Doctors and their patients: A context for understanding the wish to hasten death

There is a paucity of research that has directly examined the role of the health professional in dealing with a terminally ill patient's wish to hasten death (WTHD) and the implications of this for the support and services needed in the care for a dying patient. Themes to emerge from a qualitative analysis of interviews conducted on doctors (n = 24) involved in the treatment and care of terminally ill patients were (i) the doctors' experiences in caring for their patients (including themes of emotional demands/expectations, the duration of illness, and the availability of palliative care services); (ii) the doctors' perception of the care provided to their respective patients (comprising themes concerning satisfaction with the care for physical symptoms, for emotional symptoms, or overall care); (iii) the doctors' attitudes to euthanasia and (iv) the doctors' perception of their patients' views/beliefs 'regarding euthanasia and hastened death. When responses were categorised according to the patients' level of a WTHD, the theme concerning the prolonged nature of the patients' illnesses was prominent in the doctor group who had patients with the highest WTHD, whereas there was only a minority of responses concerning support from palliative care services and satisfaction with the level of emotional care in this group. This exploratory study presents a set of descriptive findings identifying themes among a small group of doctors who have been involved in the care of terminally ill cancer patients, to investigate factors that may be associated with the WTHD among these patients. The pattern of findings suggest that research investigating the doctor-patient interaction in this setting may add to our understanding of the problems (for patients and their doctors) that underpins the wish to hasten death in the terminally ill. Copyright (C) 2003 John Wiley Sons, Ltd.

Estimating trends and seasonality in coronary heart disease

We present two methods of estimating the trend, seasonality and noise in time series of coronary heart disease events. In contrast to previous work we use a non-linear trend, allow multiple seasonal components, and carefully examine the residuals from the fitted model. We show the importance of estimating these three aspects of the observed data to aid insight of the underlying process, although our major focus is on the seasonal components. For one method we allow the seasonal effects to vary over time and show how this helps the understanding of the association between coronary heart disease and varying temperature patterns. Copyright (C) 2004 John Wiley Sons, Ltd.

Simultaneous determination of delta(33) SV-CDT and delta S-34(V-CDT) using masses 48, 49 and 50 on a continuous flow isotope ratio mass spectrometer

A new, fast, continuous flow technique is described for the simultaneous determination of 633 S and delta(34)S using SO masses 48, 49 and 50. Analysis time is similar to5min/sample with measurement precision and accuracy better than +/-0.3parts per thousand. This technique, which has been set up using IAEA Ag2S standards S-1, S-2 and S-3, allows for the fast determination of mass-dependent or mass-independent fractionation (MIF) effects in sulfide, organic sulfur samples and possibly sulfate. Small sample sizes can be analysed directly, without chemical pre-treatment. Robustness of the technique for natural versus artificial standards was demonstrated by analysis of a Canon Diablo troilite, which gave a delta(33)S of 0.04parts per thousand and a delta(34)S of -0.06parts per thousand compared to the values obtained for S-1 of 0.07parts per thousand and -0.20parts per thousand, respectively. Two pyrite samples from a banded-iron formation from the 3710 Ma Isua Greenstone Belt were analysed using this technique and yielded MIF (Delta(33)S of 2.45 and 3.31parts per thousand) comparable to pyrite previously analysed by secondary ion probe. Copyright (C) 2004 John Wiley Sons, Ltd.

Chloride as a signature indicator of soil textural and hydrologic stratigraphies in variable charge deep profiles

Soil properties that influence water movement through profiles are important for determining flow paths, reactions between soil and solute, and the ultimate destination of solutes. This is particularly important in high rainfall environments. For highly weathered deep profiles, we hypothesize that abrupt changes in the distribution of the quotient [QT = (silt + sand)/clay] reflect the boundaries between textural units or textural (TS) and hydrologic (HS) stratigraphies. As a result, QT can be used as a parameter to characterize TS and as a surrogate for HS. Secondly, we propose that if chloride distributions were correlated with QT, under non-limiting anion exchange, then chloride distributions can be used as a signature indicator of TS and HS. Soil cores to a depth of 12.5 in were taken from 16 locations in the wet tropical Johnstone River catchment of northeast Queensland, Australia. The cores belong to nine variable charge soil types and were under sugarcane (Saccharun officinarum-S) production, which included the use of potassium chloride, for several decades. The cores were segmented at I m depth increments and subsamples were analysed for chloride, pH, soil water content (theta), clay, silt and sand contents. Selected bores were capped to serve as piezometers to monitor groundwater dynamics. Depth incremented QT, theta and chloride correlated, each individually, significantly with the corresponding profile depth increments, indicating the presence of textural, hydrologic and chloride gradients in profiles. However, rapid increases in QT down the profile indicated abrupt changes in TS, suggesting that QT can be used as a parameter to characterize TS and as a surrogate for HS. Abrupt changes in chloride distributions were similar to QT, suggesting that chloride distributions can be used as a signature indicator of QT (TS) and HS. Groundwater data indicated that chloride distributions depended, at least partially, on groundwater dynamics, providing further support to our hypothesis that chloride distribution can be used as a signature indicator of HS. Copyright (c) 2005 John Wiley & Sons, Ltd.

Analytical solutions of linear finite- and small-strain one-dimensional consolidation

Analytical solutions are presented for linear finite-strain one-dimensional consolidation of initially unconsolidated soil layers with surcharge loading for both one- and two-way drainage. These solutions complement earlier solutions for initially unconsolidated soil layers without surcharge and initially normally consolidated soil layers with surcharge. Small-strain solutions for the consolidation of initially unconsolidated soil layers with surcharge loading are also presented, and the relationship between the earlier solutions for initially unconsolidated soil without surcharge and the corresponding small-strain solutions, which was not addressed in the earlier work, is clarified. The new solutions for initially unconsolidated soil with surcharge loading can be applied to the analysis of low stress consolidation tests and to the partial validation of numerical solutions of non-linear finite-strain consolidation. They also clarify a formerly perplexing aspect of finite-strain solution charts first noted in numerical solutions. Copyright (C) 2004 John Wiley Sons, Ltd.

Export processing zones and growth triangle development: The case of the BIMP-EAGA, Southeast Asia

Exorts processing zones (EPZs) and growth triangles have been two common Asian initiatives to increase wealth and regional competitiveness in the world economy. Since they are seldom analysed jointly, this paper investigates their mutuality in the development process. Taking the problematic case of the Brunei-Indonesia-Malaysia-Philippines East ASEAN Growth Area (BIMP-EAGA) triangle, we explore the role of EPZs in enhancing regional collaboration, competitiveness, and domestic linkages. Despite the triangle's weak economic complementarities, its processing zones are found capable of advancing development by furthering opportunities in regionalisation/localisation of production. Latterly, trade and investment liberalisation within ASEAN raises broad questions about the rationale of EPZs and growth triangles. Zone-triangle nexuses will require rethinking as, under different regulatory conditions, the zones compete more directly across ASEAN and also with global rivals. Copyright © 2005 John Wiley & Sons, Ltd.

When differences matter: Intergroup distinctiveness and the evaluation of impostors

The present study examined the effect of intergroup distinctiveness and group membership on evaluations of impostors. We predicted that ingroup members would be harsher than outgroup members on an impostor and that perceptions of intergroup distinctiveness would further moderate these evaluations. Specifically, we tested the social identity theory prediction that low intergroup distinctiveness would lead to greater derogation of the impostor (the 'reactive distinctiveness' hypothesis) against the self-categorization hypothesis that high intergroup distinctiveness would instigate more derogation of an impostor (the 'reflective distinctiveness' hypothesis). In this study, vegetarians (ingroup members) and meat eaters (outgroup members) were presented with a target claiming to be vegetarian, but caught indulging in a meat dish. We found that ingroup members derogated the impostor more and felt less pleased about discovering the impostor behaviour than did outgroup members. In line with the reflective distinctiveness hypothesis, the heightened derogation displayed by ingroup members only emerged when intergroup distinctiveness was high, an effect that was mediated by ratings of group identification. The discussion focuses on the different responses intergroup distinctiveness may evoke. Copyright (c) 2005 John Wiley & Sons, Ltd.

The representation of majorities and minorities in the British press: A content analytic approach

A content analysis examined the way majorities and minorities are represented in the British press. An analysis of the headlines of five British newspapers, over a period of five years, revealed that the words 'majority' and 'minority' appeared 658 times. Majority headlines were most frequent (66%), more likely to emphasize the numerical size of the majority, to link majority status with political groups, to be described with positive evaluations, and to cover political issues. By contrast, minority headlines were less frequent (34%), more likely to link minority status with ethnic groups and to other social issues, and less likely to be described with positive evaluations. The implications of examining how real-life majorities and minorities are represented for our understanding of experimental research are discussed. Copyright (C) 2004 John Wiley Sons, Ltd.

A comparison of body-image dissatisfaction and eating disturbance among Australian and Hong Kong women

The current cross-cultural study was designed to test the validity of a biopsychosocial mediation model which hypothesized that a variety of biological, psychological and social variables would have their mode of action upon eating disturbance through the mediation of body-image dissatisfaction. The biopsychosocial variables examined were body mass, self-esteem, weight-related teasing, previous dieting and sociocultural influences. Forty-eight Hong Kong and 100 Australian females aged 17-28 years were assessed. Results revealed no significant difference between the groups of women in levels of body dissatisfaction and eating disturbance; however, different variables in the biopsychosocial model appeared to have contributed to their predisposition to these conditions. The findings suggest that there appear to exist important cultural differences in various aspects of dieting and body image in young women. Implications for prevention, treatment and future research are discussed. Copyright (c) 2005 John Wiley & Sons, Ltd and Eating Disorders Association.

EGFR amplification and lack of activating mutations in metaplastic breast carcinomas

Metaplastic breast carcinomas are reported to harbour epidermal growth factor receptor (EGFR) overexpression in up to 80% of the cases, but EGFR gene amplification is the underlying genetic mechanism in around one-third of these. In this study, EGFR gene amplification as defined by chromogenic in situ hybridization and protein overexpression was examined in a cohort of 47 metaplastic breast carcinomas. Furthermore, the presence of activating EGFR mutations in exons 18, 19, 20, and 21 was investigated. Thirty-two cases showed EGFR overexpression and of these, 11 (34%) harboured EGFR gene amplification. In addition, EGFR amplification showed a statistically significant association with EGFR overexpression (p < 0.0094) and was restricted to carcinomas with homologous metaplasia. Ten cases, five with and five without EGFR amplification, were subjected to microarray-based CGH, which demonstrated that EGFR copy number gain may occur by amplification of a discrete genomic region or by gains of the short arm of chromosome 7 with a breakpoint near the EGFR gene locus, the minimal region of amplification mapping to EGFR, LANCL2, and SECOG. No activating EGFR mutations were identified, suggesting that this is unlikely to be a common alternative underlying genetic mechanism for EGFR expression in metaplastic breast carcinomas. Given that metaplastic breast carcinomas are resistant to conventional chemotherapy or hormone therapy regimens and that tumours with EGFR amplification are reported to be sensitive to EGFR tyrosine kinase inhibitors, these findings indicate that further studies are warranted to explore EGFR tyrosine kinase inhibitors as potential therapeutic agents for metaplastic breast carcinomas harbouring amplification of 7p11.2. Copyright (c) 2006 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd

Dimensions of quality of life and psychosocial variables most salient to colorectal cancer patients

Colorectal cancer is one of the most common invasive cancers, and is responsible for considerable physical and psychosocial morbidity. Understanding the quality of life experienced by colorectal cancer patients is essential for evaluating the full impact of the disease on individuals, their families and their communities. Patient perspective is essential in establishing a proper understanding of the quality of life of colorectal cancer patients. Despite this, few studies have employed a qualitative methodology to explore quality of life issues for colorectal cancer patients. A review of the literature identified only seven qualitative studies pertaining to quality of life issues for colorectal cancer patients, a surprising finding given the prevalence of this cancer. Accordingly, this study sought to build on the findings of previous qualitative research by providing descriptive data on the quality of life and psychosocial variables most salient to colorectal cancer patients. Six core themes emerged from interview and focus group data: Satisfaction with diagnosis and treatment; support (including information provision); quality of life; benefits of diagnosis; making sense of the cancer experience; and coping strategies. The information derived from this study will help inform the development of supportive care services to address the needs of the increasing number of people diagnosed with colorectal cancer. Copyright (c) 2005 John Wiley & Sons, Ltd.

Health and developmental outcome of children following prenatal diagnosis of confined placental mosaicism

Objective To determine the long-term health and development of a cohort of children in whom confined placental mosaicism (CPM) was diagnosed at prenatal diagnosis. Methods A retrospective cohort study was performed comparing 36 children in whom CPM had been diagnosed prenatally with 195 controls subjects in whom a normal karyotype had been detected prenatally. Data comprising birth information, health, health service utilisation, growth, development, behaviour, and the family were collected by a maternal questionnaire administered when the subjects were aged between 4 and 11 years. Results CPM cases did not differ from controls across a broad range of health measures and there were no major health problems or birth defects among the CPM group. No increase was detected in the incidence of intrauterine growth retardation (IUGR) among CPM cases; however, postnatal growth was reduced compared with controls (p = 0.047). Development and behaviour in CPM cases was similar to that of controls. Conclusions The prenatal diagnosis of CPM is not associated with an increased risk of birth defects or developmental problems, but may be associated with decreased growth. Copyright (C) 2006 John Wiley & Sons, Ltd.

Characterization of tumour-infiltrating lymphocytes and apoptosis in colitis-associated neoplasia: comparison with sporadic colorectal cancer

The development of colorectal cancer is a major complication for patients with chronic idiopathic colitis. Colitis-associated tumours tend to occur at a younger age and be more aggressive than sporadic colorectal cancers. While we have previously associated the presence of tumour-infiltrating lymphocytes (TILs) and increased apoptosis in sporadic colorectal cancer with high-level microsatellite instability and improved prognosis, little is known of the relationship between these variables in colitis-associated colorectal cancer. The aim of this study was to correlate TILs and tumour cell apoptosis in colitis-associated neoplasms stratified according to microsatellite instability. Twenty tumour and 11 dysplastic samples resected from 21 patients with long-standing colitis were analysed for microsatellite instability at 10 microsatellite markers. TIL distribution (CD3, CD8) and function (granzyme B) were quantified by immunohistochemistry. Neoplastic cell apoptosis was assessed using the M30 CytoDEATH antibody. These findings were compared with 40 microsatellite stable (MSS) sporadic colorectal cancers previously evaluated for TILs and neoplastic apoptosis. Low-level microsatellite instability was found in 1/20 colitis-associated tumours. All other colitis-associated lesions were designated MSS. CD3(+) and CD8(+) TIL counts were significantly higher in colitis-associated lesions compared with NISS sporadic colorectal cancer (p < 0.0001, p = 0.001 respectively). Despite their higher TIL density, colitis-associated tumours were more likely to present late (Dukes' stage C or D) (P = 0.02). Functionally, colitis-associated TILs demonstrated significantly less granzyme B expression compared to sporadic cancers (p = 0.002). The level of tumour cell apoptosis was similar between the two groups (sporadic, 1.53%; colitis cancers, 1.45%). In conclusion, NISS colitis-associated tumours have a higher prevalence of CD3(+)/CD8(+) TILs but no associated increase in tumour cell killing by apoptosis. Unlike cytotoxic T cells in sporadic colorectal cancer, TILs do not appear to enhance the prognosis of colitis-associated colorectal cancer. This may be related to an impairment of granzyme B expression within these lesions. Copyright (c) 2005 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.