Hanging with the ‘The Chronics’ Online: Autopathography and Narrative Associations in an Online Support Group for Chronic Lymphocytic Leukemia

This paper forms part of the digitally archived conference proceedings from the Understanding Chronicity Conference at Mansfield College, Oxford University in August, 2012. Presenting early findings from a two year project mapping narrative engagement, mediation and translation in online networks of chronic lymphocytic leukemia patients and carers, the study explores a range of narrative forms online including multi-media patient stories, medical research papers, and clinical test results. The work triangulates autopathography with observations drawn from around 300 consenting CLL patients globally to map current issues for this patient group and their carers, illuminating the evolving phenomenon of e-patienthood in a rapidly evolving biomedical environment. An actor network approach facilitates mapping of complex scientific research papers, laboratory test results, and the political economy of contemporary medicine intersect with patient stories, observation and advice across multi-media platforms online. The paper outlines key emerging sites in the current landscape of CLL patients, and considers how they extrapolate to chronic illness experience generally in a digital era. Finally, the work addresses creative ethical approaches to the presentation of complex assemblages of data reflecting the multiplicity of texts and experiences involved in understanding, and living with disease. The work’s emphasis on the ways in which patient-connectedness is replacing patient centredness has been picked up by a significant contributor to the study of medical humanities and cited with attributions in a forthcoming major textbook on the subject, currently in publication. Early findings have contributed to the re-design of the website of a major leukemia support site. Several major support sites globally have expressed interest in the work, and have requested to contribute their perspectives to what will be the largest scale work on CLL of its type to date, and a significant contribution to actor network methodologies and an understanding of disease experience in the digital age

In Our Blood: Mapping Narrative Enactments of Leukaemia Online

Often externally invisible, and currently considered incurable, chronic lymphocytic leukaemia (CLL) presents with variable progression outcomes from indolent, through actively progressive, to terminal in some cases. Diagnosed with CLL myself, and having learned much of what I know about my disease online, this virtual ethnography triangulates autopathographic narrative with object oriented philosophies to map digital narrative circulations relating to the disease. Observing that key CLL online support sites function as hubs within complex networks connecting through to a variety of narrative enactments of CLL, this thesis draws on Actor-Network-Theory (ANT) throughout to explore and explain these narrative phenomena. The work shows that stories relating to CLL circulate in differing forms across networks peopled with varied actors (both human and non-human artefacts), key among which is the informed, connected and empowered ‘e-patient’. These digital actors mobilize a wealth of information from translations of the complex evolving science pushing the boundaries of biomedical understanding and treatment, to sharing the daily effects of living with a cancer whose sufferers record exceptionally low emotional well-being. By exploring the intersection of circulating narratives of a single disease online from a perspective of their material rather than representational effects, I locate them as inscriptions of the practices enacted by the individuals, organizations and institutions producing and putting them into circulation. In doing so, I argue that this study successfully puts into practice an innovative approach for studying disease and its narrative performances in online support and knowledge exchange networks, revealing complex networks of intersections among the multiple narrative inscriptions of CLL online. The work identifies some of the key actors and narratives engaged in that process, demonstrating some of the network effects produced when they come together. Notable among the multiple effects generated through these complex assemblages of collaborative narrative circulation in online communities are changing patterns of knowledge exchange in clinical relationships, an over-arching potential for a variety of forms of patient empowerment, and the emergence of new open and generative forms of digital pathographies

PELATIHAN PEMBUATAN HAND SANITIZER DENGAN PENAMBAHAN LEMON SEBAGAI PEWANGI ALAMI PADA MASYARAKAT KECAMATAN MEDAN TIMUR

Cairan   penyanitasi   tangan   (handsanitizer) adalah  cairan  yang  berisikan  bahan-bahan  yang dapat membunuh mikroorganisme dengan cepat. Panyanitasi   tangan   adalah   solusi   saat   tidak ditemukan  tempat  cuci  tangan,  sehingga  dapat menjadi  pengganti  untuk membebaskantangan dari    mikroorganisme. Buah lemon merupakan tanaman yang memiliki manfaat sebagai antioksidan alami karena memiliki kandungan vitamin C, asam sitrat, minyak atsiri, bioflavonoid, polifenol, kumarin, flavonoid, dan minyak-minyak volatil pada kulitnya seperti limonen (±70%), α-terpinen, α-pinen, β-pinen, serta kumarin, dan polifenol (Nizhar, 2012). Tujuan dari kegiatan ini adalah memberikan informasi dan pengenalan pemanfaatan lemon sebagai hand sanitizer sebagai pswzzewangi alami, Kegiatan ini dilaksanakan di kabupaten Langkat. Hasil pelaksanaan ini kepada masyarakat dalam bentuk informasi dan cara pembuatan hand sanitizer cair berbahan alam. Setelah melaksanakan kegiatan ini masyarakat lebih mengetahui cara pembuatan hand sanitizer berbahan alam

Cryogenic cold war : closing the thermal conductivity gap

A critical analysis of published thermal conductivity data is presented which highlights failures in data extrapolation, unexplained sudden drops in previously observed material data sets and the clarity of equipment design. Thermal conductivity measurements on a range of materials were performed using a Gifford-McMahon cryostat with the aim of consolidating current information on thermal properties as well as collecting data on new materials executed from 3 K to 30 K using the steady state method. The ability of the cryostat to accurately cycle between desired temperatures was verified and used for thermal stability tests of materials for the Mid-Infrared Instrument to be launched on the James Webb Space Telescope. Test undertaken on the electrical resistivity of aluminium foam were used to confirm the accuracy of the system. For steady state measurements of samples, the temperature across a known thickness of material was varied using a resistor heater of known power permitting the calculation of the thermal conductivity. The robustness of the system up to 20 K was shown using a Stainless Steel 316 sample, which agreed with expectations at the 2.1% level. The thermal conductivity of boron-doped silicon was measured, specifically looking at the conductivity across a hydroxide-catalysis bond. Such bonded silicon and silicate bonds are integral to the ongoing research for the next generation of gravitational wave detectors. The thermal conductivity of p-type boron-doped silicon was shown to increase form 24.06 - 46.44W/mK over the 4 -19 K temperature range. The improvement in the design features of cryogenic systems outlined are being implemented in labs at the University of Glasgow. The experimental setup developed during the course of this PhD project will also be used for data collection for medical diagnostic equipment

Photocatalytic reforming for hydrogen production using metal/TiO2

The aim of this study was to develop photocatalysts which are active for the production of hydrogen from water and to further understanding of the factors involved in promoting the reaction. Different metals were loaded onto titania and used as photocatalysts for photocatalytic methanol reforming for hydrogen production. The catalysts were characterised using XPS and TPR to understand what produced highly active catalyst. The main factors influencing the catalysts were found to be the ease of reducibility and the work function of the metal used. Pt/TiO2 was the most active of the catalysts tested for photocatalytic methanol reforming. This was attributed to the fact that platinum oxide is easily reduced to platinum metal. Platinum also has a high work function and it was concluded that this property allows better charge transfer and longer charge separation due to a Schottky barrier. Different sacrificial agents with varying numbers of hydroxyl species were tested for photocatalytic hydrogen production. Alcohols, polyols, cyclo-alcohols and carboxylic acids were investigated. A relationship between the number of hydroxyl groups and hydrogen yield was established. The formula suggested for this was 2n+1 = number of moles of hydrogen, where n = number of C-OH groups. The best sacrificial agent was found to be xylitol as it has five C-OH groups and it fully decomposes to carbon dioxide and hydrogen. TiO2 was synthesised using a sol-gel preparation method in an attempt to produce active photocatalysts for photocatalytic methanol reforming for hydrogen production. The phases of TiO2 produced via this method were found to be anatase and brookite. The catalysts with more brookite were found to be more active. The study also highlighted the importance of crystallinity and surface area. The Turkevich method of producing gold nanoparticles was used to produce Au/TiO2. This method produced a more active catalyst than the incipient wetness Au/TiO2 and also emphasized the importance of removal of stabilising agents

Learning and spatial memory in Ruby-throated Hummingbird (Archilochus colubris)

General EcologyHummingbirds have the highest mass specific metabolism of any known vertebrate.These small birds arc also known lo fly extraordinary distances during migration. As a result ofthese pressures, hummingbirds require an incredible amount of energy. It is therefore imperativethat hummingbirds quickly learn and remember the locations of high energy food sources. Thepurpose of this study was to observe the learning period and spatial memory exhibited byRuby-throated Hummingbirds (Archilochus colubris). An additional objective was to identifyand understand the cues used by the birds to find the energetically rewarding feeders. It waspredicted that hummingbirds would primarily use spatial memory to find high-energy foodsources. The results suggest Ruby-throated Hummingbirds have a learning period of about onehour and that they may use multiple senses to efficiently find food sources.https://deepblue.lib.umich.edu/bitstream/2027.42/143557/1/Ginsburg_Kennedy_Onsi_Strobel_Weiss_2017.PD

Service delivery interventions to increase uptake of voluntary medical male circumcision for HIV prevention: A systematic review.

BackgroundVoluntary medical male circumcision (VMMC) remains an essential component of combination HIV prevention services, particularly in priority countries in sub-Saharan Africa. As VMMC programs seek to maximize impact and efficiency, and to support World Health Organization guidance, specific uptake-enhancing strategies are critical to identify.MethodsWe systematically reviewed the literature to evaluate the impact of service delivery interventions (e.g., facility layout, service co-location, mobile outreach) on VMMC uptake among adolescent and adult men. For the main effectiveness review, we searched for publications or conference abstracts that measured VMMC uptake or uptake of HIV testing or risk reduction counselling within VMMC services. We synthesized data by coding categories and outcomes. We also reviewed studies assessing acceptability, values/preferences, costs, and feasibility.ResultsFour randomized controlled trials and five observational studies were included in the effectiveness review. Studies took place in South Africa, Tanzania, Uganda, Zambia, and Zimbabwe. They assessed a range of service delivery innovations, including community-, school-, and facility-based interventions. Overall, interventions increased VMMC uptake; some successfully improved uptake among age-specific subpopulations, but urban-rural stratification showed no clear trends. Interventions that increased adult men's uptake included mobile services (compared to static facilities), home-based testing with active referral follow-up, and facility-based HIV testing with enhanced comprehensive sexual education. Six acceptability studies suggested interventions were generally perceived to help men choose to get circumcised. Eleven cost studies suggested interventions create economies-of-scale and efficiencies. Three studies suggested such interventions were feasible, improving facility preparedness, service quality and quantity, and efficiencies.ConclusionsInnovative changes in male-centered VMMC services can improve adult men's and adolescent boys' VMMC uptake. Limited evidence on interventions that enhance access and acceptability show promising results, but evidence gaps persist due to inconsistent intervention definition and delivery, due in part to contextual relevance and limited age disaggregation

Economic compensation interventions to increase uptake of voluntary medical male circumcision for HIV prevention: A systematic review and meta-analysis.

BackgroundEconomic compensation interventions may help support higher voluntary medical male circumcision (VMMC) coverage in priority sub-Saharan African countries. To inform World Health Organization guidelines, we conducted a systematic review of economic compensation interventions to increase VMMC uptake.MethodsEconomic compensation interventions were defined as providing money or in-kind compensation, reimbursement for associated costs (e.g. travel, lost wages), or lottery entry. We searched five electronic databases and four scientific conferences for studies examining the impact of such interventions on VMMC uptake, HIV testing and safer-sex/risk-reduction counseling uptake within VMMC, community expectations about compensation, and potential coercion. We screened citations, extracted data, and assessed risk of bias in duplicate. We conducted random-effects meta-analysis. We also reviewed studies examining acceptability, values/preferences, costs, and feasibility.ResultsOf 2484 citations identified, five randomized controlled trials (RCTs) and three non-randomized controlled trials met our eligibility criteria. Studies took place in Kenya, Malawi, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe. Meta-analysis of four RCTs showed significant impact of any economic compensation on VMMC uptake (relative risk: 5.23, 95% CI: 3.13 to 8.76). RCTs of food/transport vouchers and conditional cash transfers generally showed increases in VMMC uptake, but lotteries, subsidized VMMC, and receiving a gift appeared somewhat less effective. Three non-randomized trials showed mixed impact. Six additional studies suggested economic compensation interventions were generally acceptable, valued for addressing key barriers, and motivating to men. However, some participants felt they were insufficiently motivating or necessary; one study suggested they might raise community suspicions. One study from South Africa found a program cost of US$91 per additional circumcision and US$450-$1350 per HIV infection averted.ConclusionsEconomic compensation interventions, particularly transport/food vouchers, positively impacted VMMC uptake among adult men and were generally acceptable to potential clients. Carefully selected economic interventions may be a useful targeted strategy to enhance VMMC coverage

Food Insecurity During Childhood: Understanding Persistence and Change Using Linked Current Population Survey Data

Our paper examines the prevalence and determinants of children’s transitions into and out of food insecurity since 2001. We use longitudinally linked data from the Food Security Supplements to the Current Population Surveys to estimate one-year transition probabilities of entry and exit from food insecurity. Our results indicate that child hunger is typically short-lived, but children experiencing very low food security frequently experience multiple consecutive years of food insecurity. We demonstrate large demographic and socioeconomic differences in rates of entry into very low food security and persistence in children\u27s food insecurity. Income and employment shocks are important predictors of child hunger transitions. Finally, we find that the Great Recession increased the likelihood that children entered into and persisted in food insecurity among children