Muddling through with non-compliant biology: An ethnographic investigation the meaning and practice of evidence in an NHS thyroid disease out-patients clinic.

Thyroid diseases number amongst the most widespread and chronic conditions in the population. They are symptomatically vague, difficult to diagnose, and are more prevalent in women than men. Since the hormones produced by the gland control cell metabolism in the body, symptoms of glandular failure are elusively diverse and non-specific and are easily attributable to other diseases or no disease at all. Consequently, a definitive diagnosis conventionally relies on a blood test to measure the function of the gland. However, as observed in the clinic, such a diagnosis is often partial and is not compatible with the clinical symptoms some patients present. Predictably, many patients feel such tests are inaccurate measures of the extent of their disease and do not match their own interpretations of clinical symptoms or experiences of suffering. In response, many clinicians express concern that patients are incorrectly attributing their symptoms to thyroid disease and as a consequence are demanding treatments which are not necessary This qualitative study investigates the indeterminate aspects of thyroid dysfunction by exploring how a contest over meaning is manifest in the clinic, particularly with regards to how embodied clinical symptoms and disembodied biochemical measures are used as evidence for and against decisions over diagnosis and treatment. The thesis identifies that, due to the vague nature of both symptomatic and biochemical evidence, thyroid disease is a location where medicalisation is impossible. Subsequently, using the available discourses of the clinic, specifically EBM and patient centred medicine, clinicians and patients construct various orders of thyroid biology and pathology, in an attempt to satisfy diagnostic strategies and treatment needs. As a consequence the thesis can add to the analytical purchase of the anthropologist Paul Rabinow's concept of biosociality and theories of governmentality more generally. That is, it demonstrates how practices of re-making thyroid biology are possible, not because of a new found molecular control over thyroid biology, but due to the non-compliant nature of thyroid biology and the technical deficiency of current diagnostic and treatment strategies deployed to attend to it within the clinic

A knowledge engineering approach to the recognition of genomic coding regions

ได้ทุนอุดหนุนการวิจัยจากมหาวิทยาลัยเทคโนโลยีสุรนารี ปีงบประมาณ พ.ศ.2556-255

Some sort of larger force at work: meanings and implications of genetics for women with eating disorders

Recent research supports the idea that genes play a role in the development of many complex psychiatric and behavioral disorders, including eating disorders. Although no genes have been linked to anorexia or bulimia nervosa, heritability estimates from twin studies have been described in scientific and popular literature. Genetic causation may compete with other causal narratives that implicate individual choice, family problems, and cultural norms. In this dissertation, I treat genetic ideas as newly available cultural tools for individuals to use as they manage identities, organize action, and conceptualize their own behavior and condition. Through semi-structured interviews with fifty women who have a history of anorexia or bulimia nervosa, I describe their understandings of genetic causality for this complex disorder and its implications. Half the sample was currently receiving treatment (recruited from a hospital-based clinic); the other half had recovered (self-reported and recruited through a mass email). Chapters 3 and 4 illuminate respondents' understandings of eating disorders and their causes before the idea of genetic influence is brought up as a topic of discussion. In Chapter 3, I present the complex, dynamic causal models put forth by respondents and their perceptions of their own ambiguous, ambivalent agency in carrying out eating disorder behavior. Respondents spoke of eating disorder causation in ways that were not reducible to biological, environmental (e.g., social, cultural, familial factors), nor individual (e.g., psychological, agentic) factors and frequently involved elements of all three in interaction with each other over time. I illustrate this dynamic interactive causation by highlighting three complex causal factors frequently cited by respondents: valorization of thinness, coping responses, and repetition over time. The language respondents used to describe eating disorder behavior suggested that they held complex notions of agency; the disorder and its constitutive behaviors were not simply chosen but there was nevertheless some role for agency or quasi-agency. In Chapter 4, I focus on respondents' understandings of eating disorders and responses to specific terms describing eating disorders. There was consensus that eating disorders were problems, but disagreement about whether they were psychological problems, mental illnesses, brain diseases, physical illnesses, or choices. As respondents discussed whether and why a given term was appropriate (or not) for eating disorders, they revealed not only how they thought about eating disorders but also how they defined the terms presented. I summarized their reactions to all five terms with an index of medicalized term endorsement and found that respondents who were currently in treatment and those who had received more extensive treatment endorsed more medicalized terms. In Chapter 5, I examined respondents' initial reactions to the idea that some say there are genetic causes followed by their more considered speculations about how genes could play a role. Most respondents had already mentioned genetics in relation to eating disorders before I brought it up. There were negative and positive initial statements and reactions about genetics. Some respondents found the idea implausible and characterized genetic explanations as simplistic and deterministic, with an inadequate role for environmental causes. Others thought it made sense and expected that it would remove blame and stigma from people with eating disorders and offer hope for new genetically-based treatments. People who had earlier endorsed medicalized views of eating disorders were more likely to hold positive initial views about genetics, as were people with more or current experience of treatment. Respondents' genetic theories allowed a great deal of room for agency and environmental influence. Most respondents found genes specifically for AN or BN less plausible than genes for something more general, such as personality type or addictive tendencies. I identified four ways that respondents combined genetic and non-genetic influence and rank-ordered theories according to how much conceptual room they allowed for non-genetic forces to shape an outcome, arguing that genes for AN or BN offered the least room and genes for body type the most. Chapter 6 addresses the perceived implications of genetic causal ideas for people with eating disorders. In response to hypothetical scenarios involving genetics, most respondents perceived genetics to medicalize eating disorders by increasing their resemblance to other less contested diseases, by making treatment by healthcare professionals seem more necessary, or by raising expectations for biologically based treatments. In general, respondents interpreted genetic influence to imply less personal responsibility for the eating disorder, which in turn had a number of implications for their agency and future action vis--vis eating disorders

Secondary use of electronic medical records for early identification of raised condition likelihoods in individuals: a machine learning approach

With many symptoms being common to multiple diseases, there is a challenge in producing an initial diagnosis or recommendation for diagnostic tests from a set of symptoms that could have been produced by a number of diseases. Often the initial choice of diagnosis or testing is based on a clinician’s impression of the likelihood of that condition in a general population; however the opportunity may exist for modification of these likelihoods based on individuals’ recorded medical histories. This data-driven approach utilises existing data and is thus cheap and non-invasive. A method is proposed by which an individual’s likelihoods of having specified medical conditions are modified by the similarity of that individual’s medical history to the medical histories of other individuals, comparing the prevalence of conditions in those other individuals’ records who are similar to the individual of interest versus the prevalence of the conditions in those individuals who are dissimilar. In order to maximise the number of records available for analysis, a process was developed for the merging of data from disparate sources that used different clinical coding systems, including extensive development of a technique for semi automatically mapping clinical events coded in ICD9-CM to Clinical Terms Version 3 (CTV3), for which no existing mapping table was found. Semantically similar fields in the source code sets were identified and retained in the combined data set. ‘Codelists’ comprising multiple CTV3 codes for a variety of conditions were built that defined the presence of those conditions within individual records. The hierarchical structure of the CTV3 code table was utilised as a method of identifying codes that differed in structure but had clinically similar or related meaning. The optimum degree of granularity of the coded data to use in identifying similar records was investigated and used in subsequent analysis. Two methods were used for discovering groups of similar and dissimilar individuals: the ‘nearest neighbours’ method and the grouping of records using a clustering process. Altered likelihoods for a range of conditions were investigated and results for the nearest-neighbours approach compared to the clustering approach. Results for adjusted condition likelihoods for 18 conditions are reported, together with a discussion of possible reasons for a change, or otherwise, in the condition likelihood, and a discussion of the clinical significance and potential use of information about such a change. logistic regressions performed on a selection of conditions KNN performed better than logistic regression when judged by F-score (or sensitivity and specificity separately), however situation more nuanced when looking at likelihood ratios: Logistic regression produced higher (better) positive likelihood ratios, but KNN produced lower (better) negative likelihood ratios. Logistic regression produced higher odds ratios

LWA 2013. Lernen, Wissen & Adaptivität ; Workshop Proceedings Bamberg, 7.-9. October 2013

LWA Workshop Proceedings: LWA stands for "Lernen, Wissen, Adaption" (Learning, Knowledge, Adaptation). It is the joint forum of four special interest groups of the German Computer Science Society (GI). Following the tradition of the last years, LWA provides a joint forum for experienced and for young researchers, to bring insights to recent trends, technologies and applications, and to promote interaction among the SIGs

Incident of Sihir Upon Prophet Muhammad sallahu álaihi wassalam: Analyses of Narrations, Mental Capacity, and Its Implication on Revelation.

ntroduction: The incident of sihir inflicted upon prophet Muhammad sallahu álaihi wassalam is well-documented in traditions and historical narrations. Most scholars accept the incident indeed occurred and affected the mental capacity of the prophet in a limited manner. Anti-Islamic proponents use this as means to cast doubt on revelation. Current study sought to show the context of the mental disturbance and the implication upon revelation based on various narrations. Methods: The incident of sihir was extracted from various classical hadeeth sources using Maktabah Shamela. Relevant scholarly opinions were selected and scrutinized for the incident. Results: The incident was authenthic and reported in the major books of hadith especially Sahih al-Bukhari and Muslim. Aisyah, Zaid bin Arqam and Ibnu Abbas were the companions who reported this incident. The context of the narration does not show satanic possession of the prophet neither in anyway jeopardize revelation. The mental capacity minimally affected in which he was only imagining himself together with his wife. The period of sihir is well documented with no revelation was revealed during the incident. The prophet himself were very aware on the post-event and even did not take action on the person. Conclusion: Therefore, it can be deduced the incident did not doubt the integrity and the credibility of prophet sallahu álaihi wassalam in transmitting revelation

Introducing the “Approach to Unwell Children Under 5” (ATUCU5) Manual into the Undergraduate Medical Education

The new ATUCU5 manual provides a holistic strategy in the case management of common childhood illnesses in primary care settings. It was developed by the Ministry of Health Malaysia and the World Health Organization to reduce preventable deaths due to substandard care from the conventional “single-condition approach”. We aim to introduce the ATUCU5 manual to undergraduate medical students during the remote teaching and learning (RTL) period and describe their understanding