Notes on the Sociology of Medical Discourse: The Language of Case Presentation

Also CSST Working Paper #19.http://deepblue.lib.umich.edu/bitstream/2027.42/51147/1/379.pd

Gold nanoparticle interactions with endothelial cells cultured under physiological conditions

PEGylated gold nanoparticles (AuNPs) have an extended circulation time after intravenous injection in vivo and exhibit favorable properties for biosensing, diagnostic imaging, and cancer treatment. No impact of PEGylated AuNPs on the barrier forming properties of endothelial cells (ECs) has been reported, but recent studies demonstrated that unexpected effects on erythrocytes are observed. Almost all studies to date have been with static-cultured ECs. Herein, ECs maintained under physiological cyclic stretch and flow conditions and used to generate a blood–brain barrier model were exposed to 20 nm PEGylated AuNPs. An evaluation of toxic effects, cell stress, the release profile of pro-inflammatory cytokines, and blood–brain barrier properties showed that even under physiological conditions no obvious effects of PEGylated AuNPs on ECs were observed. These findings suggest that 20 nm-sized, PEGylated AuNPs may be a useful tool for biomedical applications, as they do not affect the normal function of healthy ECs after entering the blood stream

“It’s hard to tell”. The challenges of scoring patients on standardised outcome measures by multidisciplinary teams: a case study of Neurorehabilitation

Background Interest is increasing in the application of standardised outcome measures in clinical practice. Measures designed for use in research may not be sufficiently precise to be used in monitoring individual patients. However, little is known about how clinicians and in particular, multidisciplinary teams, score patients using these measures. This paper explores the challenges faced by multidisciplinary teams in allocating scores on standardised outcome measures in clinical practice. Methods Qualitative case study of an inpatient neurorehabilitation team who routinely collected standardised outcome measures on their patients. Data were collected using non participant observation, fieldnotes and tape recordings of 16 multidisciplinary team meetings during which the measures were recited and scored. Eleven clinicians from a range of different professions were also interviewed. Data were analysed used grounded theory techniques. Results We identified a number of instances where scoring the patient was 'problematic'. In 'problematic' scoring, the scores were uncertain and subject to revision and adjustment. They sometimes required negotiation to agree on a shared understanding of concepts to be measured and the guidelines for scoring. Several factors gave rise to this problematic scoring. Team members' knowledge about patients' problems changed over time so that initial scores had to be revised or dismissed, creating an impression of deterioration when none had occurred. Patients had complex problems which could not easily be distinguished from each other and patients themselves varied in their ability to perform tasks over time and across different settings. Team members from different professions worked with patients in different ways and had different perspectives on patients' problems. This was particularly an issue in the scoring of concepts such as anxiety, depression, orientation, social integration and cognitive problems. Conclusion From a psychometric perspective these problems would raise questions about the validity, reliability and responsiveness of the scores. However, from a clinical perspective, such characteristics are an inherent part of clinical judgement and reasoning. It is important to highlight the challenges faced by multidisciplinary teams in scoring patients on standardised outcome measures but it would be unwarranted to conclude that such challenges imply that these measures should not be used in clinical practice for decision making about individual patients. However, our findings do raise some concerns about the use of such measures for performance management

Reduction in DNA binding activity of the transcription factor Pax-5a in B lymphocytes of aged mice

Aging has been associated with intrinsic changes of the humoral immune response, which may lead to an increased occurrence of autoimmune disorders and pathogenic susceptibility. The transcription factor Pax-5 is a key regulator of B cell development. Pax-5a/B cell-specific activator protein and an alternatively spliced isoform, Pax-Sd, may have opposing functions in transcriptional regulation due to the lack of a transactivation domain in Pax-Sd. To study B cell-specific changes that occur during the aging process, we investigated expression patterns of Pax-Sa and Sd in mature B cells of young and aged mice. RNase protection assays showed a similar transcriptional pattern for both age groups that indicates that aging has no affect on transcription initiation or alternative splicing for either isoform, In contrast, a significant reduction in the DNA binding activity of Pax-Sa but not Pax-Sd protein was observed in aged B cells in vitro, while Western blot analyses showed that similar levels of Pax-Sa and Sd proteins were present in both age groups. The observed decrease in Pax-Sa binding activity correlated with changes in expression of two Pax-5 target genes in aged B cells, Expression of the Ig J chain and the secreted form of Ig mu, which are both known to be suppressed by Pax-Sa in mature B cells, were increased in B cells of aged mice, Together, our studies suggest that changes associated with the aging phenotype cause posttranslational modification(s) of Pax-Sa but not Pax-Sd, which may lead to an abnormal B cell phenotype in aged mice, associated with elevated levels of J chain, and secretion of IgM

Domestic Violence and Health Care: Opening Pandora¿s Box ¿ Challenges and Dilemmas

In this article we take a critical stance toward the rational progressive narrative surrounding the integration of domestic violence within health care. Whilst changes in recent UK policy and practice have resulted in several tangible benefits, it is argued that there may be hidden dilemmas and challenges. We suggest that the medical model of care and its discursive practices position women as individually accountable for domestic violence-related symptoms and injuries. This may not only be ineffective in terms of service provision but could also have the potential to reduce the political significance of domestic violence as an issue of concern for all women. Furthermore, it is argued that the use of specific metaphors enables practitioners to distance themselves from interactions that may prove to be less comfortable and provide less than certain outcomes. Our analysis explores the possibilities for change that might currently be available. This would appear to involve a consideration of alternative discourses and the reformulation of power relations and subject positions in health care

Incorporating silica nanoparticles with silver patches into alginate-based bioinks for 3D bioprinting

Alginate dialdehyde-gelatin (ADA-GEL) hydrogels are being studied in bioprinting for their combination of cell adhesion and printability. To incorporate specific functionalities and to improve printability, different additives to ADA-GEL inks are being proposed. Here, a novel type of functional nanoparticles comprising silver patches on silica cores was incorporated into ADA-GEL bioinks. Silver patchy particles (SPPs) were present both on the surface and interior of printed structures. Incorporation of SPPs improved printability of ADA-GEL inks and supported osteosarcoma (MG-63) cells over 7 days of culture. SPPs represent a valuable additive for ADA-GEL hydrogels, being attractive to develop bioinks with advanced functionalities. Graphical abstractOpen Access funding enabled and organized by Projekt DEAL.Deutsche Forschungsgemeinschafthttp://dx.doi.org/10.13039/501100001659Friedrich-Alexander-Universität Erlangen-Nürnberg (1041

Reinforcing medical authority: clinical ethics consultation and the resolution of conflicts in treatment decisions

Despite substantial efforts in the past 15 years to professionalise the field of clinical ethics consultation, sociologists have not re‐examined past hypotheses about the role of such services in medical decision‐making and their effect on physician authority. In relation to those hypotheses, we explore two questions: (i) What kinds of issues does ethics consultation resolve? and (ii) what is the nature of the resolution afforded by these consults? We examined ethics consultation records created between 2011 and mid‐2015 at a large tertiary care US hospital and found that in most cases, the problems addressed are not novel ethical dilemmas as classically conceived, but are instead disagreements between clinicians and patients or their surrogates about treatment. The resolution offered by a typical ethics consultation involves strategies to improve communication rather than the parsing of ethical obligations. In cases where disagreements persist, the proposed solution is most often based on technical clinical judgements, reinforcing the role of physician authority in patient care and the ethical decisions made about that care.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154312/1/shil13003.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154312/2/shil13003_am.pd

“Being Guided”: What Oncofertility Patients’ Decisions Can Teach Us About the Efficacy of Autonomy, Agency, and Decision-Making Theory in the Contemporary Critical Encounter

Recent research on patient decision-making reveals a disconnect between theories of autonomy, agency, and decision-making and their practice in contemporary clinical encounters. This study examines these concepts in the context of female patients making oncofertility decisions in the United Kingdom in light of the phenomenon of “being guided.” Patients experience being guided as a way to cope with, understand, and defer difficult treatment decisions. Previous discussions condemn guided decision-making, but this research suggests that patients make an informed, autonomous decision to be guided by doctors. Thus, bioethicists must consider the multifaceted ways that patients enact their autonomy in medical encounters