text:
Brock Peters

Brock Peters (born George Fisher; July 2, 1927 – August 23, 2005) was an American actor and singer, best known for playing the villainous "Crown" in the 1959 film version of Porgy and Bess, and Tom Robinson in the 1962 film To Kill a Mockingbird. He made his Broadway debut in the 1965 Norman Rosten play Mister Johnson. He was nominated for a Tony Award and won a Drama Desk Award and an Outer Critics Circle Award for his lead role as Rev. Stephen Kumalo in the 1972 Broadway revival of the musical Lost in the Stars. He received the Screen Actors Guild Life Achievement Award in 1991 and a star on Hollywood Walk of Fame in 1992.

In the 1980s and 1990s, Peters voiced the role of Darth Vader in the serial radio drama adaptations of the original trilogy of Star Wars films, and played two recurring roles in the Star Trek franchise: Starfleet Admiral Cartwright in two of the original-cast feature films, and Joseph Sisko (father of station commander Benjamin Sisko) in Star Trek: Deep Space Nine.

Peters notable film roles include Carmen Jones (1954), The Pawnbroker (1964), Soylent Green (1973) and Ghosts of Mississippi (1996).

Early life
Peters was born George Fisher in New York City, the son of Alma A. (née Norford) and Sonnie Fisher, a sailor. Peters set his sights on a show business career early on, at the age of 10. Avidly encouraged by his mother Alma to pursue a musical career, he studied the violin from 10 to 14 years of age, but he found out that his singing talents were more prodigious and upon enrolling at New York's famed High School of Music & Art, he immediately signed up for several productions in its musical theatre program. Upon graduation, Peters initially fielded more odd jobs than acting jobs, often working as a hospital orderly at night while he worked his way through physical education studies at the City College of New York (CCNY), but he still stayed connected to the burgeoning theatre and creative community in New York, occasionally doing background parts in musical plays like "Black Aida".

Career
After auditioning and landing a spot touring with the Leonard DePaur Infantry Chorus (of which he was a civilian member from 1945 to 1947), however, he officially quit CCNY. Peters often joked that he "grew up" in the chorus, because his vocal range changed from baritone to bass baritone during his years with them. DePaur subsequently gave him the lead in the Chorus' popular rendition of "John Henry" (which became a repertoire mainstay of Peters in later years, singing the work on one of his two solo albums which was produced by United Artists Records in the 1960s).

At the suggestion of his agent, he adopted a more memorable stage name, reversing the order of the names of childhood friend Peter Brock.

After auditioning and landing a stage role in the touring company of Porgy and Bess in 1949 on contralto Etta Moten Barnett's suggestion, he went on tour with the opera, where William Warfield commended his performances and requested that Peters be his understudy as Porgy. It was during this time while he was touring in Europe with the opera that Paul Robeson saw him in his career-defining role as "Crown" and purportedly declared that he was "a young Paul Robeson".

Peters made his film debut in Carmen Jones in 1954, but began to make a name for himself in such films as To Kill a Mockingbird and The L-Shaped Room. He received a Tony nomination for his starring stint in Broadway's Lost in the Stars.

Peters sang background vocals on the 1956 hit "Day-O" by Harry Belafonte, as well as on Belafonte's 1957 hit, "Mama Look at Bubu". He led the chorus at recording sessions for Belafonte's iconic 1956 album Calypso. He also sang on the song "Where" from Randy Weston's 1959 album Live at the Five Spot and shared vocal duties with Martha Flowers on Weston's album of the following year, Uhuru Afrika. During this time, Peters and Belafonte became close friends, sharing similar political views and approaches to their careers. In 1963, he played Matthew Robinson in Heavens Above!, a British satirical-comedy film starring Peter Sellers, directed by John and Roy Boulting. He played a supporting role as the gangster Rodriguez in the 1964 film, The Pawnbroker, one of the first confirmed homosexual characters in an American film. He played “Jesse” in a 1972 episode of Gunsmoke. He was a special guest star in the third season of The Streets of San Francisco, playing the character "Jacob" in the episode called "Jacob's Boy" (1974).

In the film Abe Lincoln, Freedom Fighter (1978), Peters plays Henry, a freed black slave who is falsely accused of robbery but, defended by Abraham Lincoln, is found not guilty due to the fact he has a damaged hand and could not have committed the crime. In To Kill a Mockingbird, Peters plays Tom Robinson, a black man falsely accused of raping a white girl, a crime Atticus Finch shows he could not have committed because his left hand and arm were damaged. In 1970 Peters portrayed the voice of African-American boxer Jack Johnson in Bill Cayton's film of the same name, and it is in this role that he can be heard at the end of Miles Davis' soundtrack album, Jack Johnson, saying: "I'm Jack Johnson. Heavyweight champion of the world. I'm black. They never let me forget it. I'm black, all right. I'll never let them forget it."

Between 1981 and 1996, Peters voiced Darth Vader in the radio adaptations of the first three Star Wars films for National Public Radio. He also played the role of a Colonial prosecutor trying to make a murder case against Starbuck in an episode of the original Battlestar Galactica.

Peters appeared in the films Star Trek IV: The Voyage Home and Star Trek VI: The Undiscovered Country as Fleet Admiral Cartwright of Starfleet Command. Peters portrayed Joseph Sisko, father of Deep Space Nine's commanding officer, Benjamin Sisko, on Star Trek: Deep Space Nine. In 1993, he was a member of the jury at the 43rd Berlin International Film Festival. In early 2005, six months before his death, Peters guest-starred in an episode of JAG during its final season, "Bridging the Gulf", season 10 episode 15. Peters worked with Charlton Heston on several theater productions in the 1940s and 1950s. The two became friends and subsequently worked together on several films, including Major Dundee, Soylent Green, and Two-Minute Warning. He voiced Lucius Fox in several episodes of Batman: The Animated Series and had a guest role as Morris Grant/Soul Power in the Static Shock episode "Blast from the Past" (2003).

He was involved in many community projects, including being chairman and a co-founder of the Dance Theatre of Harlem.

Recognition
Brock was awarded the 26th Screen Actors Guild Life Achievement Award in 1990 for his acting career and humanitarian contributions. He was given a star on the Hollywood Walk of Fame in the live theater category in 1992.

Personal life and death
Peters was once romantically involved with actress Ja'net Dubois. Peters was married to Dolores 'DiDi' Daniels from 1961 until her death in 1989. Their daughter, Lisa Jo Peters, was born November 3, 1962. Peters delivered the eulogy at Gregory Peck's funeral in 2003. His character, Tom Robinson, was defended by Peck's Atticus Finch in 1962's To Kill a Mockingbird.

Peters died in Los Angeles from pancreatic cancer on August 23, 2005, at the age of 78. Peters is buried in the Revelation section at Hollywood Hills Forest Lawn Cemetery, in Los Angeles, California.

Other notable performances

 * Nat Turner in The Original Confessions of Nat Turner As Made to T.R. Gray, November 1, 1831, LP, CMS Records (1968)
 * Stephen Kumalo in Kurt Weill and Maxwell Anderson's Lost in the Stars (stage revival and 1974 film version) – nominated for a Tony Award
 * The Reverend Canon Frederick Chasuble, DD in an all-black film version of Oscar Wilde's The Importance of Being Earnest (1992)
 * Darth Vader in the Star Wars radio series
 * Voice-acting performance as the boxer Jack Johnson on the Miles Davis album A Tribute to Jack Johnson

title: Brock Peters


text:
Talk:This Hour Has 22 Minutes

Comments
Why even have the Shaun Majumder present if nothing can be made out?

I took out this sentence because I think it is highly misleading as it stands:

 * The minimum number of signatures as by Alliance's criteria was obtained and as a result of showing the possible misuse of the measure, the platform item was soon quietly dropped by the party.

First of all, no signatures were obtained -- it was an online petition. Secondly, the Alliance has not dropped the policy (see http://www.canadianalliance.ca/english/policy/index.asp#_Toc8204945 ). It was a good joke that got the show a lot of attention but it had no serious effects on politics -- that makes it just like the Alliance, eh? Trontonian
 * (Obviously that was written before their conquest of the PCs.) Kwantus 18:23, 2004 Dec 3 (UTC)
 * So I changed the article. Trontonian

I find "The studio of This Hour... is located in Halifax, Nova Scotia" poor form, and suggest instead, "The studio of This Hour Has 22 Minutes is located in Halifax, Nova Scotia." In fact I did more than suggest, i made the change, only to have it undone by 199.43.172.254 mere momemnts later. 199.43.172.254, what's the utiltiy of the elipsis? orthogonal 17:44, 12 Nov 2003 (UTC)

 * Is it still in Halifax? Did AA revive it there? Kwantus 18:10, 2004 Dec 3 (UTC)

 * It's still in Halifax according to the CBC website.

Surely there should be a reference the original "This Hour..." somewhere in here. It's inconceivable to me that the one should not have been named in homage to the other. 18.24.0.120 21:01, 6 Dec 2003 (UTC)

 * A reference to This Hour Has Seven Days has been added along with some copy editing. Sunray 23:01, 2003 Dec 19 (UTC)

I'm not sure why the reference to This Hour Has Seven Days was removed. I've added it again. Here's a reference, if you doubt it's validity 1 Sunray 21:14, 2003 Dec 21 (UTC)

Do we know when the series officially ends? If so, we should add that.

Also, I just want to recognize the diligent work done on this page by 66.185.84.206/208 and others. One question: I had connected some of the short introductory paragraphs into a couple of more substantial ones. This was reverted back. Why?

While short paragraphs are encouraged by Wikipedia and are generally more readable, if they are too short they give the article a lightweight appearance and tone (like a series of random notes). One-sentence paragraphs should not be overdone, IMO. I know it is only a TV show, but shouldn't we try to make the article read well? Sunray 18:30, 2004 Jan 3 (UTC)

 * I've been meaning to get on that for a while now, it's been bugging me too, Sunray. I will do a complete overhaul this week. As for when the show ends, it's still in active production... despite less government funding, it's not been cancelled. - user:zanimum

 * Nice work! Sunray 00:13, 2004 Jan 8 (UTC)

 * Thank's Sunray. I'd like your and everyone else's opinion on this. An anonymous user continuously adds links to a CBC photo site. I wouldn't be at all concerned normally, but this site is a non-password protected media-only website. The main CBC pages do not link to this directory of photos, and so obviously, CBC doesn't want thousands of people downloading 1+ MB photos from their servers. Thus, we shouldn't be linking to them at all. Yes? No? -- user:zanimum

 * They are nice pics though. Even though they are not linked to CBC's main pages, they are on the Internet.  Perhaps if there was a warning about the size, such as: "Note, the following images are large files, best viewed with a high-speed connection." Sunray 02:54, 2004 Jan 9 (UTC)

 * That's not the point. The point is that CBC doesn't want the public there. Although they put up no prevention measure against public access, it's certainly not promoted or encouraged. -- user:zanimum

 * Not the point? You asked a question. I responded. If CBC doesn't want them public they can take them off the Internet! Sunray 05:22, 2004 Jan 10 (UTC)

Name
Was the name of the show a reference to This Hour Has Seven Days? I've included it in that article, but would appreciate someone taking it out if they know I'm wrong. Meelar (talk)]] 21:43, 20 Jun 2004 (UTC)

No, you're quite right. The name is a reference to the classic news show. --Zippanova 5 July 2005 19:23 (UTC)

Starring
Maybe it's just me, and not being a Canadian resident it's entirely possible, but I'm sure that on my visits to Canada I've seen some episodes of this that also had Ryan Styles. I'm sure I recall seeing him on the same shows as Colin Mochrie (I've only seen around 8 episodes though). Should he be listed somewhere? Can a more frequent watcher say yay or nay? Ben W Bell 06:25, 18 September 2005 (UTC)

No, Ryan Stiles has never appeared on the show. I believe only Canadian actors have appeared. I have only seen about 90% of the episodes so I may be wrong, can anyone confirm? CanucksRule 02:30, 27 September 2006 (UTC)

Also under starring, I notice Meredith MacNeil is listed - I know she appeared in a few episodes a couple seasons back, but the listed cast this season is Cathy Jones, Mark Critch, Susan Kent, and Trent McClellan. (I think Meredith MacNeil has moved on to the Baroness von Sketch Show, anyway.) Would it be appropriate to change that 2017- to just 2017? Additionally, I thought she was a guest star that season, not part of the main cast. Sailor7sakura (talk) 04:28, 13 November 2019 (UTC)

Dates

 * The show will be coming back for the thirteenth season very soon.

Which is when? I don't know enough to change this, but could someone who does please put in a date here? Phrases like "very soon" date horribly on Wikipedia. End of whinge. Loganberry (Talk) 21:31, 7 October 2005 (UTC)

Real names
Can anyone point out the time that the anchors stopped using their false names (eg. Gavin Cooper) and started going by their real names (eg. Gavin Crawford)? I believe it was season 11 or 12. kelvSYC 02:21, 26 November 2005 (UTC)

Inconsistent
This article claims the satirical petition for the name change had no effect on Alliance policy but the satire article claims:
 * In the 2000 Canadian federal election campaign, a Canadian Alliance proposal for a mechanism to require a referendum in response to a petition of sufficient size was satirized by the television show This Hour Has 22 Minutes so effectively that it was discredited and soon dropped.

Nil Einne 20:20, 20 September 2006 (UTC)

Fair use rationale for Image:Marg Princess Warrior.jpg
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Please go to the image description page and edit it to include a fair use rationale. Using one of the templates at Fair use rationale guideline is an easy way to insure that your image is in compliance with Wikipedia policy, but remember that you must complete the template. Do not simply insert a blank template on an image page.

If there is other other fair use media, consider checking that you have specified the fair use rationale on the other images used on this page. Note that any fair use images uploaded after 4 May, 2006, and lacking such an explanation will be deleted one week after they have been uploaded, as described on criteria for speedy deletion. If you have any questions please ask them at the Media copyright questions page. Thank you.BetacommandBot 05:12, 6 June 2007 (UTC)

I'm Just Goofin' Around!
I edited a little bit of Babe Bennett. I never recall hearing her say "that's all!" at the end of her famous quote (I'm just goofin' around). If this shouldn't have been done or something, let me know. Cheeze Master 20:46, 23 September 2007 (UTC)Cheeze Master

Majumder - Picture
It says hes in the bottom left corner in the hockey picture even though the picture is not present on the page Hojima (talk) 14:36, 17 February 2008 (UTC)

Image copyright problem with Image:Talkingtoamericans.jpg
The image Image:Talkingtoamericans.jpg is used in this article under a claim of fair use, but it does not have an adequate explanation for why it meets the requirements for such images when used here. In particular, for each page the image is used on, it must have an explanation linking to that page which explains why it needs to be used on that page. Please check

 * That there is a non-free use rationale on the image's description page for the use in this article.
 * That this article is linked to from the image description page.

This is an automated notice by FairuseBot. For assistance on the image use policy, see Media copyright questions. --05:30, 1 November 2008 (UTC)

External links modified
Hello fellow Wikipedians,

I have just added archive links to 2 one external links on This Hour Has 22 Minutes. Please take a moment to review my edit. If necessary, add after the link to keep me from modifying it. Alternatively, you can add to keep me off the page altogether. I made the following changes:
 * Added archive https://web.archive.org/20131105084501/http://tvguide.ca/Watercooler/You+Asked/Articles/120423_askamber_AD.htm to http://tvguide.ca/Watercooler/You+Asked/Articles/120423_askamber_AD.htm
 * Added archive https://web.archive.org/20071028130941/http://www.cbc.ca:80/22minutes/22_single_player.html?archive/rajbinderhockey to http://www.cbc.ca/22minutes/22_single_player.html?archive/rajbinderhockey

When you have finished reviewing my changes, please set the checked parameter below to true to let others know.

Cheers. —cyberbot II  Talk to my owner :Online 22:01, 29 August 2015 (UTC)

license: Creative Commons - Attribution Share-Alike - https://creativecommons.org/licenses/by-sa/4.0/

title: Talk:This Hour Has 22 Minutes


text:
Roxie Theater

The Roxie Theater, also known as the Roxie Cinema or just The Roxie, is a historic movie theater, founded in 1912, at 3117 16th Street in the Mission District of San Francisco. It is a non-profit community arthouse cinema.

History
The Roxie is one of the oldest continuously operating movie theaters in the US, with its history tracing back to the early 1900s.

The 300-seat theater was renovated in 1933, changed its name to the Roxie, and added its unusual marquee with neon sign but no place for movie titles. In 2003, a 49-seat theater dubbed the Little Roxie opened two doors from the main theater.

Other names for the theater:
 * The Poppy 1912–1916
 * The New 16th Street 1916–1920
 * The Rex 1920–1926
 * The Gem 1926–1930
 * The Gaiety 1930–1933
 * The Roxie 1933–present

In the late 1960s with the decline of its neighborhood, The Roxie became a pornography theater. In March 1976, film lovers Robert Christopher Evans, Dick Gaikowski, Peter Moore, and Tom Mayer bought the Roxie, remodeled it, and turned it into an art and independent film center. Between November 1–15, 1979, the Roxie hosted the U.S. premiere of Luis Buñuel's L'Âge d'Or (1930), a film that had been banned for almost 50 years. Over the years, the Roxie has been home to many film festivals such as the Frameline Film Festival, the San Francisco Jewish Film Festival, the Arab Film Festival, San Francisco Transgender Film Festival, SF Indiefest, and many others.

In December 2005, an agreement was announced under which the Roxie was acquired by New College of California, a small liberal arts college also based in the Mission District. It became part of New College's Media Studies Program on January 1, 2006, and was renamed the "Roxie Film Center at New College". An anonymous benefactor paid off the theater's debts, and the college registered it as a non-profit corporation.

On February 26, 2008, New College announced it was closing, thus ending its support of the Roxie. New College Board member Rod Holt and his son Alan subsequently took over the theater’s lease.

In 2010 Alan Holt transitioned from Executive Director to a seat on the Board and community activist and philanthropist Christopher Statton joined the Roxie as Executive Director and member of the Board. Megan Wilson, who began working for the Roxie as a development consultant, became a co-Executive Director; neither received a salary. Over his four-year tenure, Statton established the Roxie as a community-based non-profit, including the creation of the Roxie's ''Lights. Camera. Action! Awards'' to honor Bay Area social justice documentary filmmakers. The inaugural awards honored the filmmaking team of Rob Epstein and Jeffrey Friedman and filmmaker Hima B for their significant contributions in raising awareness of the challenges of living with HIV/AIDS. Statton also raised over $400,000 in contributions to help support the Roxie's programming and operations. In 2013 Statton was awarded the Marlon Riggs Award by the San Francisco Film Critics Circle for "his significant contribution to San Francisco’s film community through the Roxie Theater over the past four years". Statton resigned from the Roxie in 2013 due to health concerns.

In December 2013, the Roxie announced Isabel Fondevila, former Board President of Artists' Television Access, as the new director. She further expanded the theater's film festivals and developed RoxCine, an ongoing series of Spanish-language films.

In 2015, Dave Cowen came aboard as executive director, while Fondevila remained at the Roxie in the role of Director of Programming. Over the next two years, Cowen led the theater to profitability with projection and facilities improvements, an increased social media presence, and a successful focus on showing repertory film in 35mm. During this time, the Roxie's classic neon marquee was fully restored, and the Roxie was honored by the California State Assembly in 2017 as Small Business of the Year.

In August 2017, Sundance veteran Elizabeth O'Malley replaced Cowen as executive director, with Operations Director Lex Sloan promoted to general manager. Cowen remains on the Roxie Board of Directors and is now working with Milwaukee Film on their acquisition of the historic Oriental Theatre.

Roxie Releasing
The theatre also is home to Roxie Releasing, an independent film distributor most notably responsible for the 30th anniversary re-release of George A. Romero's Night of the Living Dead. Roxie Releasing specializes in documentaries.

title: Roxie Theater


text:
User:GUllman/List of books

This is a page where I'm compiling the current list of Wikipedia articles about books. After I arrange each of these lists of articles into alphabetical order, they are added to List of books by title: A through Z.

My working list:
Hunt down articles, find author and date, alphabetize and copy to List of books:

 * The Stars My Destination (Tiger! Tiger!) - Alfred Bester (1956)
 * The Story of the Stone - Barry Hughart (1988)
 * Success is a Choice: Ten Steps to Overachieving in Business and Life - Rick Pitino (1998)
 * Primary Chronicle (Primary Chronicle) - Nestor the Chronicler (1116), Russian history
 * Theory of Games and Economic Behavior - John von Neumann and Oskar Morgenstern (1944)
 * Think and Grow Rich - Napoleon Hill 1937
 * Thomas Guide, atlas
 * The Three Types of Legitimate Rule - Maximilian Weber 1958
 * Tiger! Tiger! (The Stars My Destination) - Alfred Bester (1956)
 * The Tipping Point - Malcolm Gladwell (2000)
 * Turner Diaries
 * Condition of Farm Labour in Eastern Germany - Maximilian Weber (1892)
 * William Does His Bit - Richmal Crompton (1941), children's short stories
 * The Witches - Roald Dahl 1983
 * Where Late the Sweet Birds Sang - Kate Wilhelm (1976)
 * World of Tiers series - Philip José Farmer (1965-1993)
 * Young, Gay and Proud - Sasha Alyson and Lynne Yamaguchi Fletcher
 * Zur Geschichte der Handelgesellschaften im Mittelatler (The History of Medieval Business Organisations) - Maximilian Weber (1889)

Books found on:

 * New Pages (continually watched)
 * Recent Changes (occasionally watched)
 * List of encyclopedias - done
 * List of books - done
 * Years in literature (1950 thru 2003 - done)
 * Author - in progress
 * List of biographers - done
 * List of children's literature authors - in progress (A-L done)
 * Western canon - in progress
 * User:Danny (Talk page)
 * User:Ed Poor (User contributions 12/2003-3/2004) a rampant creator of orphaned articles ;-)

Google searches performed:

 * 'manual' - done
 * 'atlas' - mostly done
 * 'book' OR 'novel' (first 350 results - done)

Next Big Project
Find all books written by these authors:

 * - Mary Pope Osbourne - Magic Treehouse series
 * - Charles Perrault, (1628-1703), Tales of Mother Goose
 * - José Cardoso Pires
 * - Sylvia Plath
 * - Pliny the Elder
 * - Pliny the Younger
 * - Plutarch
 * - Alexander Pope
 * - Beatrix Potter, (1866-1943), The Tale of Peter Rabbit
 * - Aleksandr Pushkin
 * - Arthur Ransome, (1884-1967), Swallows and Amazons series
 * - Marjorie Rawlings - The Yearling
 * - H.A. Rey, (1898-1977), and Margret Rey - Curious George
 * - Edwin Arlington Robinson
 * - J. K. Rowling, (born 1965), Harry Potter series
 * - Louis Sachar -- Wayside School is Falling Down series
 * - Antoine de Saint-Exupery, (1900-1944), The Little Prince
 * - Richard Scarry - (1919-1994) Busytown series
 * - Ouida Sebestyen - American, (1924- ) - Far From Home
 * - Maurice Sendak - Where the Wild Things Are
 * - Theodor "Dr. Seuss" Geisel - The Cat in the Hat
 * - Anna Sewell, (1820-1878), Black Beauty
 * - Shel Silverstein, (1930-1999), The Giving Tree, Where the Sidewalk Ends
 * - Francesca Simon, (born 1955), Horrid Henry series
 * - Zilpha Keatley Snyder - The Egypt Game
 * - Don Sobol - Encyclopedia Brown series
 * - Johanna Spyri, (1827-1901), Heidi
 * - Robert Louis Stevenson, (1850-1894), A Child's Garden of Verses, Treasure Island
 * - R. L. Stine - Goosebumps series
 * - Frank R. Stockton, (1834-1902), The Lady or the Tiger?
 * - Edward L. Stratemeyer - (see Victor Appleton, Jr., Carolyn Keene, Franklin Dixon)
 * - Jonathan Swift, (1667-1745), Gulliver's Travels
 * - Ann Jane Taylor - Twinkle,Twinkle,Little Star
 * - Kaye Thompson - Eloise
 * - J.R.R. Tolkien, (1892-1973), The Hobbit
 * - Georg Trakl
 * - Pamela Travers - Mary Poppins
 * - Ethel Turner - Seven Little Australians
 * - Samuel "Mark Twain" Clemens - Tom Sawyer, Huckleberry Finn
 * - Jules Verne, (1828-1905), A Journey to the Center of the Earth
 * - Judith Viorst - Alexander and the Terrible, Horrible, No Good, Very Bad Day
 * - Alice Walker
 * - Franz Werfel
 * - E.B. White - Charlotte's Web, Stuart Little, The Trumpet of the Swan
 * - Kate Douglas Wiggin, (1856-1923), Rebecca of Sunnybrook Farm
 * - Laura Ingalls Wilder, (1867-1957), Little House on the Prairie
 * - Jesse Lynch Williams
 * - Margery Williams - The Velveteen Rabbit
 * - Ludwig Wittgenstein
 * - Johann David Wyss
 * - William Butler Yeats
 * - Jane Yolen -- the Commander Toad series, the Dragon's Blood series
 * - Ed Young -- Lon Po Po, Seven Blind Mice
 * - Marya Zaturenska

title: User:GUllman/List of books


text:
Alpe d'Huez

L'Alpe d'Huez is a ski resort in Southeastern France at 1250 to 3330 m. It is a mountain pasture in the central French Western Alps, in the commune of Huez, which is part of the Isère department in the Auvergne-Rhône-Alpes region.

It is part of the Grandes Rousses massif, over the Oisans, and is 59 km from Grenoble. The Alpe d'Huez resort is accessible from Grenoble by the, which runs along the Romanche Valley passing through the communes of Livet-et-Gavet and Le Bourg-d'Oisans as well as Haut-Oisans via the Col de Sarenne.

Alpe d'Huez is known internationally as an iconic cycling venue, as it is used regularly in the Tour de France cycle race, including twice on the same day in 2013. In 2019, it became the site of the first Tomorrowland Winter festival.

History
The site of the Alpe has been permanently occupied since the Middle Ages. East of L'Alpe veti, a medieval agglomeration had grown from the end of the 11th to the 14th century under the name of Brandes. It was composed of a castle, a parish church with a cemetery, a village with about 80 homes, surface and underground mine workings, as well as several industrial districts. Its occupants operated a silver mine on behalf of the Dauphin. It is currently the only medieval known and preserved in its entirety, making it a unique site in Europe and classified as historical monuments by a decree of 6 August 1995.

Excavated and studied continuously since 1977 by a team of the CNRS, this site is registered as an historic monument. The medieval mining operation stretched from Gua (the Valley) to the Lac Blanc [White Lake] (Massif des Rousses). The massif was also the subject of mining operations, including copper, from the Bronze Age.

It is also at Alpe d'Huez where botanist Gaston Bonnier began his study of flora of France in 1871.

The station was developed from the 1920s. This is where the first platter lift for skiers was opened in 1936 with perches by, creator of the Poma company.

Climate
On average, Alpe d'Huez experiences 159.9 days per year with a minimum temperature below 0 C, 22.7 days per year with a minimum temperature below -10 C, and 42.4 days per year with a maximum temperature below 0 C. The record high temperature was 29.5 C on 18 July 2023, while the record low temperature was -25.2 C on 5 February 2012.

Economy
Each year, the Alpe d'Huez Film Festival is held in January.

Alpe d'Huez also has an altiport, the Alpe d'Huez Airport, built for the 10th Winter Olympics held at Grenoble in 1968. It was named for on 15 April 2000, in memory of the famous mountain pilot. The altiport hosts helicopters including those of civil security, SAF Helicopteres and the Dauphiné flying club. A gourmet restaurant is located on the edge of the platform.

The church
Alpe d'Huez has a modern and original church, the appearance of which recalls a silhouette of the Virgin Mary. Under the leadership of Father Jaap Reuten, head of the parish from 1964 to 1992, it was designed by the architect Jean Marol in the 1960s (completed in 1970), and decorated with colour-rich stained-glass windows by the artist Arcabas.

This church houses a pipe organ which is unique in the world. The organ takes the form of a hand drawn up towards the sky, designed by composer Jean Guillou and the German organ builder Detlef Kleuker. Each year, concerts are held around this instrument on Thursday night, winter and summer, as well as organ, pan flute and choral courses during the summer.

Cultural heritage

 * The (or Musée d'Huez et de Oisans), of the Musée de France.

Winter sports
Alpe d'Huez is primarily used for downhill, or Alpine skiing.

Skiing at Alpe d'Huez
Alpe d'Huez is one of Europe's premier skiing venues. The site of the Pomagalski's first surface lift in the mid thirties, the resort gained popularity when it hosted the bobsleigh events of the 1968 Winter Olympics. At that time the resort was seen as a competitor to Courchevel as France's most upmarket purpose built resort but the development of Les Trois Vallées, Val d'Isère, Tignes, La Plagne and Les Arcs saw Alpe D'Huez fall from favour in the 1970s and early 1980s.

With 249 km of piste and 84 ski lifts, the resort is now one of the world's largest. Extensive snowmaking facilities helped combat the ski area's largely south-facing orientation and helped Alpe d'Huez appeal to beginner skiers, with very easy slopes. The expansion of the skiing above the linked resorts of Vaujany, Oz-en-Oisans, Villard Reculas and Auris boosted the quantity and quality of intermediate grade slopes but the resort is mostly known for freeskiing, drawing many steep skiing enthusiasts to its high altitude terrain.

Aside from the Tunnel and Sarenne black runs, the latter the world's longest at 16 km, many Off-piste opportunities exist both from the summit of the 3330 m Pic Blanc and the 2808 m Dome des Petites Rousses. These include the 50-degree Cheminees du Mascle couloirs, the open powder field of Le Grand Sablat, the Couloir Fleur and the Perrins bowl. Up to 2200 m of vertical descent are available with heli drops back to the resort's altiport. The proximity to the exclusively off-piste resort of La Grave as well as tree skiing at Serre Chevalier and the glacier and terrain parks of Les Deux Alpes have made Alpe d'Huez a popular base for skiers looking to explore the Oisans region.

1968 Winter Olympics
Alpe d'Huez hosted the bobsleigh events at the 1968 Winter Olympics based at Grenoble 65 km away. The track, built in spring 1966 for FRF 5.5 million, hosted the World Championships in 1967. The cooling could not keep the ice solid in bright daylight – not least because the track faced south. The four-man event was cancelled because of thawing ice, and modifications were made that spring to prepare for the Games. The refrigeration system was strengthened in turns 6, 9, 12, and 13; turn 12 was covered with stone and earthwork to prevent concrete coming up, turn 12 was cooled with liquid nitrogen, and shades were built on turns 6, 9, 12, and 13 to minimise direct sunlight. Thawing remained a problem and Olympic bobsleigh events had to be scheduled before sunrise. The track closed in 1972 due to high operating costs; the structure remains as demolition was not economical.

 * {| class=wikitable style="text-align:center"

! Sport ! Length ! Turns ! Vertical drop ! Average grade (%)
 * + Physical statistics
 * Bobsleigh
 * 1500 m
 * 13
 * 140 m
 * 9.33
 * }
 * No turn names were given for the track.
 * No turn names were given for the track.

Details
The climb to the summit starts at Le Bourg d'Oisans in the Romanche valley. The climb goes via the D211 from where the distance to the summit (at 1860 m) is 13.8 km, with an average gradient of 8.1%, with 21 hairpin bends and a maximum gradient of 13%. Despite its notoriety, Alpe d'Huez is only the 56th hardest bike climb in France.

Tour de France
L'Alpe d'Huez is climbed regularly in the Tour de France. It was first included in the race in 1952 and has been a stage finish regularly since 1976. The race was brought to the mountain by Élie Wermelinger, the chief commissaire or referee. He drove his Panhard Dyna car between snow banks that lined the road in March 1952, invited by a consortium of businesses who had opened hotels at the summit. Their leader was Georges Rajon, who ran the Hotel Christina. The ski station there opened in 1936. Wermelinger reported to the organiser, Jacques Goddet, and the Tour signed a contract with the businessmen to include the Alpe. It cost them the modern equivalent of €3,250.

That first Alpe d'Huez stage was won in 1952 by Fausto Coppi. Coppi attacked 6 km from the summit to rid himself of the French rider Jean Robic. This was the year that motorcycle television crews first came to the Tour. It was also the Tour's first mountain-top finish. The veteran reporter, Jacques Augendre, said:

 * "The Tourmalet, the Galibier and the Izoard were the mythical mountains of the race. These three cols were supplanted by the Alpe d'Huez. Why? Because it's the col of modernity. Coppi's victory in 1952 was the symbol of a golden age of cycling, that of champions [such as] Coppi, Bartali, Kubler, Koblet, Bobet. But only Coppi and Armstrong and Carlos Sastre have been able to take the maillot jaune on the Alpe and to keep it to Paris. That's not by chance. From the first edition, shown on live television, the Alpe d'Huez definitively transformed the way the Grande Boucle ran. No other stage has had such drama. With its 21 bends, its gradient and the number of spectators, it is a climb in the style of Hollywood."

Augendre omitted Laurent Fignon, who, along with Coppi and Armstrong, took yellow on the Alpe without winning the stage in 1983, 1984, and 1989. He held it into Paris in 1983 and 1984 but in 1989 he lost it on the final stage to Paris, a time trial, to Greg LeMond to finish second by 8", the closest finish in tour history.

After Coppi's win, the Alpe was dropped until 1964, when it was included as a mid-stage climb, and then again until 1976, both times at Rajon's instigation. The hairpin bends are named after the winners of stages. All hairpins had been named by the 22nd climb in 2001 so naming restarted at the bottom with Lance Armstrong's name added to Coppi's.

Stage 18 of the 2013 Tour de France included a double ascent of the climb, reaching 1765 m on the first passage, and continuing to the traditional finish on the second.

Only one rider has won the Alpe stage while in yellow, Geraint Thomas in the second of two back to back Alpine stage wins in 2018. He also held on to win the overall Tour.

French journalist and L'Équipe sportswriter Jean-Paul Vespini wrote a book about Alpe d'Huez and its role in the Tour de France: The Tour Is Won on the Alpe: Alpe d'Huez and the Classic Battles of the Tour de France.

Spectators
The Alpe has chaotic crowds of spectators. In 1999, Giuseppe Guerini won despite being knocked off by a spectator who stepped into his path to take a photograph. The 2004 individual time trial became chaotic when fans pushed riders toward the top. Attendance figures on the mountain have to be treated with caution. A million spectators were claimed for 1997. Eric Muller, the mayor of Alpe d'Huez, however, said there were 350,000 in 2001, four years later despite acceptance that the number rises every year. "We expect more than 400,000 for the centenary race in 2003", he said. The author Tim Moore wrote:

"As a variant on a sporting theme, Alpe d'Huez annoys the purists but enthrals the broader public, like 20/20 cricket or beach volleyball. Last year, a full-blown tent-stamping riot had required heavy police intervention. During this year's clean-up operation, down in a ravine with the bottle shards and dented emulsion tins, a body turned up. He'd fallen off the mountain and no one had noticed. When the Tour goes up Alpe d'Huez, it's a squalid, manic and sometimes lethal shambles, and that's just the way they like it. It's the Glastonbury Festival for cycling fans."

Alpe d'Huez has been nicknamed the "Dutch Mountain", since Dutchmen won eight of the first 14 finishes in le Tour De France. British author Geoffrey Nicholson wrote:

"The attraction of opposites draws [Dutch spectators] from the Low Countries to the Alps each summer in any case. But all winter in the Netherlands coach companies offer two or three nights at Alpe d'Huez as a special feature of their alpine tours. And those Dutch families who don't come by coach, park their campers and pitch their tents along the narrow ledges beside the road like sea-birds nesting at St Kilda. The Dutch haven't adopted the Alpe d'Huez simply because it is sunny and agreeable, or even because the modern, funnel-shaped church, Notre Dame des Neiges, has a Dutch priest, Father Reuten (until a few years ago, it was used as a press room and was probably the only church in France where, for one day at least, there were ashtrays in the nave and a bar in the vestry, or where an organist was once asked to leave because he was disturbing the writers' concentration). No, what draws the Dutch to Alpe d'Huez is the remarkable run of success their riders have had there'."

Significant stages
1952: Jean Robic attacked at the start of the climb and only Fausto Coppi could stay with him. The two climbed together until Coppi attacked at bend five, 4 km from the top. He won the stage, the lead in the general classification, and kept it till the end of the race.

1977: Lucien Van Impe, a Belgian rider leading the climbers' competition, broke clear on the Col du Glandon. He gained enough time to threaten the leader, Bernard Thévenet. He was still clear on the Alpe when a car drove into him. The time that Van Impe lost waiting for another wheel may have been enough to cost him the Yellow Jersey, as Thévenet and Hennie Kuiper charged on to the finish with Thévenet remaining in the lead by eight seconds over Kuiper.

1978: Another Belgian leading the mountains race also came close to taking the yellow jersey as leader of the general classification. Michel Pollentier also finished alone, but he was caught soon afterwards defrauding a drugs control and was disqualified. Due to this disqualification Dutch rider Joop Zoetemelk, who finished 3rd on the stage and would have climbed to 2nd in the General Classification, took over the yellow jersey, but would lose it on the final time trial to Bernard Hinault. Zoetemelk has his name on two of the hairpin turns at Alp d'Huez being one of the select few riders to win this stage twice; once in 1976 and once in 1979.

1984: The Tour invited amateurs to take part in the 1980s. The best was Luis Herrera, who lived at 2000 m altitude in Colombia. None of the professionals could follow him. He won alone to the cacophony of broadcasters who had arrived to report his progress.

1986: Bernard Hinault said he would help Greg LeMond win the Tour but appeared to ride otherwise. The two crossed the line arm in arm in an apparent sign of truce creating a moment that has become one of the most iconic photographs in Tour history.

1997: Marco Pantani, who won on the Alpe two years earlier, attacked three times and only Jan Ullrich could match him. He lasted until 10 km from the summit and Pantani rode on alone to win in what is often quoted as record speed (see below).

1999: Giuseppe Guerini, who broke away on his own, collided with a spectator but got up and went on to win the stage.

2001: Lance Armstrong feigned vulnerability earlier in the stage, appearing to be having an off-day. At the bottom of the Alpe d'Huez climb, Armstrong moved to the front of the lead group of riders and then looked back at Jan Ullrich. Armstrong later commented that he wasn't looking back at Ullrich but was actually looking back to see the position of his teammate Chechu Rubiera. Seeing no response from Ullrich, Armstrong accelerated away from the field to claim the victory, 1:59 ahead of Ullrich. Armstrong would later be stripped of this achievement and his tour win by his conviction for doping in 2012. His name however, is still honored on one of the 21 signs of previous winners, lining the hairpin turns of Alpe d'Huez.

2013: Christophe Riblon won the stage at the summit of Alpe d'Huez during the 100th edition of the Tour. For the first time ever, riders rode up the climb twice with the descent over the Col de Sarenne in between.

2018: Geraint Thomas, Tom Dumoulin, Chris Froome, Romain Bardet and Mikel Landa were able to catch Steven Kruijswijk, who had been on a 70 km solo attack, about 2/3 of the way up the climb and with about 500 meters to go Thomas dropped the remaining elite riders to become the first rider to win the Alpe d’Huez stage while wearing the yellow jersey.

2022: World cyclo-cross and Olympic mountain-bike champion Tom Pidcock, riding his first Tour, broke away on the Galibier descent, before going solo from a break including four-time Tour winner Chris Froome with around 8 km to go and won on the Alpe, the youngest winner on the Alpe in Tour de France history.

Winners
* In 1979 there were two stages at Alpe d'Huez. † Stage 18 of the 2013 Tour climbed to Alpe d'Huez twice. Moreno Moser was the leader at the first time over the summit.

Fastest ascents

The climb has been timed since 1994 so earlier times are subject to discussion. From 1994 to 1997 the climb was timed from 14.5 km from the finish. Since 1999 photo-finish has been used from 14 km. Other times have been taken 13.8 km from the summit, which is the start of the climb. Others have been taken from the junction 700 m from the start.

These variations have led to a debate. Pantani's 37m 35s has been cited by Procycling and World Cycling Productions, publisher of Tour de France DVDs, and by Cycle Sport. In a biography of Pantani, Matt Rendell notes Pantani at: 1994 – 38m 0s; 1995 – 38m 4s; 1997 – 37m 35s. The Alpe tourist association describes the climb as 14.454 km and lists Pantani's 37m 35s (23.08 km/h) as the record.

Other sources give Pantani's times from 1994, 1995 and 1997 as the fastest, based on timings adjusted for the 13.8 km. Such sources list Pantani's time in 1995 as the record at 36m 40s. In Blazing Saddles, Rendell has changed his view and listed it as 36m 50s as does CyclingNews. Second, third, and fourth fastest are Pantani in 1997 (36m 55s), Pantani in 1994 (37m 15s) and Lance Armstrong in 2004 (37m 36s). Jan Ullrich's time in 1997 (37m 41s) makes him the fifth fastest, highlighting how the 1990s had faster ascents than other eras.

A number of cycling publications cite times prior to 1994, although distances are typically not included, making comparisons difficult. Coppi has been listed with 45m 22s for 1952.

In the 1980s Gert-Jan Theunisse, Pedro Delgado, Luis Herrera, and Laurent Fignon rode in times stated to be faster than Coppi's, but still not breaking 40m. Greg LeMond and Bernard Hinault have been reported as having the times of 48m 0s in 1986.

It was not until Gianni Bugno and Miguel Indurain in 1991, that times faster than 40m were reported, including in the 39m range for Bjarne Riis in 1995 and Richard Virenque in 1997.

Ascent times
Some times based on 14.454 km according to Matt Rendell's first book, other times based on 13.8 km. * The 2004 stage was an individual time trial.

†Lance Armstrong, and Floyd Landis admitted to doping and had the Tour de France titles withdrawn. Jan Ullrich also admitted to doping and Virenque was implicated in what, at the time, was the biggest doping scandal in Tour history.

Based on 13.8 km

Other cycle races
The peak is also the finish of La Marmotte, a one-day, 175 km ride with 5000 m of climbing. Stage 8 of the 2024 Tour de France Femmes will end there.

Mountain biking
The resort caters for mountain bikers during the summer months, the pinnacle of which is the Megavalanche, a 'Downhill Enduro' Event that takes riders from lift station at the highest peak, Pic Blanc, to Allemont in the valley floor.

Triathlon
Since 2006 Cyrille Neveu has organized the Triathlon EDF Alpe d'Huez, which has become a major summer attraction.

Zwift
In 2018, the virtual cycling training and racing program Zwift released a recreation of the Alpe d'Huez climb called Alpe du Zwift. This virtual version of the climb was created using GPS data from the original route to copy it perfectly in both gradient and distance.

Twin towns – Sister cities
Alpe d'Huez is twinned with:
 * 🇮🇹 Bormio, Italy, since 2005.

title: Alpe d'Huez


text:
USS Defiant

The USS Defiant is the name of two starships in the Star Trek media franchise, most notably featured in the television series Star Trek: Deep Space Nine (1993–1999) and the film Star Trek: First Contact (1996). Introduced in Deep Space Nine 's third season, it is a warship attached to the show's eponymous space station. The original Defiant is destroyed during the Dominion War in the seventh season and replaced with a largely identical ship.

The Defiant was designed by Jim Martin, Gary Hutzel and Tony Meinger.

Design and development
For the first two seasons of Deep Space Nine, stories requiring characters to travel off-station typically involved small runabout vessels. Producer Ira Steven Behr and writer Robert Hewitt Wolfe believed runabouts would be insufficient to confront the adversarial Dominion introduced in the second season, and they convinced executive producer Rick Berman of the need for a new ship. Additionally, the Defiant was intended to solve the problem of cramped runabout sets.

The Defiant was initially designed by art illustrator Jim Martin, with contributions from visual effects supervisor Gary Hutzel and modelmaker Tony Meininger. Original designs called for a "beefed-up" runabout-type ship, but this gave way to a full-fledged starship design initially called Valiant. This name was dropped out of fear that it would conflict with Star Trek: Voyager 's titular starship, also beginning with a "V".

An early screenplay for Star Trek: First Contact (1996) called for the Defiant to be destroyed, but Behr objected and the idea was dropped.

Following the Defiant 's destruction in "The Changing Face of Evil", the writers had wanted a new type of successor ship but the budget wasn't available. As a result, they replaced the Defiant with the same spacecraft design for the USS São Paulo in "The Dogs of War". Ron Moore said in the Star Trek: Deep Space Nine Companion that the new ship was intended to be designated "Defiant-A", but it would have been too costly to redo the CG model for one episode because stock shots from earlier episodes had to be used as well for budgetary reasons.

Depiction
Benjamin Sisko helped design the Defiant, which was conceived as a prototype vessel to counter the Borg. Sisko receives command of the Defiant in 2370 to make contact with the Dominion in the show's third-season premier. Unlike most Starfleet ships, the Defiant is built for combat rather than science and exploration. The Defiant remains attached to Deep Space Nine under Sisko's command for the remainder of the series, carrying the crew on missions beyond the space station. It appears briefly in Star Trek: First Contact under the command of Worf. The Breen destroy the Defiant during the show's finale arc. Starfleet gives Sisko command of a new ship of the same class, the USS Sao Paulo, which he renames Defiant. The Defiant is seen briefly in the Star Trek: Picard third season episode "The Bounty", out of commission and docked at Starfleet's Fleet Museum.

The Defiant also appears in numerous spin-off books, comics, and video games.

Reception
The USS Defiant is noted as a powerful spacecraft vessel of the Star Trek science fiction universe in the late 24th century. CBR compared the maneuverable and powerful Defiant to the Millennium Falcon. Space.com also noted the Defiant as one of the more agile science fiction spacecraft, compared to some of the slower, almost-nautical movement of larger spacecraft of Star Trek.

The moment when Sisko decloaks the Defiant spacecraft for the first time in "The Search" was rated by Geek.com in 2015 as one of the top 35 moments in Star Trek; they said it marked a "great start" to the third season of Deep Space Nine. The addition of the Defiant helped the show dig deeper into stories set in the Gamma Quadrant, as well as the long war-saga arc of the show's later seasons.

A miniature model of the USS Defiant sold for 106,000 USD in 2006 at auction.

title: USS Defiant


text:
Palliative care

Palliative care (derived from the Latin root palliare, or 'to cloak') is an interdisciplinary medical caregiving approach aimed at optimizing quality of life and mitigating suffering among people with serious, complex, and often terminal illnesses. Within the published literature, many definitions of palliative care exist. The World Health Organization (WHO) describes palliative care as "an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain, illnesses including other problems whether physical, psychosocial, and spiritual". In the past, palliative care was a disease specific approach, but today the WHO takes a broader patient-centered approach that suggests that the principles of palliative care should be applied as early as possible to any chronic and ultimately fatal illness. This shift was important because if a disease-oriented approach is followed, the needs and preferences of the patient are not fully met and aspects of care, such as pain, quality of life, and social support, as well as spiritual and emotional needs, fail to be addressed. Rather, a patient-centered model prioritizes relief of suffering and tailors care to increase the quality of life for terminally ill patients.

Palliative care is appropriate for individuals with serious illnesses across the age spectrum and can be provided as the main goal of care or in tandem with curative treatment. It is provided by an interdisciplinary team which can include physicians, nurses, occupational and physical therapists, psychologists, social workers, chaplains, and dietitians. Palliative care can be provided in a variety of contexts, including hospitals, outpatient, skilled-nursing, and home settings. Although an important part of end-of-life care, palliative care is not limited to individuals near the end of life.

Evidence supports the efficacy of a palliative care approach in improvement of a person's quality of life. Palliative care's main focus is to improve the quality of life for those with chronic illnesses. It is commonly the case that palliative care is provided at the end of life, but it can be helpful for a person of any stage of illness that is critical or any age.

Scope
Palliative care is able to improve healthcare quality in three sectors: Physical and emotional relief, strengthening of patient-physician communication and decision-making, and coordinated continuity of care across various healthcare settings, including hospital, home, and hospice. The overall goal of palliative care is to improve quality of life of individuals with serious illness, any life-threatening condition which either reduces an individual's daily function or quality of life or increases caregiver burden, through pain and symptom management, identification and support of caregiver needs, and care coordination. Palliative care can be delivered at any stage of illness alongside other treatments with curative or life-prolonging intent and is not restricted to people receiving end-of-life care. Historically, palliative care services were focused on individuals with incurable cancer, but this framework is now applied to other diseases, including severe heart failure, chronic obstructive pulmonary disease, multiple sclerosis and other neurodegenerative conditions. Forty million people each year are expected to need palliative care, with approximately 78% of this population living in low and middle income countries. However, only 14% of this population is able to receive this kind of care, with a majority in high-income countries, making this an important sector to pay attention to.

Palliative care can be initiated in a variety of care settings, including emergency rooms, hospitals, hospice facilities, or at home. For some severe disease processes, medical specialty professional organizations recommend initiating palliative care at the time of diagnosis or when disease-directed options would not improve a patient's prognosis. For example, the American Society of Clinical Oncology recommends that patients with advanced cancer should be "referred to interdisciplinary palliative care teams that provide inpatient and outpatient care early in the course of disease, alongside active treatment of their cancer" within eight weeks of diagnosis.

Appropriately engaging palliative care providers as a part of patient care improves overall symptom control, quality of life, and family satisfaction of care while reducing overall healthcare costs.

Palliative care vis-à-vis hospice care
The distinction between palliative care and hospice differs depending on global context. In the United States, the term hospice refers specifically to a benefit provided by the federal government since 1982. Hospice care services and palliative care programs share similar goals of mitigating unpleasant symptoms, controlling pain, optimizing comfort, and addressing psychological distress. Hospice care focuses on comfort and psychological support and curative therapies are not pursued. Under the Medicare Hospice Benefit, individuals certified by two physicians to have less than six months to live (assuming a typical course) have access to specialized hospice services through various insurance programs (Medicare, Medicaid, and most health maintenance organizations and private insurers). An individual's hospice benefits are not revoked if that individual lives beyond a six-month period. In the United States, in order to be eligible for hospice, patients usually forego treatments aimed at cure, unless they are minors. This is to avoid what is called concurrent care, where two different clinicians are billing for the same service. In 2016 a movement began to extend the reach of concurrent care to adults who were eligible for hospice but not yet emotionally prepared to forego curative treatments.

Outside the United States, the term hospice usually refers to a building or institution that specializes in palliative care. These institutions provide care to patients with end of life and palliative care needs. In the common vernacular outside the United States, hospice care and palliative care are synonymous and are not contingent on different avenues of funding. Over 40% of all dying patients in the United States currently undergo hospice care. Most of the hospice care occurs at a home environment during the last weeks/months of their lives. Of those patients, 86.6% believe their care is "excellent". Hospice's philosophy is that death is a part of life, so it is personal and unique. Caregivers are encouraged to discuss death with the patients and encourage spiritual exploration (if they so wish).

History
The field of palliative care grew out of the hospice movement, which is commonly associated with Dame Cicely Saunders, who founded St. Christopher's Hospice for the terminally ill in 1967, and Elisabeth Kübler-Ross who published her seminal work "On Death and Dying" in 1969. In 1974, Balfour Mount coined the term "palliative care". and Paul Henteleff became the director of a new "terminal care" unit at Saint Boniface Hospital in Winnipeg. In 1987, Declan Walsh established a palliative medicine service at the Cleveland Clinic Cancer Center in Ohio which later expanded to become the training site of the first palliative care clinical and research fellowship as well as the first acute pain and palliative care inpatient unit in the United States. The program evolved into The Harry R. Horvitz Center for Palliative Medicine which was designated as an international demonstration project by the World Health Organization and accredited by the European Society for Medical Oncology as an Integrated Center of Oncology and Palliative Care.

Advances in palliative care have since inspired a dramatic increase in hospital-based palliative care programs. Notable research outcomes forwarding the implementation of palliative care programs include:

 * Evidence that hospital palliative care consult teams are associated with significant hospital and overall health system cost savings.
 * Evidence that palliative care services increase the likelihood of dying at home and reduce symptom burden without impacting on caregiver grief among the vast majority of Americans who prefer to die at home.
 * Evidence that providing palliative care in tandem with standard oncologic care among patients with advanced cancer is associated with lower rates of depression, increased quality of life, and increased length of survival compared to those receiving standard oncologic care and may even prolong survival.

Over 90% of US hospitals with more than 300 beds have palliative care teams, yet only 17% of rural hospitals with 50 or more beds have palliative care teams. Hospice and palliative medicine has been a board certified sub-specialty of medicine in the United States since 2006. Additionally, in 2011, The Joint Commission began an Advanced Certification Program for Palliative Care that recognizes hospital inpatient programs demonstrating outstanding care and enhancement of the quality of life for people with serious illness.

Practice of palliative care
Medications used in palliative care can be common medications but used for a different indication based on established practices with varying degrees of evidence. Examples include the use of antipsychotic medications, anticonvulsants, and morphine. Routes of administration may differ from acute or chronic care, as many people in palliative care lose the ability to swallow. A common alternative route of administration is subcutaneous, as it is less traumatic and less difficult to maintain than intravenous medications. Other routes of administration include sublingual, intramuscular and transdermal. Medications are often managed at home by family or nursing support.

Palliative care interventions in care homes may contribute to lower discomfort for residents with dementia and to improve family members' views of the quality of care. However, higher quality research is needed to support the benefits of these interventions for older people dying in these facilities.

High-certainty evidence supports the finding that implementation of home-based end-of-life care programs may increase the number of adults who will die at home and slightly improve patient satisfaction at a one-month follow-up. The impact of home-based end-of-life care on caregivers, healthcare staff, and health service costs are uncertain.

Pain, distress, and anxiety
For many patients, end of life care can cause emotional and psychological distress, contributing to their total suffering. An interdisciplinary palliative care team consisting of a mental health professional, social worker, counselor, as well as spiritual support such as a chaplain, can play important roles in helping people and their families cope using various methods such as counseling, visualization, cognitive methods, drug therapy and relaxation therapy to address their needs. Palliative pets can play a role in this last category.

Total pain

In the 1960s, hospice pioneer Cicely Saunders first introduced the term "total pain" to describe the heterogenous nature of pain. This is the idea that a patient's experience of total pain has distinctive roots in the physical, psychological, social and spiritual realm but that they are all still closely linked to one another. Identifying the cause of pain can help guide care for some patients, and impact their quality of life overall.

Physical pain
Physical pain can be managed using pain medications as long as they do not put the patient at further risk for developing or increasing medical diagnoses such as heart problems or difficulty breathing. Patients at the end of life can exhibit many physical symptoms that can cause extreme pain such as dyspnea (or difficulty breathing), coughing, xerostomia (dry mouth), nausea and vomiting, constipation, fever, delirium, and excessive oral and pharyngeal secretions ("Death Rattle"). Radiation is commonly used with palliative intent to alleviate pain in patients with cancer. As an effect from radiation may take days to weeks to occur, patients dying a short time following their treatment are unlikely to receive benefit.

Psychosocial pain and anxiety
Once the immediate physical pain has been dealt with, it is important to remember to be a compassionate and empathetic caregiver that is there to listen and be there for their patients. Being able to identify the distressing factors in their life other than the pain can help them be more comfortable. When a patient has their needs met then they are more likely to be open to the idea of hospice or treatments outside comfort care. Having a psychosocial assessment allows the medical team to help facilitate a healthy patient-family understanding of adjustment, coping and support. This communication between the medical team and the patients and family can also help facilitate discussions on the process of maintaining and enhancing relationships, finding meaning in the dying process, and achieving a sense of control while confronting and preparing for death. For adults with anxiety, medical evidence in the form of high-quality randomized trials is insufficient to determine the most effective treatment approach to reduce the symptoms of anxiety.

Spirituality
Spirituality is a fundamental component of palliative care. Moreover, hospices where palliative care is administered have usually available chaplains.

According to the Clinical Practice Guidelines for Quality Palliative Care, spirituality is a "dynamic and intrinsic aspect of humanity" and has been associated with "an improved quality of life for those with chronic and serious illness", especially for patients who are living with incurable and advanced illnesses of a chronic nature. Spiritual beliefs and practices can influence perceptions of pain and distress, as well as quality of life among advanced cancer patients. Spiritual needs are often described in literature as including loving/being loved, forgiveness, and deciphering the meaning of life.

Most spiritual interventions are subjective and complex. Many have not been well evaluated for their effectiveness, however tools can be used to measure and implement effective spiritual care.

Nausea and vomiting
Nausea and vomiting are common in people who have advanced terminal illness and can cause distress. Several antiemetic pharmacologic options are suggested to help alleviate these symptoms. For people who do not respond to first-line medications, levomepromazine may be used, however there have been insufficient clinical trials to assess the effectiveness of this medication. Haloperidol and droperidol are other medications that are sometimes prescribed to help alleviate nausea and vomiting, however further research is also required to understand how effective these medications may be.

Hydration and nutrition
Many terminally ill people cannot consume adequate food or drink. Providing medically assisted food or drink to prolong their life and improve the quality of their life is common, however there have been few high quality studies to determine best practices and the effectiveness of these approaches.

Symptom assessment
One instrument used in palliative care is the Edmonton Symptom Assessment Scale (ESAS), which consists of eight visual analog scales (VAS) ranging from 0–10, indicating the levels of pain, activity, nausea, depression, anxiety, drowsiness, appetite, sensation of well-being, and sometimes shortness of breath. A score of 0 indicates absence of the symptom, and a score of 10 indicates the worst possible severity. The instrument can be completed by the patient, with or without assistance, or by nurses and relatives.

Pediatric palliative care
Pediatric palliative care is family-centered, specialized medical care for children with serious illnesses that focuses on mitigating the physical, emotional, psychosocial, and spiritual suffering associated with illness to ultimately optimize quality of life.

Pediatric palliative care practitioners receive specialized training in family-centered, developmental and age-appropriate skills in communication and facilitation of shared decision making; assessment and management of pain and distressing symptoms; advanced knowledge in care coordination of multidisciplinary pediatric caregiving medical teams; referral to hospital and ambulatory resources available to patients and families; and psychologically supporting children and families through illness and bereavement.

Symptoms assessment and management of children
As with palliative care for adults, symptom assessment and management is a critical component of pediatric palliative care as it improves quality of life, gives children and families a sense of control, and prolongs life in some cases. The general approach to assessment and management of distressing symptoms in children by a palliative care team is as follows:

 * Identify and assess symptoms through history taking (focusing on location, quality, time course, as well as exacerbating and mitigating stimuli). Symptoms assessment in children is uniquely challenging due to communication barriers depending on the child's ability to identify and communicate about symptoms. Thus, both the child and caregivers should provide the clinical history. With this said, children as young as four years of age can indicate the location and severity of pain through visual mapping techniques and metaphors.
 * Perform a thorough exam of the child. Special attention to the child's behavioral response to exam components, particularly in regards to potentially painful stimuli. A commonly held myth is that premature and neonatal infants do not experience pain due to their immature pain pathways, but research demonstrates pain perception in these age groups is equal or greater than that of adults. With this said, some children experiencing intolerable pain present with 'psychomotor inertia', a phenomenon where a child in severe chronic pain presents overly well behaved or depressed. These patients demonstrate behavioral responses consistent with pain relief when titrated with morphine. Finally, because children behaviorally respond to pain atypically, a playing or sleeping child should not be assumed to be without pain.
 * Identify the place of treatment (tertiary versus local hospital, intensive care unit, home, hospice, etc.).
 * Anticipate symptoms based on the typical disease course of the hypothesized diagnosis.
 * Present treatment options to the family proactively, based on care options and resources available in each of the aforementioned care settings. Ensuing management should anticipate transitions of palliative care settings to afford seamless continuity of service provision across health, education, and social care settings.
 * Consider both pharmacologic and non-pharmacologic treatment modalities (education and mental health support, administration of hot and cold packs, massage, play therapy, distraction therapy, hypnotherapy, physical therapy, occupational therapy, and complementary therapies) when addressing distressing symptoms. Respite care is an additional practice that can further aid alleviating the physical and mental pain from the child and their family. By allowing the caregiving to ensue by other qualified individuals, it allows the family time to rest and renew themselves
 * Assess how the child perceives their symptoms (based on personal views) to create individualized care plans.
 * After the implementation of therapeutic interventions, involve both the child and family in the reassessment of symptoms.

The most common symptoms in children with severe chronic disease appropriate for palliative care consultation are weakness, fatigue, pain, poor appetite, weight loss, agitation, lack of mobility, shortness of breath, nausea and vomiting, constipation, sadness or depression, drowsiness, difficulty with speech, headache, excess secretions, anemia, pressure area problems, anxiety, fever, and mouth sores. The most common end of life symptoms in children include shortness of breath, cough, fatigue, pain, nausea and vomiting, agitation and anxiety, poor concentration, skin lesions, swelling of the extremities, seizures, poor appetite, difficulty with feeding, and diarrhea. In older children with neurologic and neuromuscular manifestations of disease, there is a high burden of anxiety and depression that correlates with disease progression, increasing disability, and greater dependence on carers. From the caregiver's perspective, families find changes in behavior, reported pain, lack of appetite, changes in appearance, talking to God or angels, breathing changes, weakness, and fatigue to be the most distressing symptoms to witness in their loved ones.

As discussed above, within the field of adult palliative medicine, validated symptoms assessment tools are frequently utilized by providers, but these tools lack essential aspects of children's symptom experience. Within pediatrics, there is not a comprehensive symptoms assessment widely employed. A few symptoms assessment tools trialed among older children receiving palliative care include the Symptom Distress Scale, and the Memorial Symptom Assessment Scale, and Childhood Cancer Stressors Inventory. Quality of life considerations within pediatrics are unique and an important component of symptoms assessment. The Pediatric Cancer Quality of Life Inventory-32 (PCQL-32) is a standardized parent-proxy report which assesses cancer treatment-related symptoms (focusing mainly on pain and nausea). But again, this tool does not comprehensively assess all palliative are symptoms issues. Symptom assessment tools for younger age groups are rarely utilized as they have limited value, especially for infants and young children who are not at a developmental stage where they can articulate symptoms.

Communication with children and families
Within the realm of pediatric medical care, the palliative care team is tasked with facilitating family-centered communication with children and their families, as well as multidisciplinary pediatric caregiving medical teams to forward coordinated medical management and the child's quality of life. Strategies for communication are complex as the pediatric palliative care practitioners must facilitate a shared understanding of and consensus for goals of care and therapies available to the sick child amongst multiple medical teams who often have different areas of expertise. Additionally, pediatric palliative care practitioners must assess both the sick child and their family's understanding of complex illness and options for care, and provide accessible, thoughtful education to address knowledge gaps and allow for informed decision making. Finally, practitioners are supporting children and families in the queries, emotional distress, and decision making that ensues from the child's illness.

Many frameworks for communication have been established within the medical literature, but the field of pediatric palliative care is still in relative infancy. Communication considerations and strategies employed in a palliative setting include:

 * Developing supportive relationships with patients and families. An essential component of a provider's ability to provide individualized palliative care is their ability to obtain an intimate understanding of the child and family's preferences and overall character. On initial consultation, palliative care providers often focus on affirming a caring relationship with the pediatric patient and their family by first asking the child how they would describe themself and what is important to them, communicating in an age and developmentally cognizant fashion. The provider may then gather similar information from the child's caregivers. Questions practitioners may ask include 'What does the child enjoy doing? What do they most dislike doing? What does a typical day look like for the child?' Other topics potentially addressed by the palliative care provider may also include familial rituals as well as spiritual and religious beliefs, life goals for the child, and the meaning of illness within the broader context of the child and their family's life.
 * Developing a shared understanding of the child's condition with the patient and their family. The establishment of shared knowledge between medical providers, patients, and families is essential when determining palliative goals of care for pediatric patients. Initially, practitioners often elicit information from the patient and child to ascertain these parties' baseline understanding of the child's situation. Assessing for baseline knowledge allows the palliative care provider to identify knowledge gaps and provide education on those topics. Through this process, families can pursue informed, shared medical decision making regarding their child's care. A framework often employed by pediatric palliative care providers is 'ask, tell, ask' where the provider asks the patient and their family for a question to identify their level of comprehension of the situation, and then subsequently supplements the family's knowledge with additional expert knowledge. This information is often conveyed without jargon or euphemism to maintain trust and ensure understanding. Providers iteratively check for comprehension of this knowledge supplementation by asking questions related to previous explanations, as information retention can be challenging when undergoing a stressful experience.
 * Establishing meaning and dignity regarding the child's illness. As part of developing a shared understanding of a child's illness and character, palliative providers will assess both the child and their family's symbolic and emotional relationship to disease. As both the somatic and psychologic implications of illness can be distressing to children, palliative care practitioners look for opportunities to establish meaning and dignity regarding the child's illness by contextualizing disease within a broader framework of the child's life. Derived from the fields of dignity therapy and meaning-centered psychotherapy, the palliative care provider may explore the following questions with the sick child and their family:
 * What gives your life meaning, worth, or purpose?
 * Where do you find strength and support?
 * What inspires you?
 * How do you like to be thought of?
 * What are you most proud of?
 * What are the particular things you would like your family to know or remember about you?
 * When was the last time you laughed really hard?
 * Are you frightened by all of this? What, in particular, are you most frightened of?
 * What is the meaning of this (illness) experience for you? Do you ever think about why this happened to you?
 * Assessing preferences for decision making. Medical decision making in a pediatric setting is unique in that it is often the child's legal guardians, not the patient, who ultimately consent for most medical treatments. Yet within a palliative care setting, it is particularly consequential to incorporate the child's preferences within the ultimate goals of care. Equally important to consider, families may vary in the level of responsibility they want in this decision-making process. Their preference may range from wanting to be the child's sole decision makers, to partnering with the medical team in a shared decision making model, to advocating for full deferral of decision-making responsibility to the clinician. Palliative care providers clarify a family's preferences and support needs for medical decision making by providing context, information, and options for treatment and medical palliation. In the case of critically ill babies, parents are able to participate more in decision making if they are presented with options to be discussed rather than recommendations by the doctor. Utilizing this style of communication also leads to less conflict with doctors and might help the parents cope better with the eventual outcomes.

 * Optimizing the environment for effective conversations around prognosis and goals of care. Essential to facilitating supportive, clear communication around potentially distressing topics such as prognosis and goals of care for seriously ill pediatric patients is optimizing the setting where this communication will take place and developing informed consensus among the child's caregiving team regarding goals and options for care. Often, these conversations occur within the context of family meetings, which are formal meetings between families and the child's multidisciplinary medical team. Prior to the family meeting, providers often meet to discuss the child's overall case, reasonably expected prognosis, and options for care, in addition to clarifying specific roles each provider will take on during the family meeting. During this meeting, the multidisciplinary medical team may also discuss any legal or ethical considerations related to the case. Palliative care providers often facilitate this meeting and help synthesize its outcome for children and their families. Experts in optimized communication, palliative care providers may opt to hold the family meeting in a quiet space where the providers and family can sit and address concerns during a time when all parties are not constrained. Additionally, parents' preferences regarding information exchange with the sick child present should be clarified. If the child's guardians are resistant to disclosing information in front of their child, the child's provider may explore parental concerns on the topic. When excluded from family meetings and moments of challenging information exchange, adolescents, in particular, may have challenges with trusting their medical providers if they feel critical information is being withheld. It is important to follow the child's lead when deciding whether to disclose difficult information. Additionally, including them in these conversations can help the child fully participate in their care and medical decision making. Finally, it is important to prioritize the family's agenda while additionally considering any urgent medical decisions needed to advance the child's care.
 * Supporting emotional distress. A significant role of the pediatric palliative care provider is to help support children, their families, and their caregiving teams through the emotional stress of illness. Communication strategies the palliative care provider may employ in this role are asking for permission when engaging with potentially distressing conversations, naming emotions witnessed to create opportunities to discuss complex emotional responses to illness, actively listening, and allowing for invitational silence. The palliative care provider may iteratively assess the child and family's emotional responses and needs during challenging conversations. At times, the medical team may be hesitant to discuss a child's prognosis out of fear of increasing distress. This sentiment is not supported by the literature; among adults, end of life discussions are not associated with increased rates of anxiety or depression. Though this topic is not well studied in pediatric populations, conversations about prognosis have the potential to increase in parental hope and peace of mind.
 * SPIKE framework. This is a framework that is designed to assist healthcare workers deliver bad news. The acronym stands for: setting, perception, invitation, knowledge, empathy, and summarize/strategy. When giving bad news it is important to consider the setting, which considers the environment in which the healthcare provider is delivering the news including privacy, sitting, time, and the inclusion of family members. What to say should also be considered, as well as rehearsed. It is important to understand how a patient is receiving the information by asking open ended questions and asking them to repeat what they learned in their own words, which is perception aspect of the framework. The healthcare provider should seek an invitation from the patient to disclose additional information before doing so in order to prevent overwhelming or distressing the patient further. In order to ensure the patient understands what is being told, knowledge must be used. This includes speaking in a way that the patient will understand, using simple words, not being excessively blunt, giving information in small chunks and checking in with the patient to confirm that they understand, and not providing poor information that may not be completely true. In order to alleviate some of a patient's distress it is crucial to be empathetic in the sense of understanding how a patient is feeling and the reactions they are having. This can allow one to change how they are delivering information, allow the patient to have time to process the information, or console them if needed. Connecting with patients is an important step in delivering bad news; maintaining eye contact proves that the healthcare provider is present and the patient and family has their full attention. Furthermore, the provider may make a connection by touching the patients shoulder or hand, giving them a physical connection to know that they are not alone. Finally, it is important to summarize all the information given in order to ensure the patient fully understands and takes away the major points. Additionally, patients who have a clear plan for the future are less likely to feel anxious and uncertain, but it is important to ask people if they are ready for that information before providing them with it.

Geriatric palliative care
With the transition in the population toward lower child mortality and lower death rates, countries around the world are seeing larger elderly populations. In some countries, this means a growing burden on national resources in the shape of social security and health care payments. As aging populations put increasing pressure on existing resources, long-term palliative care for patients' non-communicable, chronic conditions has emerged as a necessary approach to increase these patient's quality of life, through prevention and relief by identifying, assessing, and treating the source of pain and other psychosocial and spiritual problems.

In religions
Doctrine of Catholic Church, as a traditional reference, accepts and supports the use of palliative care. Most of main religions in the world (and the biggest in amount of believers) are concordant with this point of view.

Costs and funding
Funding for hospice and palliative care services varies. In Great Britain and many other countries all palliative care is offered free, either through the National Health Service or through charities working in partnership with the local health services. Palliative care services in the United States are paid by philanthropy, fee-for-service mechanisms, or from direct hospital support while hospice care is provided as a Medicare benefit; similar hospice benefits are offered by Medicaid and most private health insurers. Under the Medicare Hospice Benefit (MHB), a person signs off their Medicare Part B (acute hospital payment) and enrolls in the MHB through Medicare Part B with direct care provided by a Medicare certified hospice agency. Under terms of the MHB, the hospice agency is responsible for the care plan and may not bill the person for services. The hospice agency, together with the person's primary physician, is responsible for determining the care plan. All costs related to the terminal illness are paid from a per diem rate (~US $126/day) that the hospice agency receives from Medicare – this includes all drugs and equipment, nursing, social service, chaplain visits, and other services deemed appropriate by the hospice agency; Medicare does not pay for custodial care. People may elect to withdraw from the MHB and return to Medicare Part A and later re-enroll in hospice.

Certification and training for services
In most countries, hospice care and palliative care is provided by an interdisciplinary team consisting of physicians, pharmacists, nurses, nursing assistants, social workers, chaplains, and caregivers. In some countries, additional members of the team may include certified nursing assistants and home healthcare aides, as well as volunteers from the community (largely untrained but some being skilled medical personnel), and housekeepers.

In the United Kingdom, Palliative Medicine specialist training is delivered alongside Internal Medicine stage two training over an indicative four years. Entry into Palliative medicine training is possible following successful completion of both a foundation programme and a core training programme. There are two core training programmes for Palliative Medicine training:

 * Internal Medical Training (IMT)
 * Acute Care Common Stem - Internal Medicine (ACCS-IM)

In the United States, the physician sub-specialty of hospice and palliative medicine was established in 2006 to provide expertise in the care of people with life-limiting, advanced disease, and catastrophic injury; the relief of distressing symptoms; the coordination of interdisciplinary care in diverse settings; the use of specialized care systems including hospice; the management of the imminently dying patient; and legal and ethical decision making in end of life care.

Caregivers, both family and volunteers, are crucial to the palliative care system. Caregivers and people being treated often form lasting friendships over the course of care. As a consequence caregivers may find themselves under severe emotional and physical strain. Opportunities for caregiver respite are some of the services hospices provide to promote caregiver well-being. Respite may last a few hours up to several days (the latter being done by placing the primary person being cared for in a nursing home or inpatient hospice unit for several days).

In the US, board certification for physicians in palliative care was through the American Board of Hospice and Palliative Medicine; recently this was changed to be done through any of 11 different speciality boards through an American Board of Medical Specialties-approved procedure. Additionally, board certification is available to osteopathic physicians (D.O.) in the United States through four medical specialty boards through an American Osteopathic Association Bureau of Osteopathic Specialists-approved procedure. More than 50 fellowship programs provide one to two years of specialty training following a primary residency. In the United Kingdom palliative care has been a full specialty of medicine since 1989 and training is governed by the same regulations through the Royal College of Physicians as with any other medical speciality. Nurses, in the United States and internationally, can receive continuing education credits through Palliative Care specific trainings, such as those offered by End-of-Life Nursing Education Consortium (ELNEC).

The Tata Memorial Centre in Mumbai has offered a physician's course in palliative medicine since 2012, the first one of its kind in the country.

Regional variation in services
In the United States, hospice and palliative care represent two different aspects of care with similar philosophies, but with different payment systems and location of services. Palliative care services are most often provided in acute care hospitals organized around an interdisciplinary consultation service, with or without an acute inpatient palliative care unit. Palliative care may also be provided in the dying person's home as a "bridge" program between traditional US home care services and hospice care or provided in long-term care facilities. In contrast over 80% of hospice care in the US is provided at home with the remainder provided to people in long-term care facilities or in free standing hospice residential facilities. In the UK hospice is seen as one part of the speciality of palliative care and no differentiation is made between 'hospice' and 'palliative care'.

In the UK palliative care services offer inpatient care, home care, day care and outpatient services, and work in close partnership with mainstream services. Hospices often house a full range of services and professionals for children and adults. In 2015 the UK's palliative care was ranked as the best in the world "due to comprehensive national policies, the extensive integration of palliative care into the National Health Service, a strong hospice movement, and deep community engagement on the issue".

In 2021 the UK's National Palliative and End of Life Care Partnership published their six ambitions for 2021–26. These include fair access to end of life care for everyone regardless of who they are, where they live or their circumstances, and the need to maximise comfort and wellbeing. Informed and timely conversations are also highlighted.

Acceptance and access
The focus on a person's quality of life has increased greatly since the 1990s. In the United States today, 55% of hospitals with more than 100 beds offer a palliative-care program, and nearly one-fifth of community hospitals have palliative-care programs. A relatively recent development is the palliative-care team, a dedicated health care team that is entirely geared toward palliative treatment.

Physicians practicing palliative care do not always receive support from the people they are treating, family members, healthcare professionals or their social peers. More than half of physicians in one survey reported that they have had at least one experience where a patient's family members, another physician or another health care professional had characterized their work as being "euthanasia, murder or killing" during the last five years. A quarter of them had received similar comments from their own friends or family member, or from a patient.

Despite significant progress that has been made to increase access to palliative care within the United States and other countries, many countries have not yet considered palliative care as a public health problem, and therefore do not include it in their public health agenda. Resources and cultural attitudes both play significant roles in the acceptance and implementation of palliative care in the health care agenda. A study identified the current gaps in palliative care for people with severe mental illness (SMI's). They found that due to the lack of resources within both mental health and end of life services people with SMI's faced a number of barriers to accessing timely and appropriate palliative care. They called for a multidisciplinary team approach, including advocacy, with a point of contact co-ordinating the appropriate support for the individual. They also state that end of life and mental health care needs to be included in the training for professionals.

A review states that by restricting referrals to palliative care only when patients have a definitive time line for death, something that the study found to often be inaccurate, can have negative implications for the patient both when accessing end of life care, or being unable to access services due to not receiving a time line from medical professionals. The authors call for a less rigid approach to referrals to palliative care services in order to better support the individual, improve quality of life remaining and provide more holistic care.

Many people with chronic pain are stigmatized and treated as opioid addicts. Patients can build a tolerance to drugs and have to take more and more to manage their pain. The symptoms of chronic pain patients do not show up on scans, so the doctor must go off trust alone. This is the reason that some wait to consult their doctor and endure sometimes years of pain before seeking help.

In media
Palliative care was the subject of the 2018 Netflix short documentary, End Game by directors Rob Epstein and Jeffrey Friedman about terminally ill patients in a San Francisco hospital and features the work of palliative care physician, BJ Miller. The film's executive producers were Steven Ungerleider, David C. Ulich and Shoshana R. Ungerleider.

In 2016, an open letter to the singer David Bowie written by a palliative care doctor, Professor Mark Taubert, talked about the importance of good palliative care, being able to express wishes about the last months of life, and good tuition (nutrition?) and education about end of life care generally. The letter went viral after David Bowie's son Duncan Jones shared it. The letter was subsequently read out by the actor Benedict Cumberbatch and the singer Jarvis Cocker at public events.

Research
Research funded by the UK's National Institute for Health and Care Research (NIHR) has addressed these areas of need. Examples highlight inequalities faced by several groups and offers recommendations. These include the need for close partnership between services caring for people with severe mental illness, improved understanding of barriers faced by Gypsy, Traveller and Roma communities, the provision of flexible palliative care services for children from ethnic minorities or deprived areas.

Other research suggests that giving nurses and pharmacists easier access to electronic patient records about prescribing could help people manage their symptoms at home. A named professional to support and guide patients and carers through the healthcare system could also improve the experience of care at home at the end of life. A synthesised review looking at palliative care in the UK created a resource showing which services were available and grouped them according to their intended purpose and benefit to the patient. They also stated that currently in the UK palliative services are only available to patients with a timeline to death, usually 12 months or less. They found these timelines to often be inaccurate and created barriers to patients accessing appropriate services. They call for a more holistic approach to end of life care which is not restricted by arbitrary timelines.

title: Palliative care