Bromine, iodine and sodium along the EAIIST traverse: Bulk and surface snow latitudinal variability.

During the East Antarctic International Ice Sheet Traverse (Eaiist, december 2019), in an unexplored part of the East Antarctic Plateau, snow samples were collected to expand our knowledge of the latitudinal variability of iodine, bromine and sodium as well as their relation in connection with emission processes and photochemical activation in this unexplored area. A total of 32 surface (0-5 cm) and 32 bulk (average of 1 m depth) samples were taken and analysed by Inductively Coupled Plasma Mass Spectrometry (ICP-MS). Our results show that there is no relevant latitudinal trend for bromine and sodium. For bromine they also show that it has no significant post-depositional mechanisms while its inland surface snow concentration is influenced by spring coastal bromine explosions. Iodine concentrations are several orders of magnitude lower than bromine and sodium and they show a decreasing trend in the surface samples concentration moving southward. This suggests that other processes affect its accumulation in surface snow, probably related to the radial reduction in the ozone layer moving towards central Antarctica. Even though all iodine, bromine and sodium present similar long-range transport from the dominant coastal Antarctic sources, the annual seasonal cycle of the ozone hole over Antarctica increases the amount of UV radiation (in the 280-320 nm range) reaching the surface, thereby affecting the surface snow photoactivation of iodine. A comparison between the bulk and surface samples supports the conclusion that iodine undergoes spring and summer snow recycling that increases its atmospheric lifetime, while it tends to accumulate during the winter months when photochemistry ceases.

Domoic acid at trace levels in lagoon waters: assessment of a method using internal standard quantification.

Domoic acid (DA) is a neurotoxin produced by different algae, including pennate diatoms, principally from the genus Pseudo-nitzschia, and it is the main cause of amnesic shellfish poisoning. Determination of this toxin in seawater samples is fundamental to define the real contamination risks for aquatic species. We have developed two very sensitive instrumental methods using hydrophilic interaction liquid chromatography coupled using tandem mass spectrometry in positive and negative polarity modes. Instrumental detection limits were 9 pg mL(-1) for positive and 19 pg mL(-1) for negative ionisation. A procedural method based on solid-phase extraction for the determination of dissolved DA present in seawater has been developed, and an extraction procedure was employed for the determination of the toxin in the particulate fraction. DA quantification was performed using the internal standard method to account for signals fluctuations and random errors during sample treatment. To our knowledge, this is the first study to use this quantification method for DA determination. Trueness, extraction yield, matrix effects, repeatability and procedural detection limits were evaluated during method validation. Procedural detection limits of 0.3 pg mL(-1) (positive mode) and 0.6 pg mL(-1) (negative mode) were found for the dissolved fraction, and absolute limits of 0.4 pg (positive mode) and 6.0 pg (negative mode) for particulate samples were obtained. The most sensitive method in positive mode was applied to define DA occurrence in the Venice Lagoon. Trace concentrations of domoic acid ranging from 1.5 to 16.2 pg mL(-1) were found for the first time in the Venetian environment.

The direct influence of ship traffic on atmospheric PM2.5, PM10 and PAH in Venice.

The direct influence of ship traffic on atmospheric levels of coarse and fine particulate matter (PM(2.5), PM(10)) and fifteen polycyclic aromatic hydrocarbons (PAHs) has been estimated in the urban area of Venice. Data analysis has been performed on results collected at three sites over the summer, when ship traffic is at a maximum. Results indicate that monitoring of the PM daily concentrations is not sufficiently detailed for the evaluation of this contribution, even though it could be useful for specific markers such as PAHs. Therefore a new methodology, based on high temporal resolution measurements coupled with wind direction information and the database of ship passages of the Harbour Authority of Venice has been developed. The sampling sites were monitored with optical detectors (DustTrack(®) and Mie pDR-1200) operating at a high temporal resolution (20s and 1s respectively) for PM(2.5) and PM(10). PAH in the particulate and gas phases were recovered from quartz fibre filters and polyurethane foam plugs using pressurised solvent extraction, the extracts were then analysed by gas chromatography- high-resolution mass spectrometry. Our results shows that the direct contribution of ships traffic to PAHs in the gas phase is 10% while the contribution to PM(2.5) and to PM(10) is from 1% up to 8%.

Quantifying Individual Response to PRRSV Using Dynamic Indicators of Resilience Based on Activity.

Pigs are faced with various perturbations throughout their lives, some of which are induced by management practices, others by natural causes. Resilience is described as the ability to recover from or cope with a perturbation. Using these data, activity patterns of an individual, as well as deviations from these patterns, can potentially be used to quantify resilience. Dynamic indicators of resilience (DIORs) may measure resilience on a different dimension by calculating variation, autocorrelation and skewness of activity from the absolute activity data. The aim of this study was to investigate the potential of using DIORs of activity, such as average, root mean square error (RMSE), autocorrelation or skewness as indicators of resilience to infection with the Porcine Reproductive and Respiratory Syndrome Virus (PRRSV). For this study, individual activity was obtained from 232 pigs equipped with ear tag accelerometers and inoculated with PRRSV between seven and 9 weeks of age. Clinical scores were assigned to each individual at 13 days post-challenge and used to distinguish between a resilient and non-resilient group. Mortality post-challenge was also recorded. Average, RMSE, autocorrelation and skewness of activity were calculated for the pre- and post-challenge phases, as well as the change in activity level pre- vs. post-challenge (i.e., delta). DIORs pre-challenge were expected to predict resilience to PRRSV in the absence of PRRSV infection, whereas DIORs post-challenge and delta were expected to reflect the effect of the PRRSV challenge. None of the pre-challenge DIORs predicted morbidity or mortality post-challenge. However, a higher RMSE in the 3 days post-challenge and larger change in level and RMSE of activity from pre- to post-challenge tended to increase the probability of clinical signs at day 13 post-infection (poor resilience). A higher skewness post-challenge (tendency) and a larger change in skewness from pre- to post-challenge increased the probability of mortality. A decrease in skewness post-challenge lowered the risk of mortality. The post-challenge DIOR autocorrelation was neither linked to morbidity nor to mortality. In conclusion, results from this study showed that post-challenge DIORs of activity can be used to quantify resilience to PRRSV challenge.

Effect of sonication on UV disinfectability of primary effluents.

In this paper, the effect of sonication on the UV disinfection kinetics of primary effluents was investigated. Wastewater samples were collected from local municipal treatment plants and were sonicated with a 20-kHz ultrasound reactor at constant power but varying sonication times. Sonicated samples were irradiated using low-pressure UV light to obtain the UV dose-response curves (DRC). Results showed that sonication improved the UV disinfection of primary effluents by (1) increasing the initial slope of DRC (i.e., k1) and (2) decreasing the tailing level of the UV dose-response curve (i.e., beta). This improvement was confirmed to be caused by the breakage of large particles (> 60 microm) that are known to protect coliforms from UV photons. It also was found that the log reduction of the tailing level of DRC was directly proportional to the log reduction of the number of large particles (> 60 microm) present in the effluent sample. Although the number of large particles was proportional to the coliform count at high UV dosage, the proportionality constant varied from 0.05 to 0.25, depending on the sample.

Sequencing and functional assessment of hPXR (NR1I2) variants in intrahepatic cholestasis of pregnancy.

1. The purpose of this study was to evaluate the role of coding variation in hPXR (NR1I2) in intrahepatic cholestasis of pregnancy (ICP) and to functionally asses the response of PXR variants to ligands of interest in ICP. 2. The coding region of hPXR was sequenced in a cohort of 121 Caucasian ICP patients and exon 2 was sequenced in an additional 226 cases. Reporter assays were used to evaluate the function of all known hPXR variants in response to the secondary bile acid lithocholic acid and therapeutic agents rifampicin, ursodeoxycholic acid and dexamethasone. 3. Two coding single nucleotide polymorphisms (C79T and G106A) were detected in the ICP cohort at frequencies consistent with healthy populations. These do not alter hPXR function in response to ligands of interest to ICP. Analysis of all known coding hPXR variants demonstrates that while subtle changes in experimental design mask or may unveil the functional effects of genetic variation, these are not maintained in a standard functional assay. 4. Coding genetic variation in hPXR does not contribute to the aetiology of ICP in Caucasian populations.

Twelve tips for developing and sustaining a programme of student selected components.

BACKGROUND: Student selected components (SSCs) represent a significant component of medical curricula in the UK and a new approach in medical education. Despite the prominence given to SSCs by the General Medical Council in each of its seminal papers regarding undergraduate medical education, there remains a diverse view of the purpose, outcomes, structure and assessment of SSCs. Many Schools have adopted their own perspective of SSCs and created different but often innovative courses. AIMS: This article brings together the Scottish Medical Schools and their experience in organising SSCs, highlights some of the challenges and offers possible solutions to some of the difficulties encountered. METHOD: The SSC Director from each of the Scottish medical schools each contributed their own '12 Tips'. From these a consensus was achieved. RESULTS: Even though the Scottish medical schools have a wide range of curriculum and timetable formats, there was a great deal of agreement in the challenges and problems encountered in their SSC programmes, as expressed through these 12 Tips. CONCLUSION: There is much diversity in SSC programmes at different medical schools, although there is also much commonality in the challenges that arise. We hope that this paper will promote thought and discussion amongst those involved, and be useful to those involved in curriculum and programme development and also to those new to medical education.

Functional interaction between nucleosome assembly proteins and p300/CREB-binding protein family coactivators.

The p300/CREB-binding protein (CBP) family of proteins consists of coactivators that influence the activity of a wide variety of transcription factors. Although the mechanisms that allow p300/CBP proteins to achieve transcriptional control are not clear, it is believed that the regulation of chromatin is an important aspect of the process. Here, we describe a new level of p300-dependent control mediated through the functional interaction between p300/CBP and members of the family of nucleosome assembly proteins (NAP), which includes NAP1, NAP2, and TAF1. We find that NAP proteins, which have previously been implicated in the regulation of transcription factor binding to chromatin, augment the activity of different p300 targets, including p53 and E2F, through a process that is likely to involve the physical interaction between p300 and NAP. NAP proteins can form oligomers, and the results show that NAP proteins can bind to both core histones and p300 coactivator proteins, perhaps in a multicomponent ternary complex. We also provide data in support of the idea that histones can influence the interaction between p300 and NAP protein. These results argue that NAP is a functionally important component of the p300 coactivator complex and suggest that NAP may serve as a point of integration between transcriptional coactivators and chromatin.

Seasonal evolution of gas-phase PCB concentrations in the Venice Lagoon area.

The concentrations of gas-phase PCBs were measured from March 2002 to June 2003 at two sites of the Venice Lagoon and at one site of the Euganei hills. The aims of this study were to evaluate the various gas-phase PCB sources, the spatial and temporal variability of PCB concentrations in the gas-phase that enter the Venice Lagoon atmosphere and the influence of the air temperature on PCB trends. The highest annual average concentration of summation PCBs was observed at the station directly influenced by "urban" sources with values about 3 and 1.5 times higher compared to the concentrations found at the stations where "marine" sources and "not subjected to direct local sources" were respectively sampled from. The temporal trends of summation PCBs concentrations were similar at the three sampling stations corresponding to seasonal temperature changes. Greater concentrations occurred in the summer and first autumn months while the lower ones occurred in late autumn and winter. The temperature dependences were investigated using plots of the natural logarithm of the summation PCBs concentrations vs. reciprocal mean temperatures.

A descriptive study comparing health attitudes of urban and rural oncology patients.

INTRODUCTION: Rural patients have poor outcomes in cancer management. Previous studies have shown different health beliefs and values in rural populations with high levels of stoicism and fatalism, leading to later presentation and diagnosis, with subsequent poorer prognosis and survival. This study explores the relationship between urban or rural background and health attitudes of newly diagnosed oncology patients, attending one oncology unit in north Queensland, during a 5 month period. This study is a forerunner to a planned larger project to explore the research question: do oncology patients from rural backgrounds differ in their health attitudes and hope levels compared with those from urban backgrounds? The aim of this study was to determine the utility of the selected validated instruments, newly diagnosed patients' willingness and ability to complete the composite survey instrument, and to identify likely issues for inclusion and/or greater focus in the larger project. As pilot studies are also used to develop or refine research questions and hypotheses, this article also considers some research questions for the planned large scale study. METHODS: Self-administered questionnaire survey of 47 patients newly referred to the Medical Oncology Department in The Townsville Cancer Centre. Scales used were: the EORTC QLQ-C30 to assess symptom burden and quality of life; the Duke UNS Functional Social Support Questionnaire to assess social support; the Herth Hope Index to assess hope; and the Multi-Dimensional Health Locus of Control to assess health beliefs. Data were collated and transformed according to the various scales' scoring manuals. Rurality was ascertained using the RRMA classification and patient self-assessment. Uni-variate analyses were conducted as small numbers precluded multi-variate analysis. Non-parametric Mann-Whitney U and Kruskal-Wallis tests were used where data were skewed, or categorical. Monte-Carlo estimations of p-values were generated. RESULTS: In all, 28 of 47 patients classified as rural, 27 were suitable for curative treatment, and 31 were male. Median age was 56 years. Some respondents (17%) identified as 'rural', although they had an urban residence, and vice versa. Health attitude scores were not affected by global health scores or by intent of treatment (palliative/curative). Males scored significantly higher for belief in chance. Rural patients scored significantly higher for internal belief and belief in chance. No statistically significant differences were evident between rural/urban patients by gender, nor social support scores. Hope levels were generally high with no significant difference between urban and rural patients, regardless of treatment intent. DISCUSSION: The study does reveal differences in health attitudes between urban and rural populations; however, there are several confounding factors which may contribute to this, especially gender. In this study women were under-represented. People with fatalistic beliefs (high belief in chance) tend to have poor initiative in health matters which may cause delay in seeking treatment, or poor compliance with treatment. Analysis is limited by small numbers of patients. This study is a pilot to a larger project to investigate health attitudes and decisions by oncology patients in northern Queensland. The questionnaire was well received by patients, but the need for a dedicated recruitment person was evident. There is a need to determine how patients identify in terms of rurality over and above their actual place of residence.

Cloning, functional characterisation and population analysis of a variant form of the human glycine type 2 transporter.

Two forms of glycine transporter have been described to date, GlyT-1 and GlyT-2. The GlyT-2 form is expressed mainly in the spinal cord, brainstem and cerebellum. Here we describe the identification of a variant form of the human GlyT-2 (SC6), showing three amino acid changes to the previously reported protein. Population analysis identified the allele causing one of the polymorphisms, D463N, at 10% within the population with 3% being homozygous for the change. We also transfected our new variant into mammalian cells and compared it to the published cDNA, showing that the three amino acid changes present have no major effect on the biochemical properties of the transporter.

Changes in chronic pain severity over time: the Chronic Pain Grade as a valid measure.

Our understanding of the natural history of chronic pain in the community is limited. This is partly due to the lack of a validated measure of chronic pain severity known to be responsive to change over time. The Chronic Pain Grade questionnaire has been shown to be valid and reliable for use in a general population as a self-completion questionnaire. However, its reliability and validity for use in longitudinal studies and its responsiveness to change over time has not yet been assessed. We undertook a postal survey designed to test the responsiveness and the validity of the Chronic Pain Grade questionnaire over time. A random sample of 560 chronic pain patients, aged 25 years and over was drawn from an existing cohort and stratified for age, gender and chronic pain severity. Subjects were re-surveyed by a postal self-completion questionnaire consisting of the Chronic Pain Grade and the SF-36 general health questionnaire, which is known to be responsive to change in health over time. To test whether changes in CPG scores correlated with changes in SF-36 scores, Spearman's rank correlation coefficients were calculated. A response rate of 86% was achieved for the follow-up study. The majority of SF-36 scores changed in the hypothesized directions. Changes in CPG scores were significantly correlated with changes in most of the SF-36 domains. We concluded that the CPG is a useful and valid objective instrument for measuring change in severity of chronic pain over time and could be used in longitudinal studies of chronic pain severity.

Pharmacological assessment of the role of the glycine transporter GlyT-1 in mediating high-affinity glycine uptake by rat cerebral cortex and cerebellum synaptosomes.

Two distinct types of glycine transporter, GlyT-1 and GlyT-2, have been characterised. GlyT-1 and GlyT-2 are known to be differentially expressed amongst CNS areas, but direct functional evidence for their relative contributions to high-affinity glycine uptake by brain tissues is lacking. In the present study, we have used the selective GlyT-1 inhibitor N[3-(4"-fluorophenyl)-3-(4"-phenylphenoxy)propyl]sarcosine (NFPS) to investigate the role of GlyT-1 in mediating glycine uptake. HEK293 cells expressing human GlyT-1c or GlyT-2 showed high levels of Na(+)-dependent glycine uptake, with K(m) values of 117+/-13 and 200+/-22 microM, respectively. NFPS potently inhibited uptake in GlyT-1c cells (IC(50) value 0.22+/-0.03 microM), being around 500-fold more potent than glycine or sarcosine, but had no effect on uptake in GlyT-2 cells (IC(50) >10 microM). Efflux of pre-loaded [3H]-glycine from GlyT-1c cells was increased by glycine or sarcosine, whereas NFPS had no effect on its own but blocked the effects of glycine or sarcosine. These results confirm that NFPS is a potent, selective and non-transportable GlyT-1 inhibitor. Rat cortex and cerebellum synaptosomes also showed a high-affinity Na(+)-dependent component of glycine uptake, with affinities similar to those observed for uptake in GlyT-1c or GlyT-2 cells. In cortex synaptosomes, NFPS and sarcosine produced the same maximal inhibition of uptake as glycine itself. However, in cerebellum synaptosomes, the maximal inhibition produced by NFPS and sarcosine was only half that produced by glycine. In both tissues NFPS was around 1000-fold more potent than glycine or sarcosine. Overall, our findings indicate that high-affinity glycine uptake in cerebral cortex occurs predominantly via GlyT-1. However, in cerebellum, only a part of the high-affinity uptake is mediated by GlyT-1, with the remaining NFPS-insensitive component most likely mediated by GlyT-2.

Heterogeneity in the 5' untranslated region of the rat glucocorticoid receptor mRNA.

We have cloned several novel sequences upstream from the first coding exon of the rat glucocorticoid receptor (GR) mRNA using PCR. Analysis of these sequences in RNase protection assays showed that one of the cloned sequences represents the major GR 5' non-coding exon which is expressed in all tissues studied, both at different stages of development and under different hormonal conditions. This major exon is homologous to the human GR 5' untranslated region (UTR). Three other sequences were cloned, but could not be detected in the RNase protection assay, suggesting that they are only minor transcripts, at least under the varying conditions of GR expression studied. One of these sequences is identical to a previously described rat GR cDNA sequence, while another was shown to be contiguous with the rat genomic DNA sequence.

Inhibition of gene expression by steroid hormone receptors via a negative glucocorticoid response element: evidence for the involvement of DNA-binding and agonistic effects of the antiglucocorticoid/antiprogestin RU486.

We have used a negative glucocorticoid response element (nGRE) from the bovine prolactin promoter linked to the gene for chloramphenicol acetyltransferase (PRL3CAT) to study the inhibition of gene expression by steroid hormone receptors. This nGRE increased basal expression from a heterologous promoter in COS-7 cells. In the presence of cotransfected glucocorticoid (GR), androgen, or progesterone receptor (PR) expression vectors and their cognate ligands, the expression of PRL3CAT could be repressed, indicating that these steroid receptor subfamily members could function through the same negative response element. No repression was observed with the estrogen receptor, showing that the repressive effect was specific for members of the GR-subfamily. Mutation of three amino acids within the GR-DNA binding domain that determine the specificity of GR-GRE interaction abolished the ability of the GR to inhibit the expression of PRL3CAT, demonstrating the requirement for DNA binding of the GR in the mechanism of repression. The antiglucocorticoid/antiprogestin RU486 when bound to PR or GR also repressed the expression of the PRL3CAT, but higher concentrations of RU486 were required to obtain an effect with the GR when compared to the PR. RU486 was unable to antagonize the effect of progestins on PRL3CAT and only partially antagonized the glucocorticoid repression. Thus, regarding the repression of PRL3CAT, RU486 acted as an agonist when bound to the PR and as a partial agonist when bound to the GR.

Studies on the mechanism of glucocorticoid-mediated repression from a negative glucocorticoid response element from the bovine prolactin gene.

Several models for repression of transcription by glucocorticoid hormone, some of which involve so-called negative glucocorticoid response elements (nGRE), have been suggested. In the cases where nGREs are required, the glucocorticoid receptor (GR) is thought to bind to the nGRE and interfere with transcriptional activation by positively acting transactivating factors. We have studied an nGRE from the bovine prolactin gene promoter (PRL3), which increases basal expression from a heterologous promoter in rat pituitary cells (GH3) and is repressed by glucocorticoids. Two proteins in addition to the GR were identified in pituitary cells to bind specifically to the PRL3 nGRE, one of which was the pituitary-specific transcription factor Pit-1/GHF-1. A mutation in the PRL3 nGRE, which destroyed Pit-1/GHF-1 binding, totally abolished the increased basal expression as well as glucocorticoid repression in transfected GH3 cells. A mutation in the binding site for the second protein, termed XTF, partially impaired basal activity but totally abrogated glucocorticoid repression. The same mutation had no effect on GR binding to the PRL3 nGRE. Mixing experiments with whole-cell extracts containing overexpressed GR from COS cells decreased the binding of both Pit-1/GHF-1 and XTF to the PRL3 element. However, Pit-1/GHF-1 displacement from the PRL3 element by the GR required XTF binding. Furthermore, GR binding to the PRL3 nGRE was required for glucocorticoid repression to occur, because a mutation of the GR binding site abolished the glucocorticoid effect. Moreover, the PRL3 nGRE was found to contain only half a palindromic GRE, allowing only one GR moiety to contact the DNA. These data demonstrate that the PRL3 nGRE is composite in nature and that the ability of the GR to repress transactivation by displacement requires an intermediary factor, XTF.

Characterisation using FLIPR of human vanilloid VR1 receptor pharmacology.

A full pharmacological characterisation of the recently cloned human vanilloid VR1 receptor was undertaken. In whole-cell patch clamp studies, capsaicin (10 microM) elicited a slowly activating/deactivating inward current in human embryonic kidney (HEK293) cells stably expressing human vanilloid VR1 receptor, which exhibited pronounced outward rectification (reversal potential -2.1+/-0.2 mV) and was abolished by capsazepine (10 microM). In FLIPR-based Ca(2+) imaging studies the rank order of potency was resiniferatoxin>olvanil>capsaicin>anandamide, and all were full agonists. Isovelleral and scutigeral were inactive (1 nM-30 microM). The potencies of capsaicin, olvanil and resiniferatoxin, but not anandamide, were enhanced 2- to 7-fold at pH 6.4. Capsazepine, isovelleral and ruthenium red inhibited the capsaicin (100 nM)-induced Ca(2+) response (pK(B)=6.58+/-0.02, 5.33+/-0.03 and 7.64+/-0.03, respectively). In conclusion, the recombinant human vanilloid VR1 receptor stably expressed in HEK293 cells acted as a ligand-gated, Ca(2+)-permeable channel with similar agonist and antagonist pharmacology to rat vanilloid VR1 receptor, although there were some subtle differences.

A high performance liquid chromatography - inductively coupled plasma-mass spectrometry interface employing desolvation for speciation studies of platinum in chemotherapy drugs.

A novel interface between high performance liquid chromatography (HPLC) and inductively coupled plasma-mass spectrometry (ICP-MS) is described. The eluent from the HPLC is nebulised into a heated cyclone spray-chamber and the solvent removed using a Nafion membrane drier, held at 75 degrees C, and a cryogenic condenser. The condenser consists of 6 Peltier heat pumps connected to liquid cooled aluminium blocks. At a nebuliser gas flow rate of 0.6 l min(-1), the membrane drier removes 58% of the vapour and the Peltier condenser 75% of the remaining vapour, i.e. a total desolvation efficiency of 89%. This enables the use of HPLC solvents which otherwise would destabilise the ICP, e.g. 100% acetonitrile or methanol, and permits the use of solvent gradients with minimal baseline drift. The system has been applied to the determination of platinum species in an organoplatinum drug used for chemotherapy in human plasma ultrafiltrate of patients treated with this new drug (JM-216). The limit of detection for platinum species has been 0.6 ng nl(-1) (i.e. 120 pg of Pt) and several species have been separated with good resolution.

Getting the most from your local palliative care service.

BACKGROUND: Palliative care needs to address physical symptoms and psychosocial issues for the dying patient, maximise quality of life and assist family and carers. The development of specialised palliative care services has assisted in striving toward this goal. OBJECTIVE: To outline the role of palliative care services and the ways general practitioners can engage with them to optimise patient care and enhance support for carers, family and the GP. DISCUSSION: General practitioners have a vital role to play in the care of the dying patient because of their long term relationship with the patient and the family, their ability to deal with medical problems and their knowledge of the community and its resources. However, no one individual can meet the needs associated with palliative care and the team approach of the palliative care service can bring a wide variety of skills and experience to problems encountered.