A ‘healthy baby’: The double imperative of preimplantation genetic diagnosis

This is the author's accepted manuscript. The final published article is available from the link below. Copyright @ 2010 The Authors.This article reports from a study exploring the social processes, meanings and institutions that frame and produce ‘ethical problems’ and clinical dilemmas for practitioners, scientists and others working in the specialty of preimplantation genetic diagnosis (PGD). A major topic in the data was that, in contrast to IVF, the aim of PGD is to transfer to the woman’s womb only those embryos likely to be unaffected by serious genetic disorders; that is, to produce ‘healthy babies’. Staff described the complex processes through which embryos in each treatment cycle must meet a double imperative: they must be judged viable by embryologists and ‘unaffected’ by geneticists. In this article, we focus on some of the ethical, social and occupational issues for staff ensuing from PGD’s double imperative.The Wellcome Trus

Hepatitis B and C co-Infection are independent predictors of progressive kidney disease in HIV-positive, antiretroviral-treated adults

Chronic kidney disease (CKD) is an important cause of morbidity and mortality in HIV-positive individuals. Hepatitis C (HCV) co-infection has been associated with increased risk of CKD, but prior studies lack information on potential mechanisms. We evaluated the association between HCV or hepatitis B (HBV) co-infection and progressive CKD among 3,441 antiretroviral-treated clinical trial participants. Progressive CKD was defined as the composite of end-stage renal disease, renal death, or significant glomerular filtration rate (eGFR) decline (25% decline to eGFR 800,000 IU/ml had increased odds (OR 3.07; 95% CI 1.60–5.90). Interleukin-6, hyaluronic acid, and the FIB-4 hepatic fibrosis index were higher among participants who developed progressive CKD, but were no longer associated with progressive CKD after adjustment. Future studies should validate the relationship between HCV viremia and CKD

Accuracy of diabetes screening methods used for people with tuberculosis, Indonesia, Peru, Romania, South Africa

Objective To evaluate the performance of diagnostic tools for diabetes mellitus, including laboratory methods and clinical risk scores, in newly-diagnosed pulmonary tuberculosis patients from four middle-income countries. Methods In a multicentre, prospective study, we recruited 2185 patients with pulmonary tuberculosis from sites in Indonesia, Peru, Romania and South Africa from January 2014 to September 2016. Using laboratory-measured glycated haemoglobin (HbA1c) as the gold standard, we measured the diagnostic accuracy of random plasma glucose, point-of-care HbA1c, fasting blood glucose, urine dipstick, published and newly derived diabetes mellitus risk scores and anthropometric measurements. We also analysed combinations of tests, including a two-step test using point-of-care HbA1cwhen initial random plasma glucose was ≥ 6.1 mmol/L. Findings The overall crude prevalence of diabetes mellitus among newly diagnosed tuberculosis patients was 283/2185 (13.0%; 95% confidence interval, CI: 11.6–14.4). The marker with the best diagnostic accuracy was point-of-care HbA1c (area under receiver operating characteristic curve: 0.81; 95% CI: 0.75–0.86). A risk score derived using age, point-of-care HbA1c and random plasma glucose had the best overall diagnostic accuracy (area under curve: 0.85; 95% CI: 0.81–0.90). There was substantial heterogeneity between sites for all markers, but the two-step combination test performed well in Indonesia and Peru. Conclusion Random plasma glucose followed by point-of-care HbA1c testing can accurately diagnose diabetes in tuberculosis patients, particularly those with substantial hyperglycaemia, while reducing the need for more expensive point-of-care HbA1c testing. Risk scores with or without biochemical data may be useful but require validation

Identity and belonging in social learning groups : the importance of distinguishing social, operational and knowledge-related identity congruence

Collaborative learning has much to offer but not all learners participate fully and peer groups can be exclusive. The paper examines how belonging or 'congruence' in learning groups is related to identities of gender, age, ethnicity and socio-economic status. A study of student experiences of collaborative learning on three different blended learning courses illustrated how learners negotiate identity congruence with peer groups to belong and engage. An analytical framework that distinguishes social, operational and knowledge-related identity congruence has emerged. Contrary to received wisdom, the social aspect appears least important for learner engagement while knowledge-related identity congruence is fundamental. Some of the consequences of identity incongruence, particularly concerning gender and maturity, are discussed and the paper points towards the pedagogies which might enable identities of group members to shift so that collaborative learning can flourish

Governing the governors : a case study of college governance in English further education

This paper addresses the nature of governors in the governance of further education colleges in an English context (1). It explores the complex relationship between governors (people/agency), government (policy/structure) and governance (practice), in a college environment. While recent research has focused on the governance of schooling and higher education there has been little attention paid to the role of governors in the lifelong learning sector. The objective of the paper is to contribute to the debate about the purpose of college governance at a time when the Learning and Skills Council (LSC) commissioning era ends, and new government bodies responsible for further education and training, including local authorities, arrive. The paper analyses the nature of FE governance through the perspectives and experiences of governors, as colleges respond to calls from government for greater improvement and accountability in the sector (LSIS, 2009a). What constitutes creative governance is complex and controversial in the wider framework of regulation and public policy reform (Stoker, 1997; Seddon, 2008). As with other tricky concepts such as leadership, professionalism and learning, college governance is best defined in the contexts, cultures and situations in which it is located. College governance does not operate in a vacuum. It involves governors, chairs, principals, professionals, senior managers, clerks, community, business and wider agencies, including external audit and inspection regimes. Governance also acts as a prism through which national education and training reforms are mediated, at local level. While governing bodies are traditionally associated with the business of FE - steering, setting the tone and style, dealing with finance, funding, audit and procedural matters – they are increasingly being challenged to be more creative and responsive to the wider society. Drawing on a recent case study of six colleges, involving governors and key policy stakeholders, this paper explores FE governance in a fast changing policy environment

The natural history, treatment strategies and clinical outcomes of HIV/HCV coinfection

While the rate of AIDS-related death has declined, as a consequence of the effectiveness of antiviral treatment for HIV, HIV/HCV coinfection and in particular liver-related death (LRD) has assumed increasing importance. This thesis aims to analyse important epidemiological areas of HIV/HCV coinfection to improve the knowledge base of the subject and provide guidance to clinicians in a fast moving area of research. Data for this thesis are from the EuroSIDA study, which is a large multi-centre pan-European prospective observational cohort study with over 18,000 HIV-positive individuals including approaching 5,000 HIV/HCV coinfected individuals. The study was initiated in 1994 and continues to expand and diversify to meet current research needs. Results from the studies included in this thesis have shown that treatment for HIV in coinfected individuals can also have a beneficial effect on the natural course of HCV, with HCV viral load remaining stable over time in those treated for HIV compared with increasing HCV viral load in those not yet treated. The incidence of treatment for HCV has steadily increased in Europe to 4.7 per 100 PYFU in 2010, but remains low with just 25% of eligible patients receiving treatment. LRD accounts for more than a fifth of deaths in this population, with significant liver fibrosis and those triple infected with HBV at increased risk. The 5-year probability of LRD is low for those with F0/F1 fibrosis (2.2%), but increases substantially for those with F2/F3 (10.3%) and F4 (14.0%) fibrosis. With potent new treatments for HCV coming to market, it is clear that while they remain prohibitively expensive they should be targeted at those at the greatest risk of LRD. The prognostic LRD score derived here will help clinicians to make difficult decisions on who should be prioritised for HCV treatment

Bodies, technologies and action possibilities: when is an affordance?

Borrowed from ecological psychology, the concept of affordances is often said to offer the social study of technology a means of re-framing the question of what is, and what is not, ‘social’ about technological artefacts. The concept, many argue, enables us to chart a safe course between the perils of technological determinism and social constructivism. This article questions the sociological adequacy of the concept as conventionally deployed. Drawing on ethnographic work on the ways technological artefacts engage, and are engaged by, disabled bodies, we propose that the ‘affordances’ of technological objects are not reducible to their material constitution but are inextricably bound up with specific, historically situated modes of engagement and ways of life

'Getting people on board': Discursive leadership for consensus building in team meetings

Meetings are increasingly seen as sites where organizing and strategic change take place, but the role of specific discursive strategies and related linguistic-pragmatic and argumentative devices, employed by meeting chairs, is little understood. The purpose of this article is to address the range of behaviours of chairs in business organizations by comparing strategies employed by the same chief executive officer (CEO) in two key meeting genres: regular management team meetings and ‘away-days’. While drawing on research from organization studies on the role of leadership in meetings and studies of language in the workplace from (socio)linguistics and discourse studies, we abductively identified five salient discursive strategies which meeting chairs employ in driving decision making: (1) Bonding; (2) Encouraging; (3) Directing; (4) Modulating; and (5) Re/Committing. We investigate the leadership styles of the CEO in both meeting genres via a multi-level approach using empirical data drawn from meetings of a single management team in a multinational defence corporation. Our key findings are, first, that the chair of the meetings (and leading manager) influences the outcome of the meetings in both negative and positive ways, through the choice of discursive strategies. Second, it becomes apparent that the specific context and related meeting genre mediate participation and the ability of the chair to control interactions within the team. Third, a more hierarchical authoritarian or a more interpersonal egalitarian leadership style can be identified via specific combinations of these five discursive strategies. The article concludes that the egalitarian leadership style increases the likelihood of achieving a durable consensus. Several related avenues for research are outlined

Regional differences in AIDS and non-AIDS related mortality in HIV-positive individuals across Europe and Argentina: the EuroSIDA study

BACKGROUND Differences in access to care and treatment have been reported in Eastern Europe, a region with one of the fastest growing HIV epidemics, compared to the rest of Europe. This analysis aimed to establish whether there are regional differences in the mortality rate of HIV-positive individuals across Europe, and Argentina. METHODS 13,310 individuals under follow-up were included in the analysis. Poisson regression investigated factors associated with the risk of death. FINDINGS During 82,212 person years of follow-up (PYFU) 1,147 individuals died (mortality rate 14.0 per 1,000 PYFU (95% confidence interval [CI] 13.1-14.8). Significant differences between regions were seen in the rate of all-cause, AIDS and non-AIDS related mortality (global p<0.0001 for all three endpoints). Compared to South Europe, after adjusting for baseline demographics, laboratory measurements and treatment, a higher rate of AIDS related mortality was observed in East Europe (IRR 2.90, 95%CI 1.97-4.28, p<.0001), and a higher rate of non-AIDS related mortality in North Europe (IRR 1.51, 95%CI 1.24-1.82, p<.0001). The differences observed in North Europe decreased over calendar-time, in 2009-2011, the higher rate of non-AIDS related mortality was no longer significantly different to South Europe (IRR 1.07, 95%CI 0.66-1.75, p = 0.77). However, in 2009-2011, there remained a higher rate of AIDS-related mortality (IRR 2.41, 95%CI 1.11-5.25, p = 0.02) in East Europe compared to South Europe in adjusted analysis. INTERPRETATIONS There are significant differences in the rate of all-cause mortality among HIV-positive individuals across different regions of Europe and Argentina. Individuals in Eastern Europe had an increased risk of mortality from AIDS related causes and individuals in North Europe had the highest rate of non-AIDS related mortality. These findings are important for understanding and reviewing HIV treatment strategies and policies across the European region

The Rise of the Resilient Local Authority?

The term resilience is increasingly being utilised within the study of public policy to depict how individuals, communities and organisations can adapt, cope, and ‘bounce back’ when faced with external shocks such as climate change, economic recession and cuts in public expenditure. In focussing on the local dimensions of the resilience debate, this article argues that the term can provide useful insights into how the challenges facing local authorities in the UK can be reformulated and reinterpreted. The article also distinguishes between resilience as ‘recovery’ and resilience as ‘transformation’, with the latter's focus on ‘bouncing forward’ from external shocks seen as offering a more radical framework within which the opportunities for local innovation and creativity can be assessed and explained. While also acknowledging some of the weaknesses of the resilience debate, the dangers of conceptual ‘stretching’, and the extent of local vulnerabilities, the article highlights a range of examples where local authorities – and crucially, local communities – have enhanced their adaptive capacity, within existing powers and responsibilities. From this viewpoint, some of the barriers to the development of resilient local government are not insurmountable, and can be overcome by ‘digging deep’ to draw upon existing resources and capabilities, promoting a strategic approach to risk, exhibiting greater ambition and imagination, and creating space for local communities to develop their own resilience