Palliative care in Yorkshire, UK 1987-2008: survival and mortality in a hospice.

OBJECTIVE: To provide new epidemiological evidence base of information on models of hospice care for children and young adults. DESIGN: Retrospective cohort study of children referred to a hospice. SETTING: Martin House Children's and Young Person's Hospice in Boston Spa, North Yorkshire, UK. PARTICIPANTS: All children who had been referred for care at Martin House Children's Hospice since it opened in August 1987, until May 2008. MAIN OUTCOME MEASURES: Demographic profiles and survival times overall and by diagnostic group classified by the Association of Children's Palliative Care (ACT) Diagnostic Categories, calculated using the Kaplan- Meier and log rank pair-wise methodology. RESULTS: Over a 20-year period, 1554 children aged from birth to 19 years were referred to Martin House, of whom 89.5% (mean age 7.45 years) were accepted. The deprivation profile, referral source and distribution of diagnoses of these children have changed over time with recently increasing numbers of non-progressive disorders (ACT category 4). The ethnicity profile has changed with an increase in the numbers of South Asian children. The overall mean survival time was 5.6 years (95% CI 5.1 to 6.1) but this differed by ACT category. Diagnostic category was significantly associated with differing survival patterns. CONCLUSIONS: There are a disproportionate number of children from areas of higher deprivation being referred for palliative care services. There has been a recent increase in the number of children from South Asian families being referred to palliative care services in Yorkshire. Survival times for children and young people receiving care from a hospice can vary from hours and days to more than 20 years.

Visual and socio-cognitive information processing in primate brain evolution.

Social group size has been shown to correlate with neocortex size in primates. Here we use comparative analyses to show that social group size is independently correlated with the size of non-V1 neocortical areas, but not with other more proximate components of the visual system or with brain systems associated with emotional cueing (e.g. the amygdala). We argue that visual brain components serve as a social information 'input device' for socio-visual stimuli such as facial expressions, bodily gestures and visual status markers, while the non-visual neocortex serves as a 'processing device' whereby these social cues are encoded, interpreted and associated with stored information. However, the second appears to have greater overall importance because the size of the V1 visual area appears to reach an asymptotic size beyond which visual acuity and pattern recognition may not improve significantly. This is especially true of the great ape clade (including humans), that is known to use more sophisticated social cognitive strategies.

Social pressures have selected for an extended juvenile period in primates.

Primates are highly social animals. As such, they utilize a large repertoire of social skills to manage their complex and dynamic social environments. In order to acquire complex social skills, primates require an extended learning period. Here 1 perform a comparative analysis using independent contrasts to show that social pressures have favored an extension in the proportion of time primates spend as juveniles.