‘I am not someone who gets skin cancer’: Risk, time and malignant melanoma

‘Delay’ is a term used in the cancer literature since the 1930s to describe the period between self-detection of a concerning sign of possible disease and presentation to a health professional. This linguistic choice carries an implication of blame for apparent failure to manage a risk appropriately, drawing attention away from the contemporaneous perspectives of those who respond to suspicious indicators more or less quickly. We present findings from a grounded theory study of accounts given by 45 patients about their slower or quicker journeys to a diagnosis of cutaneous malignant melanoma, a cancer which can ‘hide in plain sight’. There has been little research exploring in qualitative detail patients’ perspectives on their decision-making about what subsequently turn out to have been signs of this most risky of skin cancers. The findings frame referral time-lapses in terms of normalisation of symptoms, sometimes buttressed by reassurance derived from health promotion messages, disconfirmation of patients’ concerns by their general practitioners and prioritisation of other life concerns. We argue that a shared sense of urgency surrounding melanoma self-referral derives from a clinical representation of current knowledge which conceals numerous evidential uncertainties

Improving project processes : best practice case study

This paper describes SPICE (Structure Process Improvement for Construction Enterprises), which is a process improvement framework for construction organizations. SPICE is a five level step by step maturity framework. It assesses an organization's performance against levels of process maturity, identifies their strengths and weaknesses and highlights their improvement priorities. SPICE was developed in close collaboration with the construction industry and tested on real projects. This allowed the framework to take into account practical industrial needs. This paper provides an outline of the SPICE framework. It focuses on a best practice case study of SPICE implementation on a partnering relationship between a major client and a major contractor. The paper details the SPICE assessment and fact finding process. Based on this assessment, it identifies the strengths and weaknesses of the partnering operation and provides specific guidelines for project improvement. Main strengths of the partnering included: 1) close physical proximity of client, design and project management teams; 2) top level commitment to improve productivity; and 3) adoption of manufacturing philosophies and methods in order to deliver improvements. Main weaknesses included: 1) lack of integration between systems and processes of the partnering organizations; 2) presence of cultural and incentive differences between the partnering organizations, which led to fragmentation of the project teams; and 3) little evidence of process evaluation and improvement efforts by the teams. Based on these, some recommendations are made for future improvements

Treatment of type 2 diabetes with the designer cytokine IC7Fc

The gp130 receptor cytokines IL-6 and CNTF improve metabolic homeostasis but have limited therapeutic use for the treatment of type 2 diabetes. Accordingly, we engineered the gp130 ligand IC7Fc, in which one gp130-binding site is removed from IL-6 and replaced with the LIF-receptor-binding site from CNTF, fused with the Fc domain of immunoglobulin G, creating a cytokine with CNTF-like, but IL-6-receptor-dependent, signalling. Here we show that IC7Fc improves glucose tolerance and hyperglycaemia and prevents weight gain and liver steatosis in mice. In addition, IC7Fc either increases, or prevents the loss of, skeletal muscle mass by activation of the transcriptional regulator YAP1. In human-cell-based assays, and in non-human primates, IC7Fc treatment results in no signs of inflammation or immunogenicity. Thus, IC7Fc is a realistic next-generation biological agent for the treatment of type 2 diabetes and muscle atrophy, disorders that are currently pandemic.Maria Findeisen ... Richard L. Young ... et al