bluuebunny/crossref_metadata_2025 huggingface dataset:
ACE Activity Is Modulated by Kinin B
2
Receptor
Authors: Sabatini Regiane A. , Guimarães Paola B. , Fernandes Liliam , Reis Felipe C.G. , Bersanetti Patricia A. , Mori Marcelo A. , Navarro Alberto , Hilzendeger Aline M. , Santos Edson L. , Andrade Maria C.C. , Chagas Jair R. , Pesquero Jorge L. , Casarini Dulce E. , Bader Michael , Carmona Adriana K. , Pesquero João B.
Published: January 2008

Angiotensin-converting enzyme (ACE) is an ectoprotein able to modulate the activity of a plethora of compounds, among them angiotensin I and bradykinin. Despite several decades of research, new aspects of the mechanism of action of ACE have been elucidated, expanding our understanding of its role not only in cardiovascular regulation but also in different areas. Recent findings have ascribed an important role for ACE/kinin B
2
receptor heterodimerization in the pharmacological properties of the receptor. In this work, we tested the hypothesis that this interaction also affects ACE enzymatic activity. ACE catalytic activity was analyzed in Chinese hamster ovary cell monolayers coexpressing the somatic form of the enzyme and the receptor coding region using as substrate the fluorescence resonance energy transfer peptide Abz-FRK(Dnp)P-OH. Results show that the coexpression of the kinin B
2
receptor leads to an augmentation in ACE activity. In addition, this effect could be blocked by the B
2
receptor antagonist icatibant. The hypothesis was also tested in endothelial cells, a more physiological system, where both proteins are naturally expressed. Endothelial cells from genetically ablated kinin B
2
receptor mice showed a decreased ACE activity when compared with wild-type mice cells. In summary, this is the first report showing that the ACE/kinin B
2
receptor interaction modulates ACE activity. Taking into account the interplay among ACE, ACE inhibitors, and kinin receptors, we believe that these results will shed new light into the arena of the controversial search for the mechanism controlling these interactions.
Loss of the Aryl Hydrocarbon Receptor Induces Hypoxemia, Endothelin-1, and Systemic Hypertension at Modest Altitude
Authors: Lund Amie K. , Agbor Larry N. , Zhang Nan , Baker Amy , Zhao Huawei , Fink Gregory D. , Kanagy Nancy L. , Walker Mary K.
Published: January 2008

The aryl hydrocarbon receptor (AHR) is a basic helix-loop-helix Per-Arnt-Sim transcription factor that mediates induction of metabolic enzymes and toxicity of certain environmental pollutants. Although AHR knockout (KO) mice develop cardiac hypertrophy, conflicting reports associate this pathology with hypotension or endothelin (ET)-1-dependent hypertension. Because hypertension occurred at modest altitude, we tested the hypothesis that loss of AHR increases the sensitivity to hypoxia-induced ET-1, contributing to systemic hypertension. We found that AHR KO mice were hypertensive at modest altitude (1632 m) but hypotensive at low altitude (225 m). When AHR KO mice residing at 1632 m were exposed to the partial pressure of inspired oxygen (PIO
2
) at sea level for 11 days, blood pressure declined to levels measured at 225 m. Although plasma ET-1 in AHR KO mice was significantly elevated at 1632 m and decreased at 225 m and sea level PIO
2
, pulmonary prepro-ET-1 mRNA was significantly reduced at 1632 m and decreased further at 225 m and sea level PIO
2
. Blood gas analysis revealed that AHR KO mice were hypoxemic, hypercapnic, and acidotic at 1632 m, values that were attenuated and normalized after 24 hours and 11 days under sea level PIO
2
, respectively. Lastly, AHR inactivation in endothelial cells by small interfering RNA significantly reduced basal prepro-ET-1 mRNA but did not alter hypoxia-induced expression. Our studies establish the AHR KO mouse as a model in which modest decreases in PIO
2
lead to hypoxemia, increased plasma ET-1, and systemic hypertension without increased pulmonary prepro-ET-1 mRNA expression.
Highly Successful Schools: What Do They Do Differently and at What Cost?
Authors: Pérez María , Socias Miguel
Published: January 2008

An underlying premise of many resource adequacy studies is that reaching a specified set of educational outcomes is directly dependent on the level of resources. This article analyzes resource allocation practices among successful schools, low-performing schools, and average public schools in California. We find that differences in traditional resource measures are not able to explain the sharp differences in student achievement among these schools. While unmeasured differences in student characteristics in these schools may explain part of the difference in achievement, the schools also differ dramatically in their effectiveness even though they have very similar expenditure levels. The conclusion is not that resources do not matter. They do, but only when used wisely. This article also delves into what successful schools are doing that might explain their success.
A Framework for Understanding Educational Governance: The Case of California
Authors: Brewer Dominic J. , Smith Joanna
Published: January 2008

Governance is widely believed to be an important determinant of the effectiveness of educational systems. Yet there are few systematic evaluations of the linkages between educational governance and student outcomes, or cogent frameworks for evaluating the effectiveness of governance arrangements in a way that can guide potential policy changes. In this article, we attempt to provide such a framework by identifying indicators of effective educational governance systems drawn from previous research and more than forty interviews with stakeholders at all levels in California, the nation's biggest system. The exploratory research presented here is intended to help inform future studies of educational governance.
Assessing the Costs of Adequacy in California Public Schools: A Cost Function Approach
Authors: Imazeki Jennifer
Published: January 2008

In this study, a cost function is used to estimate the costs for California districts to meet the achievement goals set out for them by the state. I calculate estimates of base costs (i.e., per pupil costs in a district with relatively low levels of student need) and marginal costs (i.e., the additional costs associated with specific student characteristics) for poverty, English learners, and special education and then compare these estimates with the findings from cost studies in other states, which have used a variety of methods, and with other cost studies in California. Because of institutional constraints in California, the cost function estimate of total costs to achieve adequacy (which relies critically on the estimated relationship between spending and outcomes) may be quite imprecise. Nevertheless, the cost function estimates of base and marginal costs are not inconsistent with other studies, though they fall on the low end of the spectrum.
Dynamic Instabilities of Simulated Hurricane-like Vortices and Their Impacts on the Core Structure of Hurricanes. Part II: Moist Experiments
Authors: Kwon Young C. , Frank William M.
Published: January 2008

The energy flows of a simulated moist hurricane-like vortex are analyzed to examine the processes that change the intensity and structure of tropical cyclones. The moist vortex used in this study is initially axisymmetric on an f plane and is placed on a uniform surface—an ocean with constant sea surface temperature of 29°C. Two simulations are performed using the following different environmental flows: one in a calm environment and the other in weak environmental vertical shear. The differences between the intensities and structures of the two simulated vortices are discussed in terms of energy flows.

While the structure and intensity of the vortex without shear are relatively steady, those of the vortex with shear experience dramatic changes. The sheared vortex shows delayed weakening, persistent wavenumber 1 asymmetry with maximum rainfall on the downshear left side, and top-down breakdown. In both vortices barotropic energy conversion is stronger than baroclinic energy conversion. However, baroclinic processes in the upper levels of the sheared vortex play an important role in weakening the vortex. The energy flow diagram and the cross section of energy conversion terms show the existence of multiple baroclinic eddy life cycles at the upper levels of the sheared vortex. The activity of the baroclinic eddies continues until ventilation of the upper-level warm-core structure is sufficient to weaken the sheared vortex.
Size Spectra of Snow Particles Measured in Wintertime Precipitation in the Pacific Northwest
Authors: Woods Christopher P. , Stoelinga Mark T. , Locatelli John D.
Published: January 2008

Particle size spectra collected by the University of Washington’s Convair-580 research aircraft at a variety of altitudes and temperatures in winter frontal and orographic precipitation systems during the Improvement of Microphysical Parameterization through Observational Verification Experiment (IMPROVE) are analyzed in this study. The particle size spectra generally appeared to conform to an exponential size distribution, with well-correlated linear fits between the log of the number concentration and particle diameter. When the particle size spectra were grouped according to the habit composition as determined from airborne imagery, significantly improved correlations between the size spectrum parameters and temperature were obtained. This result could potentially be exploited for specifying the size distribution in a single-moment bulk microphysical scheme, if particle habit is predicted by the scheme. Analyses of “spectral trajectories” suggest that the rime-splintering process was likely responsible for the presence of needle and column habit types and the positive shift in both N0s and λs at temperatures warmer than −10°C.
A Stochastic Parameterization for Deep Convection Based on Equilibrium Statistics
Authors: Plant R. S. , Craig G. C.
Published: January 2008

A stochastic parameterization scheme for deep convection is described, suitable for use in both climate and NWP models. Theoretical arguments and the results of cloud-resolving models are discussed in order to motivate the form of the scheme. In the deterministic limit, it tends to a spectrum of entraining/detraining plumes and is similar to other current parameterizations. The stochastic variability describes the local fluctuations about a large-scale equilibrium state. Plumes are drawn at random from a probability distribution function (PDF) that defines the chance of finding a plume of given cloud-base mass flux within each model grid box. The normalization of the PDF is given by the ensemble-mean mass flux, and this is computed with a CAPE closure method. The characteristics of each plume produced are determined using an adaptation of the plume model from the Kain–Fritsch parameterization. Initial tests in the single-column version of the Unified Model verify that the scheme is effective in producing the desired distributions of convective variability without adversely affecting the mean state.
Potential Vorticity Diagnosis in the Quasigeostrophic and Nonlinear Balance Systems
Authors: Nielsen-Gammon John W. , Gold David A.
Published: January 2008

Quantitative diagnosis of low-Rossby-number flows using potential vorticity (PV) includes using elements of PV advection to deduce instantaneous tendencies of the balanced atmospheric state, most commonly the geopotential field. This technique, piecewise tendency diagnosis (PTD), is here applied with the prognostic balance equations (Bal-PTD) to obtain a quantitative dynamical diagnosis that in principle may be much more accurate than similar diagnoses using the quasigeostrophic (QG) equations.

When both are applied systematically to a case of rapid oceanic cyclogenesis, differences are found to arise owing to a variety of factors. The dominant factor is differences in the vertical influence of PV anomalies, which affects the partitioning between local and remote processes. QG overestimates the effect of lower-level PV, including surface potential temperature, in amplifying and controlling the motion of the upper-level system. Other differences are found, but overall the QG diagnosis gives results that are qualitatively similar to the nonlinear balance diagnosis. Quantitative accuracy requires the use of Bal-PTD.
The Capacitance of Pristine Ice Crystals and Aggregate Snowflakes
Authors: Westbrook Christopher David , Hogan Robin J. , Illingworth Anthony J.
Published: January 2008

A new method of accurately calculating the capacitance of realistic ice particles is described: such values are key to accurate estimates of deposition and evaporation (sublimation) rates in numerical weather models. The trajectories of diffusing water molecules are directly sampled, using random “walkers.” By counting how many of these trajectories intersect the surface of the ice particle (which may be any shape) and how many escape outside a spherical boundary far from the particle, the capacitances of a number of model ice particle habits have been estimated, including hexagonal columns and plates, “scalene” columns and plates, bullets, bullet rosettes, dendrites, and realistic aggregate snowflakes. For ice particles with sharp edges and corners this method is an efficient and straightforward way of solving Laplace’s equation for the capacitance. Provided that a large enough number of random walkers are used to sample the particle geometry (∼104) the authors expect the calculated capacitances to be accurate to within ∼1%. The capacitance for the modeled aggregate snowflakes (C/Dmax = 0.25, normalized by the maximum dimension Dmax) is shown to be in close agreement with recent aircraft measurements of snowflake sublimation rates. This result shows that the capacitance of a sphere (C/Dmax = 0.5), which is commonly used in numerical models, overestimates the evaporation rate of snowflakes by a factor of 2.

The effect of vapor “screening” by crystals growing in the vicinity of one another has also been investigated. The results clearly show that neighboring crystals growing on a filament in cloud chamber experiments can strongly constrict the vapor supply to one another, and the resulting growth rate measurements may severely underestimate the rate for a single crystal in isolation (by a factor of 3 in this model setup).
Retrieval of Urban Boundary Layer Structures from Doppler Lidar Data. Part I: Accuracy Assessment
Authors: Xia Quanxin , Lin Ching-Long , Calhoun Ronald , Newsom Rob K.
Published: January 2008

Two coherent Doppler lidars from the U.S. Army Research Laboratory (ARL) and Arizona State University (ASU) were deployed in the Joint Urban 2003 atmospheric dispersion field experiment (JU2003) held in Oklahoma City, Oklahoma. The dual-lidar data were used to evaluate the accuracy of a four-dimensional variational data assimilation (4DVAR) method and to identify the coherent flow structures in the urban boundary layer. The objectives of the study are threefold. The first objective is to examine the effect of eddy viscosity models on the quality of retrieved velocity data. The second objective is to determine the fidelity of single-lidar 4DVAR and evaluate the difference between single- and dual-lidar retrievals. The third objective is to inspect flow structures above some geospatial features on the land surface. It is found that the approach of treating eddy viscosity as part of the control variables yields better results than the approach of prescribing viscosity. The ARL single-lidar 4DVAR is able to retrieve radial velocity fields with an accuracy of 98% in the along-beam direction and 80%–90% in the cross-beam direction. For the dual-lidar 4DVAR, the accuracy of retrieved radial velocity in the ARL cross-beam direction improves to 90%–94% of the ASU radial velocity data. By using the dual-lidar-retrieved data as a reference, the single-lidar 4DVAR is able to recover fluctuating velocity fields with 70%–80% accuracy in the along-beam direction and 60%–70% accuracy in the cross-beam direction. Large-scale convective roll structures are found in the vicinity of the downtown airport and parks. Vortical structures are identified near the business district. Strong up- and downdrafts are also found above a cluster of restaurants.
Retrieval of Urban Boundary Layer Structures from Doppler Lidar Data. Part II: Proper Orthogonal Decomposition
Authors: Lin Ching-Long , Xia Quanxin , Calhoun Ronald
Published: January 2008

The proper orthogonal decomposition technique is applied to 74 snapshots of 3D wind and temperature fields to study turbulent coherent structures and their interplay in the urban boundary layer over Oklahoma City, Oklahoma. These snapshots of data are extracted from single-lidar data via a four-dimensional variational data assimilation technique. The total velocities and fluctuating temperature are used to construct the data matrix for the decomposition; thus the first eigenmode represents the temporal mean of these data. Roll vortices with a wavelength–height ratio of 3.2 are identified in the first, most energetic eigenmode and are attributed to the inflection-point instability. The second and third spatial eigenmodes also exhibit roll characteristics with different time and length scales, resulting in clockwise- and counterclockwise-rotating roll vortices above the airport and the central business districts. Their positive correlation with temperature fluctuation suggests that those roll structures are driven by thermal as well as wind shear. Their limited horizontal extent seems to coincide with the path of the Oklahoma River. With decreasing rank, coherent structures undergo a transition from roll to polygon patterns. A localized downdraft or updraft located above a cluster of restaurants is captured by the fourth eigenmode. In the capping inversion layer, gravity wave eigenmodes are observed and may be attributed to convection waves. The representation of instantaneous snapshots by high-ranking eigenmodes is then examined by reconstruction of reduced-order fields. It is found that the first four eigenmodes are sufficient to capture the overall characteristics of the 74 snapshots of data.
Multiscale Convective Wave Disturbances in the Tropics: Insights from a Two-Dimensional Cloud-Resolving Model
Authors: Tulich Stefan N. , Mapes Brian E.
Published: January 2008

Multiscale convective wave disturbances with structures broadly resembling observed tropical waves are found to emerge spontaneously in a nonrotating, two-dimensional cloud model forced by uniform cooling. To articulate the dynamics of these waves, model outputs are objectively analyzed in a discrete truncated space consisting of three cloud types (shallow convective, deep convective, and stratiform) and three dynamical vertical wavelength bands. Model experiments confirm that diabatic processes in deep convective and stratiform regions are essential to the formation of multiscale convective wave patterns. Specifically, upper-level heating (together with low-level cooling) serves to preferentially excite discrete horizontally propagating wave packets with roughly a full-wavelength structure in troposphere and “dry” phase speeds cn in the range 16–18 m s−1. These wave packets enhance the triggering of new deep convective cloud systems, via low-level destabilization. The new convection in turn causes additional heating over cooling, through delayed development of high-based deep convective cells with persistent stratiform anvils. This delayed forcing leads to an intensification and then widening of the low-level cold phases of wave packets as they move through convecting regions. Additional widening occurs when slower-moving (∼8 m s−1) “gust front” wave packets excited by cooling just above the boundary layer trigger additional deep convection in the vicinity of earlier convection. Shallow convection, meanwhile, provides positive forcing that reduces convective wave speeds and destroys relatively small-amplitude-sized waves. Experiments with prescribed modal wind damping establish the critical role of short vertical wavelengths in setting the equivalent depth of the waves. However, damping of deep vertical wavelengths prevents the clustering of mesoscale convective wave disturbances into larger-scale envelopes, so these circulations are important as well.
Ruptured Cerebral Aneurysm and Acute Coronary Artery Dissection in the Setting of Multivascular Fibromuscular Dysplasia
Authors: Brodsky Sergey V. , Ramaswamy Gita , Chander Praveen , Braun Alex
Published: January 2008

Fibromuscular dysplasia (FMD) is a segmental noninflammatory nonatherosclerotic vascular disease that has been described in almost every arterial bed, including the cerebral and coronary arteries. FMD of cerebral vessels has been associated with development of saccular aneurysms in the involved vessels. Acute dissection of coronary arteries is also a rare complication of FMD. Herein, we report the first case of both complications of FMD occurring in a single patient—a ruptured anterior communicating artery aneurysm and a right coronary artery dissection occurring in a 38-year-old woman. At autopsy, FMD was found in multiple vascular beds. Our findings reveal the potential for involvement of several vascular beds in patients with FMD, resulting in multiple vascular complications.
Associations Between Serum Lipids and Causes of Mortality in a Cohort of 3499 Urban Thais: The Electricity Generating Authority of Thailand (EGAT) Study
Authors: Sritara Piyamitr , Patoomanunt Prisana , Woodward Mark , Narksawat Kulaya , Tulyadachanon Supoj , Ratanachaiwong Wipa , Sritara Chanika , Barzi Federica , Yamwong Sukit , Tanomsup Supachai
Published: January 2008

The association between serum lipids and mortality has not previously been established in Thailand. Baseline data from the Electricity Generating Authority of Thailand (EGAT) cohort study, plus a resurvey of the cohort 15 years later were analyzed. Participants were employees of EGAT: 2702 men and 797 women. Total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), and triglycerides (TG) were taken as predictive variables; age, sex, hypertension, diabetes, cigarette smoking, alcohol drinking, and body mass index were taken as confounders. Dependent variables were all-causes and specific causes of mortality over 17 years of follow-up. The major cause of death among men was cardiovascular disease (CVD); among women, it was cancer. Relative risks (RR) for specific causes of death, for a mmol/L increase in each lipid, were estimated after adjustment for confounding factors using Cox proportional hazards regression. TC and LDL-C were negatively associated with liver cirrhosis mortality, although it was likely that the low cholesterol concentration was a consequence of the disease. HDL-C was negatively associated with CVD mortality (RR = 0.59; 95% confidence interval [CI], 0.39-0.93), coronary heart disease (CHD) mortality (RR = 0.36; 95% CI, 0.17-0.75) and all cause-mortality (RR = 0.68; 95% CI, 0.54-0.87). TG was not associated with mortality. HDL-C is an important risk factor for CVD in middle-class urban Thais. Health promotion programs to improve lipid profiles, such as effective exercise campaigns and dietary advice, are required to increase HDL-C and to help prevent CVD and premature death in Thailand.
Mesenteric Artery Occlusion Secondary to Activated Protein C Resistance
Authors: Scally N. , O'Donnell M.E. , McClintock Charlotte , Allen M. , Kirk S.J. , Dolan S.
Published: January 2008

We present a case of mesenteric ischemia in a 32-year-old woman. The rarity of this potentially fatal condition in this age group, the diagnostic and therapeutic challenges associated with such a condition, and secondary causes that must always be investigated are highlighted. In this case, activated protein C resistance resulted in thrombosis of the superior mesenteric artery and subsequent bowel ischemia.
Association of Drinking Pattern and Alcohol Beverage Type With the Prevalence of Metabolic Syndrome, Diabetes, Coronary Heart Disease, Stroke, and Peripheral Arterial Disease in a Mediterranean Cohort
Authors: Athyros Vasilios G. , Liberopoulos Evangelos N. , Mikhailidis Dimitri P. , Papageorgiou Athanasios A. , Ganotakis Emmanuel S. , Tziomalos Konstantinos , Kakafika Anna I. , Karagiannis Asterios , Lambropoulos Stylianos , Elisaf Moses
Published: January 2008

The purpose of this study was to investigate the relationship between alcohol consumption and the prevalence of the metabolic syndrome (MetS), type 2 diabetes mellitus (DM), coronary heart disease (CHD), stroke, peripheral arterial disease (PAD), and overall cardiovascular disease (CVD) in a Mediterranean cohort. It consisted of a cross-sectional analysis of a representative sample of Greek adults (n = 4153) classified as never, occasional, mild, moderate, or heavy drinkers. Cases with overt CHD, stroke, or PAD were recorded. In our population, 17% were never, 23% occasional, 27% mild, 24% moderate, and 9% heavy drinkers. Moderate alcohol consumption was associated with a lower trend for the prevalence of the MetS (P = .0001), DM (P < .0001), CHD (P = .0002), PAD (P = .005), and overall CVD (P = .001) but not stroke compared with no alcohol use. Heavy drinking was associated with an increase in the prevalence of all of these disease states. Wine consumption was associated with a slightly better effect than beer or spirits consumption on the prevalence of total CVD, and beer consumption was associated with a better effect than spirits consumption. Alcohol intake was positively related with body weight, high-density lipoprotein cholesterol levels, and hypertension. Moderate alcohol consumption is associated with a lower prevalence of the MetS, DM, PAD, CHD, and overall CVD but not stroke compared with no alcohol use in a Mediterranean population. Heavy drinking was associated with an increase in the prevalence of all of these disease states. Advice on alcohol consumption should probably mainly aim at reducing heavy drinking.
Determinants of Income Inequality in U.S. Nonmetropolitan Tourism- and Recreation-Dependent Communities
Authors: Lee Sangkwon , O'Leary Joseph T.
Published: January 2008

This study examines the determinants of income inequality in nonmetropolitan tourism- and recreation-dependent, manufacturing-dependent, and farming-dependent communities. Earnings in tourism and recreation industry, race, and region show a positive relationship with income inequality. Median household income and manufacturing employment are negatively related to income inequality. Tourism- and recreation-related variables (tourism and recreation employment, and tourism and recreation earnings) are identified as factors that contribute to income inequality. Race dualism and tourism- and recreation-dependent communities also contribute to increases in income inequality. Results of this study show that income inequality in selected U.S. nonmetropolitan communities increased during 1990 and 2000. The need for additional research on income inequality associated with tourism and recreation development is discussed. Characteristics of the labor market in the tourism and recreation industry and economic structures of the communities will be main issues in investigating the relationship between tourism and recreation development and income inequality.
Where people die (1974—2030): past trends, future projections and implications for care
Authors: Gomes Barbara , Higginson Irene J.
Published: January 2008

Background: Ageing nations have growing needs for end of life care, but these have never been projected in detail. We analysed past trends in place of death (1974—2003) and projected likely trends to 2030 in England and Wales and from these need for care.Methods: Mortality trends and forecasts were obtained from official statistics. Future scenarios were modelled using recent five-year trends in age and gender specific home death proportions to estimate numbers of deaths by place to 2030, accounting for future changes in the age and gender distribution of deaths.Results: Annual numbers of deaths fell by 8% from 1974 to 2003, but are expected to rise by 17% from 2012 to 2030. People will die increasingly at older ages, with the percentage of deaths among those aged 85 and expected to rise from 32% in 2003 to 44% in 2030. Home death proportions fell from 31% to 18% overall, and at an even higher rate for people aged 65 and over, women and noncancer deaths. If recent trends continue, numbers of home deaths could reduce by 42% and fewer than 1 in 10 will die at home in 2030. Annual numbers of institutional deaths (currently 440936) will be 530409 by 2030 (20% increase).Conclusions: In England and Wales home deaths have been decreasing. The projections underline the urgent need for planning care to accommodate a large increase of ageing and deaths. Either inpatient facilities must increase substantially, or many more people will need community end of life care from 2012 onwards. Palliative Medicine 2008;22 : 33—41
Challenges faced by palliative care physicians when caring for doctors with advanced cancer
Authors: Noble S.I.R. , Marie A. Nelson , Finlay I.G.
Published: January 2008

Background : It is possible that patients with advanced cancer, who are from the medical profession, have different or additional care needs than other patients. Previous training, professional experiences and access to information and services may influence their needs and subsequent illness behaviour. Caring for `one of our own' may also evoke particular feelings and emotions from health professionals involved in their care and pose unique challenges in the delivery of equitable patient-centred care.Aim : To explore the experiences of palliative care physicians when caring for members of the medical profession with advanced incurable cancer.Participants and methods : Semi-structured interviews exploring the experiences of senior palliative care physicians were recorded and transcribed verbatim. Transcripts were analysed using interpretative phenomenological analysis (IPA) for emergent themes. Data were collected from ten senior palliative care physicians with a combined total of 107 years of palliative care career experience, caring for a reported combined estimate of 120 doctor—patients.Results : On the basis of their reflections, palliative care physicians reported that doctor—patients appear to find it difficult to assume a patient role, especially at a time they are likely to be truly vulnerable. This patient group will routinely attempt to maintain control of their care and environment using various strategies. These include self-referrals, accessing their own tests, directing the consultation and putting barriers up to psychosocial aspects of palliative care. Doctor—patients' general practitioners are at risk of exclusion from the management of care, and referral to palliative care services appears to occur later in the illness journey of doctor—patients compared to lay patients. Participants recalled how caring for colleagues evokes powerful emotional responses, such as a strong desire to provide the best care possible as well as feelings of anxiety. They frequently find themselves under pressure to disclose confidential information from medical colleagues not involved in the doctor—patients' care. Doctor—patients frequently receive what other healthcare professionals perceive as preferential treatment, which may unintentionally result in suboptimal care.Conclusion : The core needs of doctors with advanced cancer could be assumed to be the same as other patients. However, the juxtaposition of role from professional to patient appears to evoke unique care needs from the patient, and behaviour responses from the professional. Forewarning and awareness of these issues may help prevent potential problems in this patient group's cancer journey as well as the experience of the professionals involved in their management. Palliative Medicine 2008;22 : 71—76
Supportive and palliative care needs of families of children who die from cancer: an Australian study
Authors: Monterosso Leanne , Kristjanson Linda J.
Published: January 2008

Objective To obtain feedback from parents of children who died from cancer about their understanding of palliative care, their experiences of palliative and supportive care received during their child's illness, and their palliative and supportive care needs.Design A qualitative study with semi-structured interviews.Participants: 24 parents from Perth (n = 10), Melbourne (n = 5), Brisbane (n = 5) and Sydney (n = 4). Setting: Five Australian tertiary paediatric oncology centres. Results Parents whose children died from cancer live within a context of chronic uncertainty and apprehension. Parents construed palliative care negatively as an independent process at the end of their children's lives rather than as a component of a wider and continuous process where children and their families are offered both curative and palliative care throughout the cancer trajectory. The concept of palliative care was perceived to be misunderstood by key health professionals involved in the care of the child and family. The importance and therapeutic value of authentic and honest relationships between health professionals and parents, and between health professionals and children were highlighted as a critical aspect of care. Also highlighted was the need to include children and adolescents in decision making, and for the delivery of compassionate end-of-life care that is sensitive to the developmental needs of the children, their parents and siblings.Conclusions There is a need for health professionals to better understand the concept of palliative care, and factors that contribute to honest, open, authentic and therapeutic relationships of those concerned in the care of the dying child. This will facilitate a better understanding by both parents and their children with cancer, and acceptance of the integration of palliative and supportive care in routine cancer care. Palliative Medicine 2008; 22 : 59—69
What are patients' priorities for palliative care research? — a questionnaire study
Authors: Perkins Paul , Booth Sara , Vowler Sarah L. , Barclay Stephen
Published: January 2008

This paper describes the questionnaire component of a two-stage study to examine the research priorities of palliative care patients. In the first stage focus groups were conducted to determine a list of priorities for future research: a questionnaire created from these themes was then used in five hospices across East Anglia. Patients thought that the focus group priorities were important and scored research into emergency care, pain control and helping doctors to understand what patients were saying as most important. Differences in priority were associated with gender, age and in-patient versus day therapy patients. Palliative Medicine 2008;22: 7—12