Barriers to the development of palliative care in Western Europe

The Eurobarometer Survey of the <i>EAPC Task Force on the Development of Palliative Care in Europe</i> is part of a programme of work to produce comprehensive information on the provision of palliative care across Europe. Aim: To identify barriers to the development of palliative care in Western Europe. Method: A qualitative survey was undertaken amongst boards of national associations, eliciting opinions on opportunities for, and barriers to, palliative care development. By July 2006, 44/52 (85%) European countries had responded to the survey; we report here on the results from 22/25 (88%) countries in Western Europe. Analysis: Data from the Eurobarometer survey were analysed thematically by geographical region and by the degree of development of palliative care in each country. Results: From the data contained within the Eurobarometer, we identified six significant barriers to the development of palliative care in Western Europe: (i) Lack of palliative care education and training programmes (ii) Lack of awareness and recognition of palliative care (iii) Limited availability of/knowledge about opioid analgesics (iv) Limited funding (v) Lack of coordination amongst services (vi) Uneven palliative care coverage. Conclusion: Findings from the EAPC Eurobarometer survey suggest that barriers to the development of palliative care in Western Europe may differ substantially from each other in both their scope and context and that some may be considered to be of greater significance than others. A number of common barriers to the development of the discipline do exist and much work still remains to be done in the identified areas. This paper provides a road map of which barriers need to be addressed

Wave propagation and shock formation in different magnetic structures

Velocity oscillations "measured" simultaneously at the photosphere and the chromosphere -from time series of spectropolarimetric data in the 10830 A region- of different solar magnetic features allow us to study the properties of wave propagation as a function of the magnetic flux of the structure (i.e. two different-sized sunspots, a tiny pore and a facular region). While photospheric oscillations have similar characteristics everywhere, oscillations measured at chromospheric heights show different amplitudes, frequencies and stages of shock development depending on the observed magnetic feature. The analysis of the power and the phase spectra, together with simple theoretical modeling, lead to a series of results concerning wave propagation within the range of heights of this study. We find that, while the atmospheric cut-off frequency and the propagation properties of the different oscillating modes depend on the magnetic feature, in all the cases the power that reaches the high chromosphere above the atmospheric cut-off comes directly from the photosphere by means of linear vertical wave propagation rather than from non-linear interaction of modes.Comment: Accepted for publication in The Astrophysical Journal. 29 pages, 9 figures, 12pt, preprin

Network Connectivity in Epilepsy: Resting State fMRI and EEG-fMRI Contributions.

There is a growing body of evidence pointing toward large-scale networks underlying the core phenomena in epilepsy, from seizure generation to cognitive dysfunction or response to treatment. The investigation of networks in epilepsy has become a key concept to unlock a deeper understanding of the disease. Functional imaging can provide valuable information to characterize network dysfunction; in particular resting state fMRI (RS-fMRI), which is increasingly being applied to study brain networks in a number of diseases. In patients with epilepsy, network connectivity derived from RS-fMRI has found connectivity abnormalities in a number of networks; these include the epileptogenic, cognitive and sensory processing networks. However, in majority of these studies, the effect of epileptic transients in the connectivity of networks has been neglected. EEG-fMRI has frequently shown networks related to epileptic transients that in many cases are concordant with the abnormalities shown in RS studies. This points toward a relevant role of epileptic transients in the network abnormalities detected in RS-fMRI studies. In this review, we summarize the network abnormalities reported by these two techniques side by side, provide evidence of their overlapping findings, and discuss their significance in the context of the methodology of each technique. A number of clinically relevant factors that have been associated with connectivity changes are in turn associated with changes in the frequency of epileptic transients. These factors include different aspects of epilepsy ranging from treatment effects, cognitive processes, or transition between different alertness states (i.e., awake-sleep transition). For RS-fMRI to become a more effective tool to investigate clinically relevant aspects of epilepsy it is necessary to understand connectivity changes associated with epileptic transients, those associated with other clinically relevant factors and the interaction between them, which represents a gap in the current literature. We propose a framework for the investigation of network connectivity in patients with epilepsy that can integrate epileptic processes that occur across different time scales such as epileptic transients and disease duration and the implications of this approach are discussed

Network Connectivity in Epilepsy: Resting State fMRI and EEG-fMRI Contributions.

There is a growing body of evidence pointing toward large-scale networks underlying the core phenomena in epilepsy, from seizure generation to cognitive dysfunction or response to treatment. The investigation of networks in epilepsy has become a key concept to unlock a deeper understanding of the disease. Functional imaging can provide valuable information to characterize network dysfunction; in particular resting state fMRI (RS-fMRI), which is increasingly being applied to study brain networks in a number of diseases. In patients with epilepsy, network connectivity derived from RS-fMRI has found connectivity abnormalities in a number of networks; these include the epileptogenic, cognitive and sensory processing networks. However, in majority of these studies, the effect of epileptic transients in the connectivity of networks has been neglected. EEG-fMRI has frequently shown networks related to epileptic transients that in many cases are concordant with the abnormalities shown in RS studies. This points toward a relevant role of epileptic transients in the network abnormalities detected in RS-fMRI studies. In this review, we summarize the network abnormalities reported by these two techniques side by side, provide evidence of their overlapping findings, and discuss their significance in the context of the methodology of each technique. A number of clinically relevant factors that have been associated with connectivity changes are in turn associated with changes in the frequency of epileptic transients. These factors include different aspects of epilepsy ranging from treatment effects, cognitive processes, or transition between different alertness states (i.e., awake-sleep transition). For RS-fMRI to become a more effective tool to investigate clinically relevant aspects of epilepsy it is necessary to understand connectivity changes associated with epileptic transients, those associated with other clinically relevant factors and the interaction between them, which represents a gap in the current literature. We propose a framework for the investigation of network connectivity in patients with epilepsy that can integrate epileptic processes that occur across different time scales such as epileptic transients and disease duration and the implications of this approach are discussed

Multi-layer study of wave propagation in sunspots

We analyze the propagation of waves in sunspots from the photosphere to the chromosphere using time series of co-spatial Ca II H intensity spectra (including its line blends) and polarimetric spectra of Si I 10827 and the He I 10830 multiplet. From the Doppler shifts of these lines we retrieve the variation of the velocity along the line-of-sight at several heights. Phase spectra are used to obtain the relation between the oscillatory signals. Our analysis reveals standing waves at frequencies lower than 4 mHz and a continuous propagation of waves at higher frequencies, which steepen into shocks in the chromosphere when approaching the formation height of the Ca II H core. The observed non-linearities are weaker in Ca II H than in He I lines. Our analysis suggests that the Ca II H core forms at a lower height than the He I 10830 line: a time delay of about 20 s is measured between the Doppler signal detected at both wavelengths. We fit a model of linear slow magnetoacoustic wave propagation in a stratified atmosphere with radiative losses according to Newton's cooling law to the phase spectra and derive the difference in the formation height of the spectral lines. We show that the linear model describes well the wave propagation up to the formation height of Ca II H, where non-linearities start to become very important.Comment: Accepted by The Astrophysical Journa

The Hanle and Zeeman Effects in Solar Spicules: A Novel Diagnostic Window on Chromospheric Magnetism

An attractive diagnostic tool for investigating the magnetism of the solar chromosphere is the observation and theoretical modeling of the Hanle and Zeeman effects in spicules, as shown in this letter for the first time. Here we report on spectropolarimetric observations of solar chromospheric spicules in the He I 10830 \AA multiplet and on their theoretical modeling accounting for radiative transfer effects. We find that the magnetic field in the observed (quiet Sun) spicular material at a height of about 2000 km above the visible solar surface has a strength of the order of 10 G and is inclined by approximately $35^{\circ}$ with respect to the local vertical direction. Our empirical finding based on full Stokes-vector spectropolarimetry should be taken into account in future magnetohydrodynamical simulations of spicules.Comment: 12 pages and 2 figure

The influence of coronal EUV irradiance on the emission in the He I 10830 A and D3 multiplets

Two of the most attractive spectral windows for spectropolarimetric investigations of the physical properties of the plasma structures in the solar chromosphere and corona are the ones provided by the spectral lines of the He I 10830 A and 5876 A (or D3) multiplets, whose polarization signals are sensitive to the Hanle and Zeeman effects. However, in order to be able to carry out reliable diagnostics, it is crucial to have a good physical understanding of the sensitivity of the observed spectral line radiation to the various competing driving mechanisms. Here we report a series of off-the-limb non-LTE calculations of the He I D3 and 10830 A emission profiles, focusing our investigation on their sensitivity to the EUV coronal irradiation and the model atmosphere used in the calculations. We show in particular that the intensity ratio of the blue to the red components in the emission profiles of the He I 10830 A multiplet turns out to be a good candidate as a diagnostic tool for the coronal irradiance. Measurements of this observable as a function of the distance to the limb and its confrontation with radiative transfer modeling might give us valuable information on the physical properties of the solar atmosphere and on the amount of EUV radiation at relevant wavelengths penetrating the chromosphere from above.Comment: 19 pages, 11 figures (pre-print format). Accepted for publication in Ap