Food as medicine: Diet, diabetes management, and the patient in twentieth century Britain.

This is the final version of the article. Available from the publisher via the DOI in this record.In classic accounts of the development of modern medicine in Europe and North America, the sick person is often portrayed as having a history of disappearance with the rise of the objectified body of the modern patient. To this account, sociologists and historians of medicine have added another for the period after 1950, in which the patient as subjective person "reappears" in medical discourse. However, despite histories of practice and identity revising narratives of disappearance, the patient's reappearance has largely escaped further assessment. Using an analysis of dietary management in twentieth-century British diabetes care, this article challenges accounts of this reappearance in three ways. Firstly, it argues that discursive interest in the social and psychological aspects of care emerged earlier than suggested. Secondly, it grounds such interest in reconfigured institutional arrangements that were initially designed to rationalize care and improve efficiency. Finally, it argues that patients regularly exceeded the efforts of even an expanded management regime to normalize and regulate life. Food planning, preparation, and consumption continued to sit at the nexus of competing demands that mediated medical efforts to cultivate governable selves and bodies.This work was generously supported by the Wellcome Trust [Grant Number: 100601/Z/12/Z

Reorganising chronic disease management: diabetes and bureaucratic technologies in post-war British general practice

This is the author accepted manuscript. The final version is available from Routledg

Population Pharmacokinetic and Pharmacodynamic Analysis of Buprenorphine for the Treatment of Neonatal Abstinence Syndrome

Neonatal abstinence syndrome (NAS) is a condition affecting newborns exposed to an opioid in utero. Symptoms of NAS include excessive crying, poor feeding, and disordered autonomic control. Up to 2/3 of infants will require pharmacologic therapies to reach symptom control. Opioids including morphine and methadone are the current first-line treatments. Buprenorphine is being investigated as a treatment of NAS. The purpose of this analysis was to evaluate the pharmacokinetics (PK) and pharmacodynamics (PD) of BUP in infants with NAS. Poster presented at American Society for Clinical Pharmacology and Therapeutics (ASCPT) 2017 Annual Meeting, March 15-18, 2017 in Washington DC.https://jdc.jefferson.edu/petposters/1004/thumbnail.jp

A smart phone based multi-floor indoor positioning system for occupancy detection

At present there is a lot of research being done simulating building environment with artificial agents and predicting energy usage and other building performance related factors that helps to promote understanding of more sustainable buildings. To understand these energy demands it is important to understand how the building spaces are being used by individuals i.e. the occupancy pattern of individuals. There are lots of other sensors and methodology being used to understand building occupancy such as PIR sensors, logging information of Wi-Fi APs or ambient sensors such as light or CO2 composition. Indoor positioning can also play an important role in understanding building occupancy pattern. Due to the growing interest and progress being made in this field it is only a matter of time before we start to see extensive application of indoor positioning in our daily lives. This research proposes an indoor positioning system that makes use of the smart phone and its built-in integrated sensors; Wi-Fi, Bluetooth, accelerometer and gyroscope. Since smart phones are easy to carry helps participants carry on with their usual daily work without any distraction but at the same time provide a reliable pedestrian positioning solution for detecting occupancy. The positioning system uses the traditional Wi-Fi and Bluetooth fingerprinting together with pedestrian dead reckoning to develop a cheap but effective multi floor positioning solution. The paper discusses the novel application of indoor positioning technology to solve a real world problem of understanding building occupancy. It discusses the positioning methodology adopted when trying to use existing positioning algorithm and fusing multiple sensor data. It also describes the novel approach taken to identify step like motion in absence of a foot mounted inertial system. Finally the paper discusses results from limited scale trials showing trajectory of motion throughout the Nottingham Geospatial Building covering multiple floors

Injury Due to Mechanical Falls: Future Directions in Gender-specific Surveillance, Screening, and Interventions in Emergency Department Patients.

The Centers for Disease Control and Prevention report that among older adults (≥65 years), falls are the leading cause of injury-related death. Fall-related fractures among older women are more than twice as frequent as those for men. Gender-specific evidence-based fall prevention strategy and intervention studies show that improved patient-centered outcomes are elusive. There is a paucity of emergency medicine literature on the topic. As part of the 2014 Academic Emergency Medicine (AEM) consensus conference on Gender-Specific Research in Emergency Care: Investigate, Understand, and Translate How Gender Affects Patient Outcomes, a breakout group convened to generate a research agenda on priority questions to be answered on this topic. The consensus-based priority research agenda is presented in this article

Ventral Hernia Repairs: 10 year Single Institution Review at Thomas Jefferson University Hospital

Abstract Background Definitive repair of recurrent ventral hernias using abdominal wall reconstruction techniques is an essential tool in the armentarium for general and plastic surgeons. Ramirez 1 et al describes the “component separation” technique to mobilize the rectus-abdominus internal oblique and external oblique flap to correct the defect. The recurrence rate of incisional hernias increases to 20% after gastric bypass or extensive weight loss.2 The incidence of ventral hernias after failed recurrent hernia repair increases to 40%.3 It has been reported that utilizing the sliding myofascial flap repair technique, the recurrence rate was reduced to 8.5%.4 Materials and Methods This retrospective institutional study reviews 10 years of myofascial flap reconstruction 1996-2006 at TJUH. Several techniques and prosthetic materials (alloderm, permacol, vicryl, composix) were used in our institutional review by multiple surgeons in this time period. Our goal is to identify risk factors (i.e. smoking, diabetes, obesity, size of defect, peripheral vascular disease, enterocutaneous fistula, infection) that predict or categorize patients that are at increased risk for failure of primary repair, measure the complication rates (i.e. infection, recurrence, seroma, hematoma) and evaluate the techniques and long term effectiveness of several prosthetic materials. Results Three thousand twenty ventral hernia repairs were performed at TJUH between 1996 and 2006. Two thousand three hundred eighty three approximated the rectus abdominus primarily and of these 645 utilized a component separation technique. The recurrence rate for component separations was 18.5% and 83% for primary repairs. The average follow up was 5.49 years. Statistically significant risk factors (p\u3c0.05) for recurrence were obesity (BMI\u3e30 kg/m2), age\u3e65 years, male gender, preoperative infection and postoperative seroma. Conclusion Myofascial flaps are a safe, reliable therapy for recurrent ventral hernias that addresses the population of patients that have failed conventional primary closure and reduce the recurrence rates greater than 40 percent to 18.5 percent in the carefully selected patient population

The Effect of n-6 Polyunsaturated Fatty Acid on Blood Levels of Malondialdehyde-Deoxyguanosine Adducts In Human Subjects

The role of n-6 polyunsaturated fats upon the formation of the mutagenic DNA adduct malondialdehydedeoxyguanosine (M1dG) in blood was investigated in male volunteers (n = 13) who consumed diets high in saturated and polyunsaturated fats, and polyunsaturated fat plus a-tocopherol supplemention (400 IU per day). On day 14 there was a significant difference in adduct levels between diets with saturated fats giving higher levels than polyunsaturated fats but this effect had disappeared by day 20 indicating that there is a relatively rapid adjustment to the effects on DNA damage of changes in dietary fat. a-Tocopherol showed a small benefit by day 20. Five females participated in the PUFA study and had higher mean adduct levels than men but there was no correlation with hormonal status. Overall, PUFA had a limited beneficial effect on M1dG levels that warrants further investigation

Medical Students Using Cadavers for Procedural Simulation Education

Background: Cadaver dissection remains integrated into the curriculum of numerous medical schools. Aspiring physicians acquire the opportunity to work directly with the human body, which is intricate and tangible, yet have minimal exposure to certain procedural skills applicable­­ to patient care during the first year of their medical training. Our aim was to incorporate the cadaver as part of a process to introduce procedures to a class of first year medical students in order to improve their confidence and skill in performing these procedures in patients. Methods: During medical gross anatomy at Wayne State University School of Medicine, three workshops involving common procedures performed in the emergency department were integrated into the cadaver dissection laboratory. Each educational workshop began with a short demonstration or a short step-by-step informational video on the focused procedure. The educators consisted of emergency medicine residents, third and fourth year medical student mentors, and emergency medicine attendings. Educators directed the hands-on procedure practice on the cadavers and provided real time feedback. Students completed pre and post questionnaires with scales ranging from one to five to assess the impact of the workshop on their abilities and confidence for the specified procedures. The three sessions included intraosseous (IO) line placement, joint aspiration, and chest tube placement. Results: A total of 108 students participated in the IO line training workshop, 143 students in the arthrocentesis simulation and 79 students in the chest tube session. Prior to the hands on sessions, 0 students (0%) had performed an IO line on a simulated patient, 2 students (1.4%) had performed an arthrocentesis on a simulated patient, and 4 students (5.1%) had performed a chest tube on a simulated patient. The Likert scales were viewed as ordinal variables (categorical variables) and thus the data was analyzed by Wilcoxon signed-rank test (non-parametric paired t-test). The student’s confidence in performing the specified procedure improved with a statistically significant difference in the IO, arthrocentesis and chest tube workshops (p = \u3c0.0001). There was a statistically significant increase in the perception of adequate training in all three sessions (p = \u3c 0.0001). The self-perceived skill in performing the described procedures had a statistically significant improvement for post training session in students participating in the IO, arthrocentesis and chest tube workshops (p = \u3c 0.0001). Lastly, after the hands-on educational sessions, a median of 4.5 out of 5 and mode of 5 out of 5 recommended other medical students participate in the IO simulation activity, and a median and mode of 5 out of 5 recommended the arthrocentesis and chest tube workshops. Conclusion: Workshops introducing procedural simulation in the cadaver to first year medical students improved confidence levels, perception of being adequately trained, and self-evaluated skill. Cadavers are effective models for training medical students in common emergency medical procedures. Integrating workshops into existing medical gross anatomy courses may translate into higher procedural success rates in the clinical setting, as well as stimulate interest in understanding normal anatomy and common variants encountered in practice