Response to Suffering of the Seriously Ill Child: A History of Palliative Care for Children

Most pediatric clinicians aspire to promote the physical, emotional, and developmental well-being of children, hoping to bestow a long and healthy life. Yet, some infants, children, and adolescents confront life-threatening illnesses and life-shortening conditions. Over the past 70 years, the clinician's response to the suffering of these children has evolved from veritable neglect to the development of pediatric palliative care as a subspecialty devoted to their care. In this article, we review the history of how clinicians have understood and responded to the suffering of children with serious illnesses, highlighting how an initially narrow focus on anxiety eventually transformed into a holistic, multidimensional awareness of suffering. Through this transition, and influenced by the adult hospice movement, pediatric palliative care emerged as a new discipline. Becoming a discipline, however, has not been a panacea. We conclude by highlighting challenges remaining for the next generation of pediatric palliative care professionals to address

Parents' Perspectives on the School Experiences of Children with Cancer

Interviews with 59 parents of school age children with cancer indicate problems children encountered in returning to school: missing significant amounts of school due to illness and treatments, teasing by classmates and peers, and strained relations with teachers. Most parents report that despite missing much school their child was caught up with schoolwork, suggesting that academic difficulties are not paramount. Most parents also report receiving substantial help from sympathetic and competent educators. However, parents also indicate that some teachers were insensitive to their child's condition, while others were overprotective, suggesting the need for a delicate balance in defining appropriate teacher behavior. A responsive yet normalizing school environment can be facilitated by vigorous and proactive partnerships among the medical staff, family, and school system.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68682/2/10.1177_027112148600500405.pd

Constraining Galactic cosmic-ray parameters with Z<=2 nuclei

The secondary-to-primary B/C ratio is widely used to study Galactic cosmic-ray propagation processes. The 2H/4He and 3He/4He ratios probe a different Z/A regime, therefore testing the `universality' of propagation. We revisit the constraints on diffusion-model parameters set by the quartet (1H, 2H, 3He, 4He), using the most recent data as well as updated formulae for the inelastic and production cross-sections. The analysis relies on the USINE propagation package and a Markov Chain Monte Carlo technique to estimate the probability density functions of the parameters. Simulated data are also used to validate analysis strategies. The fragmentation of CNO cosmic rays (resp. NeMgSiFe) on the ISM during their propagation contributes to 20% (resp. 20%) of the 2H and 15% (resp. 10%) of the 3He flux at high energy. The C to Fe elements are also responsible for up to 10% of the 4He flux measured at 1 GeV/n. The analysis of 3He/4He (and to a less extent 2H/4He) data shows that the transport parameters are consistent with those from the B/C analysis: the diffusion model with delta~0.7 (diffusion slope), Vc~20 km/s (galactic wind), Va~40 km/s (reacceleration) is favoured, but the combination delta~0.2, Vc~0, and Va~80 km/s is a close second. The confidence intervals on the parameters show that the constraints set by the quartet data are competitive with those brought by the B/C data. These constraints are tighter when adding the 3He (or 2H) flux measurements, and the tightest when further adding the He flux. For the latter, the analysis of simulated and real data show an increased sensitivity to biases. Using secondary-to-primary ratio along with a loose prior on the source parameters is recommended to get the most robust constraints on the transport parameters.Comment: 17 pages, 7 tables, 20 figures (submitted to A&A

Parallel variation of ventricular CSF tryptophan and free serum tryptophan in man.

Tryptophan was measured in the ventricular CSE and serum and the neutral amino acids leucine, isoleucine, valine, phenylalanine, and tyrosine were measured in the serum of two cases with ventricular drains. Samples were taken every two hours for 24 hours in one case and for 16 hours in the other. The CSF tryptophan was correlated significantly with the free--that is, non-albumin-bound--serum tryptophan but not with the total serum tryptophan. CSF tryptophan was not correlated significantly with the ratio of free serum tryptophan to the sum of the neutral amino acids. These data suggest that, in man, brain tryptophan concentrations are influenced by the free and not the total serum tryptophan and that physiological variations of the neutral amino acids do not appreciably influence the concentration of brain trytophan