and merging of satellite estimates with all locally available rain-gauge observations are some of the approaches that could be employed to alleviate these problems.
Nanoscience provides many strategies to construct high-performance materials and devices, including solar cells, thermoelectrics, sensors, transistors, and transparent electrodes. Bottom-up ...fabrication facilitates large-scale chemical synthesis without the need for patterning and etching processes that waste material and create surface defects. However, assembly and contacting procedures still require further development. Here, we demonstrate a light-induced plasmonic nanowelding technique to assemble metallic nanowires into large interconnected networks. The small gaps that form naturally at nanowire junctions enable effective light concentration and heating at the point where the wires need to be joined together. The extreme sensitivity of the heating efficiency on the junction geometry causes the welding process to self-limit when a physical connection between the wires is made. The localized nature of the heating prevents damage to low-thermal-budget substrates such as plastics and polymer solar cells. This work opens new avenues to control light, heat and mass transport at the nanoscale.
The Open Society Foundation's International Palliative Care Initiative (IPCI) began to support palliative care development in Central and Eastern Europe and the Former Soviet Union in 1999. ...Twenty-five country representatives were invited to discuss the need for palliative care in their countries and to identify key areas that should be addressed to improve the care of adults and children with life-limiting illnesses. As a public health concern, progress in palliative care requires integration into health policy, education and training of health care professionals, availability of essential pain relieving medications, and health care services. IPCI created the Palliative Care Roadmap to serve as a model for government and/or nongovernment organizations to use to frame the necessary elements and steps for palliative care integration. The roadmap includes the creation of multiple Ministry of Health–approved working groups to address: palliative care inclusion in national health policy, legislation, and finance; availability of essential palliative care medications, especially oral opioids; education and training of health care professionals; and the implementation of palliative care services at home or in inpatient settings for adults and children. Each working group is tasked with developing a pathway with multiple signposts as indicators of progress made. The roadmap may be entered at different signposts depending upon the state of palliative care development in the country. The progress of the working groups often takes place simultaneously but at variable rates. Based on our experience, the IPCI Roadmap is one possible framework for palliative care development in resource constrained countries but requires both health care professional engagement and political will for progress to be made.
Palliative care is gaining ground globally and is endorsed in high-level policy commitments, but service provision, supporting policies, education, and funding are incommensurate with rapidly growing ...needs.
The objective of this study was to describe current levels of global palliative care development and report on changes since 2006.
An online survey of experts in 198 countries generated 2017 data on 10 indicators of palliative care provision, fitted to six categories of development. Factor analysis and discriminant analysis showed the validity of the categorization. Spearman correlation analyses assessed the relationship with World Bank Income Level (WBIL), Human Development Index (HDI), and Universal Health Coverage (UHC).
Numbers (percentages) of countries in each development category were as follows: 1) no known palliative care activity, 47 (24%); 2) capacity-building, 13 (7%); 3a) isolated provision, 65 (33%); 3b) generalized provision, 22 (11%); 4a) preliminary integration into mainstream provision, 21 (11%); 4b) advanced integration, 30 (15%). Development levels were significantly associated with WBIL (rS = 0.4785), UHC (rS = 0.5558), and HDI (rS = 0.5426) with P < 0.001. Net improvement between 2006 and 2017 saw 32 fewer countries in Categories 1/2, 16 more countries in 3a/3b, and 17 more countries in 4a/4b.
Palliative care at the highest level of provision is available for only 14% of the global population and is concentrated in European countries. An 87% global increase in serious health-related suffering amenable to palliative care interventions is predicted by 2060. With an increasing need, palliative care is not reaching the levels required by at least half of the global population.
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