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On 3–4 October 2022, the Memorial Sloan Kettering Cancer Center Supportive Care Service and Department of Psychiatry and Behavioral Sciences hosted the Third Annual United States (US) Celebration of World Hospice and Palliative Care Day (WHPCD). The purpose of this article is to reflect on the event within the broader context of the international WHPCD theme: “healing hearts and communities.” We describe lessons learned in anticipation of the fourth annual conference to be held on 3–4 October 2023.
Methods
Description of the third annual event, conference planning team reflection, and attendee evaluation responses.
Results
The Worldwide Hospice Palliative Care Alliance launched WHPCD in 2005 as an annual unified day of action to celebrate and support hospice and palliative care globally. Since 2020, the conference has attracted an increasing number of attendees from around the world. Two primary aims continue to guide the event: community building and wisdom sharing. Fifty-two interprofessional palliative care experts, advocates, patients, and caregivers provided 13 unique interactive sessions. Four hundred and fifty-eight multidisciplinary registrants from at least 17 countries joined the program. Free registration for colleagues in low- and middle-income countries, students and trainees, and individuals experiencing financial hardship remains a cornerstone of inclusion and equitable access to the event.
Significance of results
The US WHPCD celebration provides a virtual platform that offers opportunities for scientific dissemination and collective reflection on hospice and palliative care delivery amid significant local and global changes in clinical practice, research, policy and advocacy, and population health. We remain committed to ensuring an internationally relevant, culturally diverse, and multidisciplinary agenda that will continue to draw increased participation worldwide during future annual events.
On October 5–6, 2021, the Memorial Sloan Kettering Cancer Center Supportive Care Service and Department of Psychiatry and Behavioral Sciences hosted the 2nd Annual United States (US) Celebration of World Hospice and Palliative Care Day (WHPCD). The purpose of this article is to describe the event within the broader context of the international WHPCD theme: “Leave No One Behind — Equity in Access to Palliative Care.” We reflect on lessons learned in anticipation of the 3rd annual conference to be held October 3–4, 2022.
Methods
Description of the 2nd annual event, conference planning team reflection, and attendee evaluation responses.
Results
The Worldwide Hospice Palliative Care Alliance launched WHPCD in 2005 as an annual unified day of action to celebrate and support hospice and palliative care around the world. The 2021 US-based innovative virtual conference featured 37 interprofessional hospice and palliative care specialists and patient and family caregiver speakers across 11 diverse sessions with a focus on health equity and COVID-19 considerations. Two primary aims continue to guide the event: community building and wisdom sharing at the intersection of art and science. 278 registrants from at least 14 countries and 21 different states across the US joined the program, which served as a global debriefing for hospice and palliative care workers from diverse settings, contexts, and disciplines.
Significance of results
The US WHPCD Celebration creates a virtual coming together for collective reflection on hospice and palliative care delivery amid vast changes in clinical practice, research, and policy, both locally and globally. In addition, our goal to ensure an internationally relevant, culturally inclusive, and multidisciplinary agenda will continue to draw increased participation worldwide during future annual events.
On October 10, 2020, the Memorial Sloan Kettering Cancer Center Supportive Care Service hosted their first-ever United States (US) World Hospice and Palliative Care Day (WHPCD) Celebration. The purpose of this article is to describe the US inaugural event in alignment with the broader goals of WHPCD and provide lessons learned in anticipation of the second annual conference to be held on October 5–6, 2021.
Methods
Description of the inaugural event in the context of COVID-19 and WHPCD, co-planning conference team reflection, and attendee survey responses.
Results
The Worldwide Hospice Palliative Care Alliance initially launched WHPCD in 2005 as an annual unified day of action to celebrate and support hospice and palliative care around the world. The US-based innovative virtual conference featured 23 interprofessional hospice and palliative care specialists and patient and family caregiver speakers across nine diverse sessions addressing priorities at the intersection of COVID-19, social injustice, and the global burden of serious health-related suffering. Two primary aims guided the event: community building and wisdom sharing. Nearly 270 registrants from at least 16 countries and one dozen states across the US joined the free program focused on both personal and professional development.
Significance of results
Unlike many other academic conferences and professional gatherings that were relegated to online forums due to pandemic-related restrictions, the US WHPCD Celebration was intentionally established to create a virtual coming together for collective reflection on the barriers and facilitators of palliative care delivery amid vast societal change. The goal to ensure a globally relevant and culturally inclusive agenda will continue to draw increased participation at an international level during future annual events. Finally, the transparent and respectful sharing of palliative care team experiences in the year preceding the conference established a safe environment for both individual expression and scholarly discussion.
The rocky shores of the north-east Atlantic have been long studied. Our focus is from Gibraltar to Norway plus the Azores and Iceland. Phylogeographic processes shape biogeographic patterns of biodiversity. Long-term and broadscale studies have shown the responses of biota to past climate fluctuations and more recent anthropogenic climate change. Inter- and intra-specific species interactions along sharp local environmental gradients shape distributions and community structure and hence ecosystem functioning. Shifts in domination by fucoids in shelter to barnacles/mussels in exposure are mediated by grazing by patellid limpets. Further south fucoids become increasingly rare, with species disappearing or restricted to estuarine refuges, caused by greater desiccation and grazing pressure. Mesoscale processes influence bottom-up nutrient forcing and larval supply, hence affecting species abundance and distribution, and can be proximate factors setting range edges (e.g., the English Channel, the Iberian Peninsula). Impacts of invasive non-native species are reviewed. Knowledge gaps such as the work on rockpools and host–parasite dynamics are also outlined.
To determine the impact of mucosal barrier injury laboratory-confirmed bloodstream infections (MBI-LCBIs) on central-line–associated bloodstream infection (CLABSI) rates during the first year of MBI-LCBI reporting to the National Healthcare Safety Network (NHSN)
DESIGN
Descriptive analysis of 2013 NHSN data
SETTING
Selected inpatient locations in acute care hospitals
METHODS
A descriptive analysis of MBI-LCBI cases was performed. CLABSI rates per 1,000 central-line days were calculated with and without the inclusion of MBI-LCBIs in the subset of locations reporting ≥1 MBI-LCBI, and in all locations (regardless of MBI-LCBI reporting) to determine rate differences overall and by location type.
RESULTS
From 418 locations in 252 acute care hospitals reporting ≥1 MBI-LCBIs, 3,162 CLABSIs were reported; 1,415 (44.7%) met the MBI-LCBI definition. Among these locations, removing MBI-LCBI from the CLABSI rate determination produced the greatest CLABSI rate decreases in oncology (49%) and ward locations (45%). Among all locations reporting CLABSI data, including those reporting no MBI-LCBIs, removing MBI-LCBI reduced rates by 8%. Here, the greatest decrease was in oncology locations (38% decrease); decreases in other locations ranged from 1.2% to 4.2%.
CONCLUSIONS
An understanding of the potential impact of removing MBI-LCBIs from CLABSI data is needed to accurately interpret CLABSI trends over time and to inform changes to state and federal reporting programs. Whereas the MBI-LCBI definition may have a large impact on CLABSI rates in locations where patients with certain clinical conditions are cared for, the impact of MBI-LCBIs on overall CLABSI rates across inpatient locations appears to be more modest.
We have had experience with diaphragm pacing in 24 patients at the Toronto Western Hospital. Fourteen patients have undergone bilateral implants to treat chronic ventilatory insufficiency (CVI) caused by traumatic tetraplegia at the C1/2 level (eight patients), neurogenic apnea (five) and one case of neonatal apnea. Unilateral stimulators for nocturnal pacing have been implanted in five patients with central alveolar hypoventilation (sleep apnea) and five patients who suffered CVI resulting from various etiologies. Of the patients who were ventilatory dependent, 80% were successfully weaned and in the entire series, 58% of the patients are living. Diaphragm pacing was successful in 67%, partially successful in 8% and ineffective in 25%. The major complications were: death by pneumonia, failure of the radio receivers, and infection. Diaphragm pacing is the treatment of choice for patients who are ventilator dependent and tetraplegic from upper cervical trauma or in some cases of neurogenic apnea; it may be life saving for patients who suffer central alveolar hypoventilation.
Since hospitals in a region often share patients, an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) infection in one hospital could affect other hospitals.
Methods.
Using extensive data collected from Orange County (OC), California, we developed a detailed agent-based model to represent patient movement among all OC hospitals. Experiments simulated MRSA outbreaks in various wards, institutions, and regions. Sensitivity analysis varied lengths of stay, intraward transmission coefficients (β), MRSA loss rate, probability of patient transfer or readmission, and time to readmission.
Results.
Each simulated outbreak eventually affected all of the hospitals in the network, with effects depending on the outbreak size and location. Increasing MRSA prevalence at a single hospital (from 5% to 15%) resulted in a 2.9% average increase in relative prevalence at all other hospitals (ranging from no effect to 46.4%). Single-hospital intensive care unit outbreaks (modeled increase from 5% to 15%) caused a 1.4% average relative increase in all other OC hospitals (ranging from no effect to 12.7%).
Conclusion.
MRSA outbreaks may rarely be confined to a single hospital but instead may affect all of the hospitals in a region. This suggests that prevention and control strategies and policies should account for the interconnectedness of health care facilities.
This study aimed to describe the transmission dynamics, the serological and virus excretion patterns of Nipah virus (NiV) in Pteropus vampyrus bats. Bats in captivity were sampled every 7–21 days over a 1-year period. The data revealed five NiV serological patterns categorized as high and low positives, waning, decreasing and increasing, and negative in these individuals. The findings strongly suggest that NiV circulates in wild bat populations and that antibody could be maintained for long periods. The study also found that pup and juvenile bats from seropositive dams tested seropositive, indicating that maternal antibodies against NiV are transmitted passively, and in this study population may last up to 14 months. NiV was isolated from the urine of one bat, and within a few weeks, two other seronegative bats seroconverted. Based on the temporal cluster of seroconversion, we strongly believe that the NiV isolated was recrudesced and then transmitted horizontally between bats during the study period.
In February 2007 an outbreak of Nipah virus (NiV) encephalitis in Thakurgaon District of northwest Bangladesh affected seven people, three of whom died. All subsequent cases developed illness 7–14 days after close physical contact with the index case while he was ill. Cases were more likely than controls to have been in the same room (100% vs. 9·5%, OR undefined, P<0·001) and to have touched him (83% vs. 0%, OR undefined, P<0·001). Although the source of infection for the index case was not identified, 50% of Pteropus bats sampled from near the outbreak area 1 month after the outbreak had antibodies to NiV confirming the presence of the virus in the area. The outbreak was spread by person-to-person transmission. Risk of NiV infection in family caregivers highlights the need for infection control practices to limit transmission of potentially infectious body secretions.
Relations between town and country are central to Europe's long-term economic, political and social evolution. This 2001 book surveys and re-interprets these relations in particular countries and regions in the light of the most recent debates on state formation, urbanisation, proto-industrialisation, and the regional character of pre-modern economic growth. Thirteen specially commissioned chapters, ranging chronologically from the Black Death to the Enlightenment, give a comprehensive coverage of Europe, from Spain to Sweden and England, and from the Polish Commonwealth to Holland and Italy. Each chapter offers a self-contained analysis of its country or region and provides a basis for systematic comparison. The Introduction (by S. R. Epstein) discusses the historiographical and theoretical framework for the regional chapters, emphasising how evolving political configurations changed the balance between 'coercive' and 'market-based' solutions to town-country relations and set countries on different paths to growth.
For a long time guilds have been condemned as a major obstacle to economic progress in the pre-industrial era. This re-examination of the role of guilds in the early modern European economy challenges that view by taking into account fresh research on innovation, technological change and entrepreneurship. Leading economic historians argue that industry before the Industrial Revolution was much more innovative than previous studies have allowed for and explore the different products and production techniques that were launched and developed in this period. Much of this innovation was fostered by the craft guilds that formed the backbone of industrial production before the rise of the steam engine. The book traces the manifold ways in which guilds in a variety of industries in Italy, Austria, Germany, Switzerland, France, Belgium, the Netherlands, and Britain helped to create an institutional environment conducive to technological and marketing innovations.
Inertial confinement fusion (ICF) requires high compression of fusion fuel to densities approaching 1000 times liquid density of deuterium-tritium (D–T) at central temperatures in excess of 5 keV. The goal of ICF is to achieve high gain (of the order of 100 or greater) in the laboratory. To meet this objective with minimum driver energy, a number of central issues must be addressed. Research in ICF with laser drivers has shown the importance of using short wavelength (λ < 0.5 µm). To achieve conditions for high gain at driver energies of a few megajoules or less, high intensities (>1014W/cm2) are required. The directdrive approach to ICF is more energy efficient than indirect drive if the stringent drive symmetry and hydrodynamic stability requirements can be met by a suitable laser irradiation scheme and target design. Experiments carried out at 351 nm on the 2-kJ, 24-beam OMEGA laser system at the Laboratory for Laser Energetics (LLE) at the University of Rochester, and future experiments to be performed on a 30-kJ upgrade of this laser, can resolve the remaining physics issues for direct drive: (1) energy coupling and transport scaling; (2) irradiation-uniformity requirements for high gain; (3) hydrodynamic stability constraints; and (4) hot-spot and main-fuel-layer physics. We review progress made on achieving uniform drive conditions with the OMEGA system and present results for direct-drive cryogenic-fuel-capsule and CD-shell, “surrogate” cryogenic-capsule implosion experiments that illustrate the constraints imposed by hydrodynamic instabilities and drive uniformity on the design of high-performance direct-drive targets. Target designs have been identified that will explore the ignition-scaling regime using the OMEGA Upgrade. Experiments on the OMEGA Upgrade will signal whether or not there is a high probability of achieving modest to high gain using direct drive on an upgrade of the NOVA facility.
Edited by
Judith M. Rumsey, National Institute of Mental Health, Bethesda, Maryland,Monique Ernst, National Institute of Mental Health, Bethesda, Maryland
By
S. R. Epstein, Professor of Economic History and Head of the Economic History Department at the London School of Economics London School of Economics.,
Maarten Prak, Professor of Social and Economic History Utrecht University.
Edited by
S. R. Epstein, London School of Economics and Political Science,Maarten Prak, Universiteit Utrecht, The Netherlands
Craft guilds, Adam Smith famously suggested in 1776, are ‘a conspiracy against the public’, and the government should ‘do nothing to facilitate such assemblies, much less to render them necessary’. As in so much other economic thinking, Smith was a trendsetter in this too. Not only were his ideas about guilds shared by some of his late eighteenth-century contemporaries, they seemed to apply almost overnight when French revolutionaries abolished the guilds, first in France (in 1791) and then in much of the rest of continental Europe. For a long time, historians have interpreted the simultaneity of ideas and policies as definitive proof that the guilds had outlived themselves as the gothic remnants of a bygone age and should make way for the modern world of the steam engine and laissez-faire. Guilds, in other words, were seen as part of an economic system that had prevented the European economy from realising its full economic potential. It was, if anything, a demonstration of the validity of this argument, that England was the first European country to lose its guilds – English guilds were supposed to have vanished through some unplanned process starting in the second half of the seventeenth century – and also the first country to industrialise.
The negative view of guilds survived for the best part of two centuries in history textbooks and specialised works.