Background: end-of-life care is not always in line with end-of-life preferences, so patients do not always die at their preferred place of death (PPD). This study aims to identify factors associated with patients' PPD and changes in PPD. Methods: we prospectively collected data on PPD at four time points within 6 months from 230 acutely hospitalised older patients who were part of the control group in a stepped-wedge randomised controlled trial. Associations between patient characteristics and preferences were calculated using multivariable (multinomial) logistic regression analysis. Results: the mean age of participants was 80.7 years. 47.8% of the patients had no PPD at hospital admission. Patients previously admitted to hospital preferred to die at home (home versus no preference: odds ratio [OR] 2.38, 95% confidence interval [CI] 1.15-4.92; home versus healthcare facility: OR 3.25, 95% CI 1.15-9.16). Patients with more chronic diseases preferred the healthcare facility as their PPD (healthcare facility versus no preference: OR 1.33, 95% CI 1.09-1.61; healthcare facility versus home: OR 1.21, 95% CI 1.00-1.47). 32 of 65 patients changed their preference during follow-up, and most of these had no PPD at hospital admission (home versus no preference: OR 0.005, 95% CI ≤0.001-0.095) and poorer self-rated well-being (OR 1.82, 95% CI 1.07-3.08). Conclusions: almost half of the patients had no PPD at baseline. Previous hospital admission, having more chronic diseases and living alone are associated with having a PPD. Introducing PPD could make older people aware of PPD and facilitate optimal palliative care.
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Dreams that appear to predict future events that could not have been anticipated through any known inferential processes have been reported for centuries, and dreams that appear to anticipate the death of an acquaintance or loved one are particularly common. Such reports become more suggestive of genuine precognition if there are no natural cues (such as an illness) to an impending death and if the time interval between the dream and the subsequent death is brief. Most reports are difficult to evaluate because we dream many times each night but typically remember and report only a salient subset of our dreams. Thus we cannot assess whether the time interval between a death-related dream and the death of the dream character is brief or lengthy because we have no control set of non-death-related dreams to which its time interval can be compared. The study reported here provides just such a control set by comparing deathrelated and non-death-related dreams featuring the same set of dream characters who died after the dreams occurred. These were drawn from the author's own dream journal in which he has recorded his nightly dreams for nearly twenty-five years. The mean time interval between death-related dreams and the person's subsequent death was significantly shorter than the time interval between non-death-related dreams and his or her death, t(11) = 3.30, p =.004, one-tailed. Cases in which death-related dreams occurred after the characters had died are also considered. Seven of the cases are discussed in detail.
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Background: Although the number of older patients requiring medical care is increasing, caring for older patients is often seen as unattractive by medical trainees (i.e., medical students, residents, interns, and fellows). Terror Management Theory states that people have a negative attitude towards older people, because they remind people of their own mortality. We hypothesize that ageism, death anxiety, and ageing anxiety among medical trainees negatively affect their attitude towards medical care for older patients. This review aimed to examine and generate an overview of available literature on the relationship between ageism, death anxiety, and ageing anxiety among medical trainees and their attitude towards medical care for older patients. Methods: A systematic review was performed with a review protocol based on the PRISMA Statement. PubMed, Ebsco/PsycInfo, Ebsco/ERIC and Embase were searched from inception to August 2022, using the following search terms, including their synonyms and closely related words: “medical trainees” AND “ageism” OR “death anxiety” OR “ageing anxiety” AND “(attitude AND older patient)”. Results: The search yielded 4072 different studies; 12 eligible studies (10 quantitative and 2 qualitative) were identified and synthesized using narrative synthesis. Findings suggest that a positive attitude towards older people was related to a positive attitude towards medical care for older patients among medical students. The available literature on the relationship between death anxiety and/or ageing anxiety and attitude towards medical care for older patients among medical trainees was limited and had a heterogeneity in focus, which hindered comparison of results. Conclusion: Our findings suggest that a positive attitude towards older people in general is related to a positive attitude towards medical care for older patients among medical students. Future research should focus on further exploring underlying mechanisms affecting the attitude towards medical care for older patients among medical trainees.
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In large organizations, innovation activities often take place in separate departments, centers, or studios. These departments aim to produce prototypes of solutions to the problems of operational business owners. However, too often these concepts remain in the prototype stage: they are never implemented and fall into what is popularly termed the Valley of Death. A design approach to innovation is presented as a solution to the problem. However, practice shows that teams that use design nevertheless encounter implementation challenges due to the larger infrastructure of the organization they are part of. This research aims to explore which organizational factors contribute to the Valley of Death during design innovation. An embedded multiple case study at a large heritage airline is applied. Four projects are analyzed to identify implementation challenges. A thematic data analysis reveals organizational design, departmental silos, and dissimilar innovation strategies contribute to the formation of, and encounters with, the Valley of Death. Arising resource-assignment challenges that result from these factors are also identified. Materialization, user-centeredness, and holistic problem framing are identified as design practices that mitigate encounters with the Valley of Death, thus leading to projects being fully realized. https://doi.org/10.1111/dmj.12052 LinkedIn: https://www.linkedin.com/in/christine-de-lille-8039372/
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The unexpected death of a child is one of the most challenging losses as it fractures survivors’ sense of parenthood and other layers of identity. Given that not all the bereaved parents who have need for support respond well to available treatments and that many have little access to further intervention or follow-up over time, online interventions featuring therapeutic writing and peer support have strong potential. In this article we explore how a group of bereaved mothers experienced the process of participating in an online course in therapeutic writing for the integration of grief. Our research questions were: How do parents who have lost a child experience being part of an online course in therapeutic writing? What are the perceived benefits and challenges of writing in processing their grief? We followed an existential phenomenological approach and analyzed fieldwork notes (n = 13), qualitative data from the application and assessment surveys (n = 35; n = 21), excerpts from the journals of some participants (n = 3), and email correspondence with some participants (n = 5). We categorized the results in three meaning units: (1) where does my story begin? The “both and” of their silent chaos; (2) standing on the middle line: a pregnancy that does not end; (3) closures and openings: “careful optimism” and the need for community support. Participants experienced writing as an opportunity for self-exploration regarding their identities and their emotional world, as well as a means to develop and strengthen a bond with their children. They also experienced a sense of belonging, validation, and acceptance in the online group in a way that helped them make sense of their suffering. Online writing courses could be of benefit for bereaved parents who are grieving the unexpected death of a child, but do not replace other interventions such as psychotherapy. In addition to trauma and attachment informed models of grief, identity informed models with a developmental focus might enhance the impact of both low-threshold community interventions and more intensive clinical ones. Further studies and theoretical development in the area are needed, addressing dialogical notions such as the multivoicedness of the self. Lehmann OV, Neimeyer RA, Thimm J, Hjeltnes A, Lengelle R and Kalstad TG (2022) Experiences of Norwegian Mothers Attending an Online Course of Therapeutic Writing Following the Unexpected Death of a Child. Front. Psychol. 12:809848. doi: 10.3389/fpsyg.2021.809848
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The carbon sink capacity of tropical forests is substantially affected by tree mortality. However, the main drivers of tropical tree death remain largely unknown. Here we present a pan-Amazonian assessment of how and why trees die, analysing over 120,000 trees representing > 3800 species from 189 long-term RAINFOR forest plots. While tree mortality rates vary greatly Amazon-wide, on average trees are as likely to die standing as they are broken or uprooted—modes of death with different ecological consequences. Species-level growth rate is the single most important predictor of tree death in Amazonia, with faster growing species being at higher risk. Within species, however, the slowest-growing trees are at greatest risk while the effect of tree size varies across the basin. In the driest Amazonian region species-level bioclimatic distributional patterns also predict the risk of death, suggesting that these forests are experiencing climatic conditions beyond their adaptative limits.These results provide not only a holistic pan-Amazonian picture of tree death but largescale evidence for the overarching importance of the growth–survival trade-off in driving tropical tree mortality.
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Catalogue for the exhibition "Crustumerium. Death and Afterlife at the Gates of Rome"
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In large organisations, innovation activities are often located in separate departments, centres or studios. These departments aim to produce prototypes of solutions to the problems of operational business owners. However, too often these concepts remain in the prototype stage: they never cross the valley of death to become implemented. A design approach to innovation is presented as a solution to the problem. However, practice shows that teams that use this approach nevertheless encounter this problem due to the larger infrastructure of the organisation they are part of. This research aims to explore which factors contribute to the valley of death for design innovation. Additionally, this paper presents first insights into how design practices help to mitigate this phenomenon. An embedded multiple case study at a large heritage airline is used to study this phenomenon. A thematic analysis of the data finds that organisational design, departmental silo’s and dissimilar innovation strategies contribute to the valley of death. The issues with resource-assignment that result from these factors are displayed. Last, materialization, usercenteredness and holistic problem-framing are indicated as practices that help to mitigate this problem. LinkedIn: https://www.linkedin.com/in/christine-de-lille-8039372/
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Control methods are applied worldwide to reduce predation on livestock by European red foxes (Vulpes vulpes). Lethal methods can inflict suffering; however, moral debate about their use is lacking. Non-lethal methods can also inflict suffering and can unintentionally lead to death, and yet both the welfare consequences and ethical perspectives regarding their use are rarely discussed. The aim of this study was to investigate the animal welfare consequences, the level of humaneness, the ethical considerations and the moral implications of the global use of fox control methods according to Tom Regan’s animal rights view and Peter Singer’s utilitarian view. According to Regan, foxes ought not to be controlled by either lethal or potentially harmful non-lethal methods because this violates the right of foxes not to be harmed or killed. According to Singer, if an action maximises happiness or the satisfaction of preferences over unhappiness or suffering, then the action is justified. Therefore, if and only if the use of fox control methods can prevent suffering and death in livestock in a manner that outweighs comparable suffering and death in foxes is one morally obligated t
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Formation of the pro-apoptotic death-inducing signaling complex (DISC) can be initiated in cancer cells via binding of tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) to its two pro-apoptotic receptors, TRAIL receptor 1 (TRAIL-R1) and TRAIL-R2. Primary components of the DISC are trimerized TRAIL-R1/-R2, FADD, caspase 8 and caspase 10. The anti-apoptotic protein FLIP can also be recruited to the DISC to replace caspase 8 and form an inactive complex. Caspase 8/10 processing at the DISC triggers the caspase cascade, which eventually leads to apoptotic cell death. Besides TRAIL, TRAIL-R1- or TRAIL-R2-selective variants of TRAIL and agonistic antibodies have been designed. These ligands are of interest as anti-cancer agents since they selectively kill tumor cells. To increase tumor sensitivity to TRAIL death receptor-mediated apoptosis and to overcome drug resistance, TRAIL receptor ligands have already been combined with various therapies in preclinical models. In this review, we discuss factors influencing the initial steps of the TRAIL apoptosis signaling pathway, focusing on mechanisms modulating DISC assembly and caspase activation at the DISC. These insights will direct rational design of drug combinations with TRAIL receptor ligands to maximize DISC signaling. © 2009 Elsevier B.V. All rights reserved.
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