Do Patients Want to Die at Home? A Systematic Review of the UK Literature,Focused on Missing Preferences for Place of Death

Background

End-of-life care policy has a focus on enabling patients to die in their preferred place; this is believed for most to be home. This review assesses patient preferences for place of death examining: the extent of unreported preferences, the importance of patient factors (place of care and health diagnosis) and who reports preferences.

Methods and Findings

Systematic literature review of 7 electronic databases, grey literature, backwards citations from included studies and Palliative Medicine hand search. Included studies published between 2000–2015, reporting original, quantifiable results of adult UK preferences for place of death. Of 10826 articles reviewed, 61 met the inclusion criteria. Summary charts present preferences for place of death by health diagnosis, where patients were asked and who reported the preference. These charts are recalculated to include ‘missing data,’ the views of those whose preferences were not asked, expressed or reported or absent in studies. Missing data were common. Across all health conditions when missing data were excluded the majority preference was for home: when missing data were included, it was not known what proportion of patients with cancer, non-cancer or multiple conditions preferred home. Patients, family proxies and public all expressed a majority preference for home when missing data were excluded: when included, it was not known what proportion of patients or family proxies preferred home. Where patients wished to die was related to where they were asked their preference. Missing data calculations are limited to ‘reported’ data.

Conclusions

It is unknown what proportion of patients prefers to die at home or elsewhere. Reported preferences for place of death often exclude the views of those with no preference or not asked: when ‘missing data’ are included, they supress the proportion of preferences for all locations. Caution should be exercised if asserting that most patients prefer to die at home.     

Genetic history of hepatitis C virus in East Asia

The hepatitis C virus (HCV), which currently infects an estimated 3% of people worldwide, has been present in some human populations for several centuries, notably HCV genotypes 1 and 2 in West Africa and genotype 6 in Southeast Asia. Here we use newly developed methods of sequence analysis to conduct the first comprehensive investigation of the epidemic and evolutionary history of HCV in Asia. Our analysis includes new HCV core (n = 16) and NS5B (n = 14) gene sequences, obtained from serum samples of jaundiced patients from Laos. These exceptionally diverse isolates were analyzed in conjunction with all available reference strains using phylogenetic and Bayesian coalescent methods. We performed statistical tests of phylogeographic structure and applied a recently developed “relaxed molecular clock” approach to HCV for the first time, which indicated an unexpectedly high degree of rate variation. Our results reveal a >1,000-year-long development of genotype 6 in Asia, characterized by substantial phylogeographic structure and two distinct phases of epidemic history, before and during the 20th century. We conclude that HCV lineages representing preexisting and spatially restricted strains were involved in multiple, independent local epidemics during the 20th century. Our analysis explains the generation and maintenance of HCV diversity in Asia and could provide a template for further investigations of HCV spread in other regions.     

Bacterial influence on alkenones in live microalgae

The microalga Emiliania huxleyi produces alkenone lipids that are important proxies for estimating past sea surface temperatures. Field calibrations of this proxy are robust but highly variable results are obtained in culture. Here, we present results suggesting that algal‐bacterial interactions may be responsible for some of this variability. Co‐cultures of E. huxleyi and the bacterium Phaeobacter inhibens resulted in a 2.5‐fold decrease in algal alkenone‐containing lipid bodies. In addition levels of unsaturated alkenones increase in co‐cultures. These changes result in an increase in the reconstructed growth temperature of up to 2°C relative to axenic algal cultures.     

Fine‐scale coexistence between Mediterranean mesocarnivores is mediated by spatial,temporal, and trophic resource partitioning

1. The partition of the ecological niche can enhance the coexistence of predators due to differences in how they exploit three main resources: food, space, and time, the latter being an axis that often remains unexplored.
2. We studied niche segregation in a Mediterranean mesocarnivore community composed by Vulpes vulpes, Genetta genetta, Meles meles, and Herpestes ichneumon, addressing simultaneously different niche axes: the temporal, trophic, and spatial axes.
3. We assessed temporal segregation between mesopredators and prey and between potential competitors, using camera trap data between 2018 and 2020 in a Mediterranean landscape in Southern Spain. We deployed camera traps in 35 stations in three sites with varying vegetation cover within Doñana National Park. We further examined the spatial overlap in activity centers and trophic preferences between potential competitors using diet information from studies performed in the study area.
4. We found an overall temporal segregation between trophic generalist species, with species showing higher temporal overlap differing in their trophic preferences and/or showing limited spatial overlap. Furthermore, we observed an overall high overlap between the activity patterns of predators and their major prey in the area (the common genet vs. small mammals and the red fox vs. European rabbit).
5. Our study suggests that coexistence of the different species that compose the mesocarnivore assemblage in Mediterranean landscapes can be facilitated by subtle differences along the three main niche axes, with temporal segregation being a most pronounced mechanism. Our findings reinforce the idea that the coexistence mechanisms underlying community structure are multidimensional.

     

Abundance,population structure and vertical distribution of dominant calanoid copepods on the eastern Weddell Sea shelf during a spring phytoplankton bloom

The main emphasis of this study was to analyse the short-term development of abundance, population structure and vertical distribution of the dominant calanoid copepods during a phytoplankton bloom in the coastal area of the eastern Weddell Sea in December 2003. Microcalanus pygmaeus was by far the most abundant calanoid species. Metridia gerlachei, Ctenocalanus citer, Calanoides acutus, Calanus propinquus and the ice-associated Stephos longipes were also present in considerable proportions. The observed changes in the population characteristics and parameters of these species are described in detail and discussed in the context of the spring phytoplankton bloom. A conspicuous event occurring during the final stage of the study was the development of a strong storm. While the results suggest that this storm did not have any considerable influence on the populations of all other investigated copepod species, it very likely caused pronounced changes in the S. longipes population present in the water column. Before the storm, S. longipes was found primarily in the upper 100 m of the water column, and its population was dominated by adults (mean proportion = 41%) and the copepodite stage I (mean proportion = 30%). After the storm, the abundance increased considerably, and the copepodite stage I contributed by far the largest proportion (53%) of the total population indicating that the early copepodite stages probably had been released from the sea ice into the under ice water layer due to ice break-up and ice melt processes caused by the storm.     

Size-fractionated mesozooplankton biomass, metabolism and grazing along a 50{degrees}N-30{degrees}S transect of the Atlantic Ocean

Size-fractionated mesozooplankton grazing and metabolism wereinvestigated along the wide latitudinal range (50°N–30°S)covered during the Atlantic Meridional Transect (AMT) 11 cruise.Five different oceanic provinces were traversed in this cruise:North Atlantic Drift (NADR), North Atlantic Subtropical Gyral(NAST), Canary Coastal (CNRY), Eastern Tropical Atlantic (ETRA),and South Atlantic Gyral (SATL). CNRY and ETRA were affectedby the upwelling Mauritanian and equatorial respectively andprimary production in these provinces was higher than in theoligotrophic subtropical gyres (NAST and SATL). Both mesozooplanktonand phytoplankton biomass were highest around the equator. Theamount of chlorophyll a ingested daily by copepods was noticeablyhigher in mesotrophic than in oligotrophic provinces as shownby the spatial distribution of gut content values and the highabundances of copepods recorded at the equator. Grazing impactalong the transect ranged from 0.2 to 5.6% of the phytoplanktonstanding stock and from 1.6 to 14.5% of primary production.If only phytoplankton >2 µm are considered, the rangesare 1.0–19.4% (stock) and 3.4–44.7% (primary production).Grazing impact upon both phytoplankton biomass and primary productionfollowed a spatial distribution similar to that of chlorophylla ingestion, with higher values in upwelling zones than in thegyres. Weight-specific rates of respiration and NH₄⁺ and PO₄^3–excretion showed large variability both along the transect andwithin provinces, but did not differ between provinces. Therefore,zooplankton assemblages inhabiting the different provinces visitedin the AMT 11 seem to be adapted to the prevailing thermal conditions.Given the substantial proportion of nitrogen and phosphorusthat are supplied to primary producers through the excretoryactivity of mesozooplankton (the percentage of nitrogen andphosphorus requirements of phytoplankton accounted for by mesozooplanktonexcretion was >30% in all the provinces) it follows thatthey may play a crucial role as nutrient regenerators, especiallyin the oligotrophic gyres where regenerated production dominates.     

Genetic control of single lumen formation in the zebrafish gut

Most organs consist of networks of interconnected tubes that serve as conduits to transport fluid and cells and act as physiological barriers between compartments. Biological tubes are assembled through very diverse developmental processes that generate structures of different shapes and sizes. Nevertheless, all biological tubes invariably possess one single lumen. The mechanisms responsible for single lumen specification are not known. Here we show that zebrafish mutants for the MODY5 and familial GCKD gene tcf2 (also known as vhnf1) fail to specify a single lumen in their gut tube and instead develop multiple lumens. We show that Tcf2 controls single lumen formation by regulating claudin15 and Na+/K+-ATPase expression. Our in vivo and in vitro results indicate that Claudin15 functions in paracellular ion transport to specify single lumen formation. This work shows that single lumen formation is genetically controlled and appears to be driven by the accumulation of fluid.