Institutional end-of-life care policy for inpatients at a tertiary care centre in India: A way forward to provide a system for a dignified death.

India has a high share in the global burden of chronic terminal illnesses. However, there is a lack of a uniform system in providing better end-of-life care (EOLC) for large patients in their terminal stage of life. Institutional policies can be a good alternative as there is no national level policy for EOLC. This article describes the important aspects of the EOLC policy at one of the tertiary care institutes of India. A 15 member institutional committee including representatives from various departments was formed to develop this institutional policy. This policy document is aimed at helping to recognize the potentially non-beneficial or harmful treatments and provide transparency and accountability of the process of limitation of treatment through proper documentation that closely reflects the Indian legal viewpoint on this matter. Four steps are proposed in this direction: (i) recognition of a potentially non-beneficial or harmful treatment by the physicians, (ii) consensus among all the caregivers on a potentially non-beneficial or harmful treatment and initiation of the best supportive care pathway, (iii) initiation of EOLC pathways, and (iv) symptom management and ongoing supportive care till death. The article also focuses on the step-by-step process of formulation of this institutional policy, so that it can work as a blueprint for other institutions of our country to identify the infrastructural needs and resources and to formulate their own policies.

SCOPE11 Method for Estimating Aircraft Black Carbon Mass and Particle Number Emissions.

Black carbon (BC) emissions from aircraft engines lead to an increase in the atmospheric burden of fine particulate matter (PM2.5). Exposure to PM2.5 from sources, including aviation, is associated with an increased risk of premature mortality, and BC suspended in the atmosphere has a warming impact on the climate. BC particles emitted from aircraft also serve as nuclei for contrail ice particles, which are a major component of aviation's climate impact. To facilitate the evaluation of these impacts, we have developed a method to estimate BC mass and number emissions at the engine exit plane, referred to as the Smoke Correlation for Particle Emissions-CAEP11 (SCOPE11). We use a data set consisting of SN-BC mass concentration pairs, collected using certification-compliant measurement systems, to develop a new relationship between smoke number (SN) and BC mass concentration. In addition, we use a complementary data set to estimate measurement system loss correction factors and particle geometric mean diameters to estimate BC number emissions at the engine exit plane. Using this method, we estimate global BC emissions from aircraft landing and takeoff (LTO) operations for 2015 to be 0.74 Gg/year (95% CI = 0.64-0.84) and 2.85 × 1025 particles/year (95% CI = 1.86-4.49 × 1025).