Temporality and Information Work in Bone Marrow Transplant.

Time is a defining feature of chronic illness. In the context of allogeneic bone marrow transplant (BMT), which involves a long-term process that requires close monitoring of patients by BMT specialists for at least one year, this ethnographic study investigates the ways in which the illness trajectory is experienced and envisioned by the patients, caregivers, and clinicians from a temporal perspective. In addition, the study examines the effects of temporal perspectives on how the patients and caregivers gain new knowledge and skills through scaffolding – co-constructed information work where the learning process involves the guidance of clinicians – to effectively and comfortably manage care as the illness trajectory unfolds. Findings indicate that misalignments exist between the temporal perspectives of the different participants in the care process, with implications for the information work. There are four key areas in which scaffolding is essential, and in part amenable to temporal organization: disease and treatment scaffolding, institutional scaffolding, scaffolding on managing social interactions, and emotional scaffolding. A key factor has to do with the patients, caregivers, and clinicians providing, receiving, processing, and responding to information when it is practically germane, that is information-in-time.PhDInformationUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/111491/1/abuyuktu_1.pd

Estradiol and its metabolites and their association with knee osteoarthritis

Objective To determine if levels of endogenous estrogen or estrogen metabolites are associated with an increased risk of developing knee osteoarthritis (OA) in women. Methods Serum estradiol (E 2 ) and 2 urinary estrogen metabolites (2-hydroxyestrone and 16Α-hydroxyestrone) with radiographically defined prevalent and incident knee OA in 842 white and African American women from the Southeast Michigan Arthritis Cohort. Results The mean age and body mass index (BMI) of women in the cohort were 42.3 years and 28.5 kg/m 2 , respectively. Women who developed radiographically defined knee OA had significantly greater odds of having baseline endogenous early follicular phase estradiol concentrations in the lowest tertile (0.86; OR 1.86, 95% CI 1.01–3.44 compared with women with ratios in the 0.54–0.86 range), after adjustment for other covariates. Conclusion There were significant associations of lower baseline serum estradiol and urinary 2-hydroxyestrone with developing knee OA in middle-aged women.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/55806/1/22005_ftp.pd

Transition and Reflection in the Use of Health Information: The Case of Pediatric Bone Marrow Transplant Caregivers

ABSTRACT The impact of health information on caregivers is of increasing interest to HCI/CSCW in designing systems to support the social and emotional dimensions of managing health. Drawing on an interview study, as well as corroborating data including a multi-year ethnography, we detail the practices of caregivers (particularly parents) in a bone marrow transplant (BMT) center. We examine the interconnections between information and emotion work performed by caregivers through a liminal lens, highlighting the BMT experience as a time of transition and reflection in which caregivers must quickly adapt to the new social world of the hospital and learn to manage a wide range of patient needs. The transition from parent to 'caregiver' is challenging, placing additional emotional burdens on the intensive information work for managing BMT. As a time of reflection, the BMT experience also provides an occasion for generative thinking and alternative approaches to health management. Our study findings call for health systems that reflect a design paradigm focused on 'transforming lives' rather than 'transferring information.' Autho