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While dying at home is often described as desirable, to our knowledge, no reviews have focused specifically on people’s reasons for wanting to die at home. This review describes the breadth of what is known about motivations, attitudes, ideas, and reasons underlying the decision to choose “home” as one’s preferred placed of death.
Methods
This review was guided by a scoping review methodology following a five-stage approach including: (1) identify the research question, (2) identify relevant studies, (3) select studies based on inclusion/exclusion criteria, (4) chart the data, and (5) summarize and report the results.
Results
Seventeen articles were identified that met inclusion/exclusion criteria and discussed motivations underlying people’s desires to die at home. Thirty-five percent of studies were from Canada (n = 6/17), 29% were from Europe (n = 5/17), and 29% were from Asia (n = 5/17). Most studies (n = 11/17) used methods that involved collecting and/or analyzing interview data from participants, while the remaining studies (n = 6/17) used methods that involved administering and analyzing surveys or questionnaires. Characteristics of participants varied, but most commonly, studies included people with advanced illnesses who were nearing death (35% of studies, n = 6/17). Motivations for choosing a home death included desires to preserve a sense of self, factors relating to interpersonal relationships, and topics such as culture, religion, socioeconomic status, living situation, and lived experience.
Significance of results
The many interconnected reasons that lead people to choose a home death vary, as individuals have a range of motivations for choosing to die at home, which are highly influenced by contextual and cultural factors. Ultimately, this review will provide a comprehensive description of factors which may inform end-of-life planning, highlighting needs to be considered when planning the preferred location of a death.
Geophysical survey and excavations from 2010–2016 at Lawrenz Gun Club (11CS4), a late pre-Columbian village located in the central Illinois River valley in Illinois, identified 10 mounds, a central plaza, and dozens of structures enclosed within a stout 10 hectare bastioned palisade. Nineteen radiocarbon (14C) measurements were taken from single entities of wood charcoal, short-lived plants, and animal bones. A site chronology has been constructed using a Bayesian approach that considers the stratigraphic contexts and feature formation processes. The village was host to hundreds of years of continuous human activity during the Mississippi Period. Mississippian activity at the site is estimated to have begun in cal AD 990–1165 (95% probability), ended in cal AD 1295–1450 (95% probability), and lasted 150–420 yr (95% probability) in the primary Bayesian model with similar results obtained in two alternative models. The palisade is estimated to have been constructed in cal AD 1150–1230 (95% probability) and was continuously repaired and rebuilt for 15–125 yr (95% probability), probably for 40–85 yr (68% probability). Comparison to other studies demonstrates that the bastioned palisade at Lawrenz was one of the earliest constructed in the midcontinental United States.
The preconception, pregnancy and immediate postpartum and newborn periods are times for mothers and their offspring when they are especially vulnerable to major stressors – those that are sudden and unexpected and those that are chronic. Their adverse effects can transcend generations. Stressors can include natural disasters or political stressors such as conflict and/or migration. Considerable evidence has accumulated demonstrating the adverse effects of natural disasters on pregnancy outcomes and developmental trajectories. However, beyond tracking outcomes, the time has arrived for gathering more information related to identifying mechanisms, predicting risk and developing stress-reducing and resilience-building interventions to improve outcomes. Further, we need to learn how to encapsulate both the quantitative and qualitative information available and share it with communities and authorities to mitigate the adverse developmental effects of future disasters, conflicts and migrations. This article briefly reviews prenatal maternal stress and identifies three contemporary situations (wildfire in Fort McMurray, Alberta, Canada; hurricane Harvey in Houston, USA and transgenerational and migrant stress in Pforzheim, Germany) where current studies are being established by Canadian investigators to test an intervention. The experiences from these efforts are related along with attempts to involve communities in the studies and share the new knowledge to plan for future disasters or tragedies.
Despite the high prevalence of mental disorders, mental health literacy has been comparatively neglected. People's symptom-management strategies will be influenced by their mental health literacy. This study sought to determine the feasibility of using the World Health Organization mhGAP-Intervention Guide (IG) as an educational tool for one-on-one contact in a clinical setting to increase literacy on the specified mental disorders.
Methods
This study was conducted in 20 health facilities in Makueni County, southeast Kenya which has one of the poorest economies in Kenya. It has no psychiatrist or clinical psychologist. We recruited 3267 participants from a community that had already been exposed to community mental health services. We used Mental Health Knowledge Schedule to measure the changing patterns of mental health knowledge after a period of 3 months, following a training intervention using the WHO mhGAP-IG.
Results
Overall, there was a significant increase in mental health related knowledge [mean range 22.4–23.5 for both post-test and pre-test scores (p < 0.001)]. This increase varied with various socio-demographic characteristics such as sex, marital status, level of education, employment status and wealth index.
Conclusions
mhGAP-IG is a feasible tool to increase mental health literacy in low-resource settings where there are no mental health specialists. Our study lends evidence that the WHO Mental Health Action Plan 2013–2020 and reduction of the treatment gap may be accelerated by the use of mhGAP-IG through improving knowledge about mental illness and potentially subsequent help seeking for early diagnosis and treatment.
Stigma can have a negative impact on help-seeking behaviour, treatment adherence and recovery of people with mental disorders. This study aimed to determine the feasibility of the WHO Mental Health Treatment Gap Interventions Guidelines (mhGAP-IG) to reduce stigma in face-to-face contacts during interventions for specific DSM-IV/ICD 10 diagnoses over a 6-month period.
Methods
This study was conducted in 20 health facilities across Makueni County in southeast Kenya which has one of the poorest economies in the country and has no psychiatrist or clinical psychologist. We recruited 2305 participants from the health facilities catchment areas that had already been exposed to community mental health services. We measured stigma using DISC-12 at baseline, followed by training to the health professionals on intervention using the WHO mhGAP-IG and then conducted a follow-up DISC-12 assessment after 6 months. Proper management of the patients by the trained professionals would contribute to the reduction of stigma in the patients.
Results
There was 59.5% follow-up at 6 months. Overall, there was a significant decline in ‘reported/experienced discrimination’ following the interventions. A multivariate linear mixed model regression indicated that better outcomes of ‘unfair treatment’ scores were associated with: being married, low education, being young, being self-employed, higher wealth index and being diagnosed with depression. For ‘stopping self’ domain, better outcomes were associated with being female, married, employed, young, lower wealth index and a depression diagnosis. In regards to ‘overcoming stigma’ domain; being male, being educated, employed, higher wealth index and being diagnosed with depression was associated with better outcomes.
Conclusions
The statistically significant (p < 0.05) reduction of discrimination following the interventions by trained health professionals suggest that the mhGAP-IG may be a useful tool for reduction of discrimination in rural settings in low-income countries.
Lead isotope analyses of 50 Irish Chalcolithic and Early Bronze Age gold artefacts favour a gold source in southern Ireland. However when combined with major element analysis, the artefacts are not consistent with any Irish gold deposit analysed to date. Understanding the lead isotope signatures of ore deposits within a study region allows informed inferences to be drawn regarding the likelihood that an unanalysed ore deposit was exploited in the past. If an Irish gold source is assumed, then the gold is most likely to have originated from deposits hosted by Old Red Sandstone in the Variscan ore field of south-west Ireland. However, based on our current understanding of mineralisation in the region, this scenario is considered unlikely. A non-Irish source for the gold is therefore preferred – a scenario that may favour cosmologically-driven acquisition, ie, the deliberate procurement of a material from distant or esoteric sources. Available geochemical data, combined with current archaeological evidence, favour the alluvial deposits of south-west Britain as the most likely source of the gold.
Six rumen-fistulated steers were studied over six periods of 3 days at Reading University's Animal Production Research Unit. In each period, eight dacron bags comprising two replicates of the 22 factorial treatment set consisting of untreated and NH3-treated barley straw in chopped (12–54 mm) or ground (2·5 mm screen) form were placed in the rumen of each steer. Bags were left in the rumen for a given time which was one of the set 6, 9, 15, 24, 48, 72 h. Percentage dry matter (DM) disappearance from dacron bags was consistently higher for NH3-treated than untreated straw and higher for ground than chopped straw. Analysis of variance gave F ratios for period and steer which were non-significant but of similar size, showing that using fewer animals could be compensated for by using more periods. Percentage DM disappearance as a function of time was well described by the model y = a — beet. The parameter defining rate of disappearance c, was similar for the four forms of straw. Differences between straws occurred in values of a (potential degradability) and b suggesting that physical form of material put into dacron bags needs standardizing if absolute values of a are to be used (e.g. for predicting roughage intake). Experimental designs need further research.
An experiment to study the physics of merging and of focusing ion beams is under development at the Lawrence Berkeley Laboratory. In this design, parallel beams of ions (C+, Al+, or Al++) are accelerated to several MV and merged transversely. The merged beams are then further accelerated and the growth in transverse and longitudinal emittance is determined for comparison with theory. The completed apparatus will be used to study problems associated with focusing ion beams to a small spot as required for heavy ion fusion. Details of the accelerator design and considerations of the physics of combining beams are presented.
The European Grid of Solar Observations (EGSO) is a Solar virtual observatory (see Hill et al., 2002). It has been funded through the 5th Framework Program of the European Community. A dozen of laboratories, mixing Solar Physics and Information Technology, in Great Britain, France, Italy and Swiss have been involved in this project during 3 years. A grid accessing several dozens of databases and archives scattered all around the world has been developped as well as a Solar Event Catalogue and a Solar Feature Catalogue. The original aspect of this work consists in the possibility not only to search through the characteristics of observations, but also search for available data corresponding to specific kinds of events. So it is now very important to be able to follow the Sun 24 hours a day in order to enrich the events database for future queries. More informations on EGSO, catalogues and user interface can be accessd through the web site: http://www.egso.org/
This is a report of a 9-year-old female with a clinical presentation of benign intracranial hypertension (BIH) who was found to have an unruptured pial arteriovenous malformation (AVM) with a significant fistula. The AVM was completely embolized using a recently developed liquid embolic system, Onyx, after which gradual clinical improvement followed. A few cases of BIH associated with AVM have been described in adults and adolescents. Possible causal relation is discussed.
We review the processes and mechanisms by which voltage offsets occur in the hysteresis loop of ferroelectric materials. Simply stated, voltage shifts arise from nearinterfacial charge trapping in the ferroelectric. We show that the impetus behind voltage shifts in ferroelectric capacitors is the net polarization, with the net polarization being determined by the perovskite and the aligned defect-dipole components. Some common defect-dipoles in the PZT system are lead vacancy-oxygen vacancy complexes. One way to change the net polarization in the ferroelectric is to subject the PZT capacitor to a dc bias at elevated temperature; this process is spectroscopically shown to align defect-dipoles along the direction of the applied electric field. The alignment of defect-dipoles can strongly impact several material properties. One such impact is that it can lead to enhanced voltage shifts (imprint). It is proposed that the net polarization determines the spatial location of the asymmetrically trapped charge that are the cause for the voltage shifts. An enhanced polarization at one electrode interface can lead to larger voltage shifts since it lowers the electrostatic potential well for electron trapping, i.e., more electron trapping can occur. Defect-dipole alignment is also shown to increase the UV sensitivity of the ferroelectric.
1.1 This paper owes its existence on two counts to the late Jim Souness whose term of office as President of the Faculty coincided with the bulk of our research. Firstly, as President, he encouraged Faculty research groups to be active and to produce material worthy of sessional papers. More directly it was the late President who funnelled our general investigations of life office management (which had continued after the Group's 1987 sessional paper) towards the issue of demutualisation.
There have been several notable demutualisations of life offices in recent years, yet there is little published research in the UK other than case studies into the actuarial issues which these restructurings raise for the profession. Furthermore much of what has been published pertains to overseas regimes not subject to UK-style regulation. However at the time of writing we are aware that another paper (reference 20) was being written concurrently, and it relates specifically to the UK.