Sickness experience and language : aspects of Tongan and Western accounting

In this study of Tongan healing practices, the author has chosen not simply to record participants’ roles or medicinal preparations but rather, the concern of this study is to understand the ‘doing’ of sickness as a social practice. Two main sociological techniques have been applied. Firstly, a hermeneutic - phenomenological approach was used to attain recordings of, and to analyze, the sickness theorizing of members of Tongan society. The ‘sickness talk’ of these members provides a record of some aspects of contemporary Tongan healing practices. The ‘sickness talk’ is also analyzed using Wittgenstein’s concept of ‘rule-usage’ in the ‘language game’ of sickness. This form of analysis indicated certain individual and public relevances which are grounded upon the Tongan way of life. Thus speakers’ accounts are analyzed in terms of what sickness talk ‘shows’ as well as what it ‘says’, disclosing cultural process instead of simply cultural product. Discussion on ‘diagnosis’ shows that in order to define the problematic situation of sickness, the phenomena are organized into a classification, that is, members have to ‘capture’, ‘fix’, ‘concretize’ the confronting transient phenomena and apply a sickness label as a ‘working definition’. Tongan sickness ‘types’ are shown to be not only different from Western ‘types’, but aspects of the process of constructing that difference are also shown to be implicit in the sickness talk. Diagnosis as a social process is not seen as the labelling of an ‘objective fact’, ‘a sickness’; nor is therapy understood as being some ‘thing’ that gets a person ‘better’. Tongan explanatory models, developed to explain sickness causation, differ essentially from Western explanatory models of sickness in that Tongans have developed a social model of prevention and cure while in the West, a biological model has been developed. Explanation is understood here not as the causal accounting of sickness but as the explanation of enigmatic consequences. The latter sections of the study on doing sickness as ‘kinship’ and as ‘healer’ not only add to the record on contemporary healing practices but also emphasize the Tongan social model of sickness. This study therefore, is not only a record, albeit a partial one, of contemporary Tongan healing practices, it also shows how these particular Tongans define certain sickness situations and devise a strategy to resolve that problematic situation. That is, it shows how committing certain experiences to language ‘is’ the ordering process. Rather than any magico-religious or scientific-biological model providing the basis of sickness practice in Tongan society, kinship is proposed as the underlying organizing principle. The comparative mode of analysis, in relation to Tongan and Western sickness theorizing, avoids presenting Western explanation as a model by which Tongan theorizing can be evaluated. Instead, in analyzing Tongan healing practices showing knowledge and relevance(s), substantive dimensions of Western theorizing and practice are disclosed. In selecting a limited number of members’ sickness accounts over a period of six and a half months in Tonga, I have not attempted to randomly sample the Tongan population in order to generalize my ‘findings’ to the whole of Tongan society. Instead my interest has been to give an interpretation of some aspects of Tongan sickness theorizing which may or may not be altered by similar and more extensive studies in the future. Contrary to what may be seen as being medical and anthropological expectations, Tongan traditional healing practices have not declined since Western contact, rather, they have developed from reportedly limited skills at that time, to an extensive network of healing practice today

Hyperpycnal wave-modified turbidites of the Pennsylvanian Minturn Formation, north-central Colorado

The Pennsylvanian Minturn Formation in north-central Colorado exhibits a complex stratigraphic architecture of fan-delta deposits that developed in association with high topographic relief in a tectonically active setting. The formation records a wide range of environments including alluvial fan, fluvial, deltaic, and open marine settings. This field trip will examine outcrops of a remarkable ~20 to 35-m-thick, unconformity-bound unit with turbidite-like beds that presumably developed within the lower reaches of incised valleys. This unit consists of dark green shale and graded sandstone beds with tool marks produced by abundant plant material. The sandstone event beds contain evidence for strong unidirectional flows and the variable influence of storm-generated waves. Proximal deposits contain beds with evidence for wave-dominated combined flows, including well developed, large-scale hummocky cross-stratification. Distal sections contain beds with reverse-to-normal grading and vertical successions of sedimentary structures that indicate long-lived waxing-to-waning unidirectional flows in conjunction with storm waves. We interpret these beds as a record of deposition from hyperpycnal flows, i.e., turbidity currents generated directly from highly concentrated river plumes, which waxed and waned in response to the rising and falling flood hydrograph. The focus of this trip will be the hydrodynamic interpretation of these different bed types, including their spatial and stratigraphic distribution

Impacts of Leisure Activity Noise Levels A Revised Case Study

An article originally published in the International Journal of Industrial Ergonomics in 1991 discussed the effects of damaging noise levels exposed during the leisure time of industrial workers. With a noise level change preferences, this study was designed to work in collaboration with a 2013 study (Claire Drummond, 2013) which began the groundwork of measuring and examining the consistency of the data collected in 1990. Attributed to an increase in popularity of electronic music and improved digital sound equipment, indoor leisure environment sound levels have increased since the original study. The purpose of this study is to expand the collection of data on exposure levels in current leisure activities reported in the 2012 study to enhance the statistical significance that levels are indeed higher than the noise level preferences and tolerances specified by the Occupational Health and Safety Administration (OSHA) and International Standards Organization (ISO) guidelines. With strenuous legal standards, industries have taken substantial steps to follow the OSHA and ISO recommended guidelines; however, places of leisure such as bars, movie theaters, churches, and sporting events are not required to adhere to the same standards. The noise data was collected using a Quest SPL (2800) calibrated dosimeter. This device is a great improvement from the GenRad Sound Level Meter originally used in the 1990 study for the fact that the Quest SPL (2800) gives a complete printout at the end of a data run that takes in account the duration and average dose of noise exposure run as well as average and peak noise levels. The GenRad device was limited to measuring low and high noise level readings. Average leisure noise levels by category were as follows: peak levels in a sample of thirty-nine leisure activities: churches and concerts (118.06 dB (σ = 2.62 dB)), bars (117.48 dB (σ = 9.32 dB)), and sporting events (122.99 dB (σ = 10.97 dB)). Following the OSHA and ISO standards, any exposure noise level over 115.00dB exceeds the recommended allowance. Adult industrial workers exposing themselves to these levels after an eight hour workday in an OSHA-controlled environment are exceeding the allowable exposure. Industrial business are spending large sums of money to make sure they are in compliance with OSHA standards yet their employees are potentially permanently damaging hearing due to their choice of leisure activity. These individuals are thus increasing their risk of a permanent threshold shift. As a side observation to the adult exposures, many parents had their children under the age of 4 in attendance at the high level peak level leisure activities. Hearing is fully developed at birth, but extended exposure times to high peak noise levels can cause an earlier permanent threshold shift in children or permanent hearing loss at a younger age

A plain language summary of what clinical studies can tell us about the safety of evobrutinib – a potential treatment for multiple sclerosis

Immunology; Rheumatology; Systemic lupus erythematosusInmunología; Reumatología; Lupus eritematoso sistémicoImmunologia; Reumatologia; Lupus eritematós sistèmicWhat is this summary about?: This summary explains the findings from a recent investigation that combined the results of over 1000 people from three clinical studies to understand the safety of evobrutinib. Evobrutinib is an oral medication (taken by mouth), being researched as a potential treatment for multiple sclerosis (MS). This medication was also investigated in rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Over 1000 people have taken evobrutinib as part of three separate phase 2 clinical studies. These studies looked at how much of the drug should be taken, how safe the drug is, and how well it might work for treating a certain medical condition. What were the results?: Evobrutinib was well-tolerated by participants in all three studies. The number of side effects reported by participants taking the medication was very similar to those reported by participants taking the placebo (a 'dummy' treatment without a real drug). The most common side effects in clinical studies were urinary tract infections, headache, swelling of the nose and throat, diarrhoea and blood markers of potential liver damage (these returned to normal once the treatment was stopped). What do the results mean?: The safety data from all three clinical studies are encouraging and can be used to inform further research into using evobrutinib in MS.X Montalban has received speaking honoraria and travel expenses for participation in scientific meetings, has been a steering committee member of clinical trials or participated in advisory boards of clinical trials in the past years with Abbvie, Actelion, Alexion, Biogen, Bristol-Myers Squibb/Celgene, EMD Serono, Genzyme, Hoffmann-La Roche, Immunic, Janssen Pharmaceuticals, Medday, Merck, Mylan, Nervgen, Novartis, Sandoz, Sanofi-Genzyme, Teva Pharmaceutical, TG Therapeutics, Excemed, MSIF and NMSS. D Wallace has received consultant fees from Amgen, Celgene, Eli Lilly, EMD Serono Research & Development Institute, Inc., Billerica, MA, USA (an affiliate of Merck KGaA), Janssen and Merck. MC Genovese is an employee of and has financial interests in Gilead. D Tomic is an employee of Ares Trading SA, Eysins, Switzerland, an affiliate of Merck KGaA, and received stock or an ownership interest from Novartis. D Parsons-Rich was an employee of EMD Serono Research & Development Institute, Inc., Billerica, MA, USA, an affiliate of Merck KGaA, at the time of the study, and is currently an employee of and has received stock from Pfizer. C Le Bolay and H Guehring are employees of Merck Healthcare KGaA, Darmstadt, Germany. A Kao is an employee of and received stock or an ownership interest from EMD Serono Inc., Billerica, MA, USA, a healthcare business of Merck KGaA. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: this work was supported by Merck (CrossRef Funder ID: 10.13039/100009945). This summary was prepared by Lumanity on behalf of, and funded by, Merck KGaA, Darmstadt, Germany

Potential of multi-species livestock farming to improve the sustainability of livestock farms: A review.

Diversified farming systems are proposed as a major mechanism to address the many sustainability issues of today's agriculture. Multi-species livestock farming, i.e. keeping two or more animal species simultaneously on the same farm, is an option that has received little attention to date. Moreover, most studies of multi-species livestock farming are limited, usually focusing on selected dimensions of farm sustainability and addressing lower organizational levels (i.e. within the farm) and rather limited time horizons (e.g. a few weeks in a grazing season). Thus, a comprehensive assessment of multi-species livestock farming in terms of farm sustainability is lacking. In this context, we outline and discuss potential benefits and limitations of multi-species livestock farming for livestock farm sustainability from existing literature and list issues on multi-species livestock farming requiring further research. We show that multi-species livestock farming has the potential to improve the three dimensions of sustainability reviewed - economic viability for farmers, environmental soundness and social acceptability by being respectful of animals and humans - as long as locally relevant farming practices are implemented, especially an appropriate stocking rate during grazing. If relevant practices are not observed, multi-species livestock farming may produce undesirable effects, such as competition for resource acquisition during grazing, parasitic cross-infection and more intense work peaks. Therefore, we identify four focal research areas for multi-species livestock farming. First, characterizing the management of multi-species livestock farms. To do this, we suggest considering the integration of production enterprises (e.g. cattle and sheep enterprises) within the farm from three perspectives: farming practices (e.g. grazing management), work organization and sales. Second, exploring the complementarity of livestock species on multi-species livestock farms. This is especially true for species combinations that have been largely ignored (e.g. ruminants and monogastrics), even though they may have potential due to complementary diet compositions and resource-acquisition strategies. Third, assessing the sustainability of multi-species livestock farm scenarios (current or alternative) according to the management practices and production conditions, which requires adapting existing methods/models or developing new ones. Fourth, characterizing conditions for success and obstacles for multi-species livestock farming along the value chain from production to consumption, considering stakeholders' objectives, work habits and constraints. Increasing understanding should help prioritize actions and organize them to scale up multi-species livestock farming

A sweeter way of teaching health and safety

The underpinning educational theory for practical work is that of experimental learning or 'learning by and through doing'. Hands-on practical work promotes learning as it provides students with an opportunity to put theory into practice. There are many hazards with practical work, each with an associated risk that students will encounter while they are working in the laboratory and, therefore, adequate instruction should be given before students carry out any practical work. Getting students to engage with this in the past has been difficult due to the dryness of the material. Here we show how every students sweet tooth can be used to teach them risk assessment, experimental design and embedding health and safety as part of their scientific culture

The use of magnetic resonance imaging (MRI) of the knee in current clinical practice: a retrospective evaluation of the MRI reports within a large NHS trust

Background: Magnetic resonance imaging (MRI) is one of the most widely used investigations for knee pain as it provides detailed assessment of the bone and soft tissues. The aim of this study is to report the frequency of each diagnosis identified on MRI scans of the knee and explore the relationship between MRI results and onward treatment. Methods: Consecutive MRI reports from a large NHS trust performed in 2017 were included in this study. The hospital electronic system was consulted to identify whether a patient underwent x-ray prior to the MRI, attended an outpatient appointment or underwent surgery. Results: 4466 MRI knees were performed in 2017 with 71.2% requested in primary care and 28.1% requested in secondary care. The most common diagnosis was signs of arthritis (55.2%), followed by meniscal tears (42.8%) and ACL tears (8.3%). 49.4% of patients who had an MRI attended outpatients and 15.6% underwent surgery. The rate of knee surgery was significantly higher for patients who had their scans requested in secondary care (32.9% vs 8.9%, p < 0.001). Conclusion: The rate of surgical intervention following MRI is low and given these results it seems unlikely that the scan changes practice in most cases. The rate of surgery and outpatient follow up was significantly higher in scans requested by secondary care. We urge clinicians avoid wasteful use of MRI and recommend the use of plain radiography prior to MRI where arthritis may be present

DNA from Fingerprints: Attempting Dual Recovery

DNA and Fingerprints are highly prioritised evidence types as they are considered reliable when distinguishing between individuals within a population. Attempts have been documented on recovering both forms of evidence from a single source, but were met with varying success. These studies have however highlighted issues concerning interferences resulting from the methods used to either recover or visualise, with a significant issue lying with contamination or destruction of the DNA by fingerprint enhancement techniques. The aim of the research was to recover DNA prior to enhancement to determine the extent of recovery and damage of both the ridge detail and DNA. Fingerprints were deposited on textured plastic, carrier bags, glass, stainless steel and paper. DNA was recovered by the use of nylon flocked swabs (CopanTM), minitapes (ScenesafeTM) or gelatine lifts (Crime Scene Investigation LimitedTM). Extraction was conducted with QIAmp DNA micro kitTM (QIAGEN®), with Qubit® fluorometry being used for DNA quantification and NGM SelectTM (AmpFISTR®) determining the quality. For fingerprint enhancement; cyanoacrylate, aluminium powder and DFO were used to visualise the prints which were scored using the Centre of Applied Science and Technology (CAST) grading scheme. The gelatine lifts displayed higher detectable levels of DNA along with recovering more donor alleles. The lifts also resulted in the least amount of damage to ridge detail. Minitapes followed in both DNA levels and ridge damage. The nylons swabs displayed a low affinity for collecting DNA while removing all traces of the fingerprints

Emergency ambulance service involvement with residential care homes in the support of older people with dementia : an observational study

© 2014 Amador et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.BACKGROUND: Older people resident in care homes have a limited life expectancy and approximately two-thirds have limited mental capacity. Despite initiatives to reduce unplanned hospital admissions for this population, little is known about the involvement of emergency services in supporting residents in these settings.METHODS: This paper reports on a longitudinal study that tracked the involvement of emergency ambulance personnel in the support of older people with dementia, resident in care homes with no on-site nursing providing personal care only. 133 residents with dementia across 6 care homes in the East of England were tracked for a year. The paper examines the frequency and reasons for emergency ambulance call-outs, outcomes and factors associated with emergency ambulance service use. RESULTS: 56% of residents used ambulance services. Less than half (43%) of all call-outs resulted in an unscheduled admission to hospital. In addition to trauma following a following a fall in the home, results suggest that at least a reasonable proportion of ambulance contacts are for ambulatory care sensitive conditions. An emergency ambulance is not likely to be called for older rather than younger residents or for women more than men. Length of residence does not influence use of emergency ambulance services among older people with dementia. Contact with primary care services and admission route into the care home were both significantly associated with emergency ambulance service use. The odds of using emergency ambulance services for residents admitted from a relative's home were 90% lower than the odds of using emergency ambulance services for residents admitted from their own home. CONCLUSIONS: Emergency service involvement with this vulnerable population merits further examination. Future research on emergency ambulance service use by older people with dementia in care homes, should account for important contextual factors, namely, presence or absence of on-site nursing, GP involvement, and access to residents' family, alongside resident health characteristics.Peer reviewedFinal Published versio

Characterisation of the safety profile of evobrutinib in over 1000 patients from phase II clinical trials in multiple sclerosis, rheumatoid arthritis and systemic lupus erythematosus: an integrated safety analysis

Immunology; Multiple sclerosis; RheumatologyInmunología; Esclerosis múltiple; ReumatologíaImmunologia; Esclerosi múltiple; ReumatologiaObjective Analyse the integrated safety profile of evobrutinib, a Bruton’s tyrosine kinase inhibitor (BTKi), using pooled data from multiple sclerosis (MS), rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) trials. Methods Phase II, randomised, double-blind, placebo-controlled trial data were analysed (N=1083; MS: n=213, 48 weeks (W); RA: n=390, 12W; SLE: n=480, 52W). The analysis included all patients who received ≥1 dose of evobrutinib (25 mg or 75 mg once daily, or 50 mg or 75 mgtwice daily) or placebo. Descriptive statistics and exposure-adjusted incidence rates (EAIR) were used to report treatment-emergent adverse events (TEAEs). Results Data from 1083 patients were pooled: evobrutinib, n=861; placebo, n=271 (sum >1083 due to MS trial design: n=49 received both placebo (W0–24) and evobrutinib 25 mg (W25–48)); median follow-up time (pt-years): evobrutinib, 0.501; placebo, 0.463. Across indications, the proportion of patients with TEAEs and the EAIR were similar for evobrutinib and placebo (66.2% (247.6 events/100 pt-years) vs 62.4% (261.4 events/100 pt-years)). By indication, the EAIR (events/100 pt-years) of TEAEs for evobrutinib versus placebo were: MS: 119.7 vs 148.3; RA: 331.8 vs 306.8; SLE: 343.0 vs 302.1. Two fatal events occurred (in SLE). The serious infections EAIR was 2.7 and 2.1 events/100 pt-years for evobrutinib and placebo. For previously reported BTKi-class effects, the EAIR of transient elevated alanine aminotransferase/aspartate aminotransferase TEAEs (events/100 pt-years) with evobrutinib versus placebo was 4.8 vs 2.8/3.5 vs 0.7, respectively. IgG levels were similar in evobrutinib/placebo-treated patients. Conclusions This is the first BTKi-integrated safety analysis that includes patients with MS. Overall, evobrutinib treatment (all doses) was generally well tolerated across indications.The trial was sponsored by Merck Healthcare KGaA (CrossRef Funder ID: 10.13039/100009945)