Why Understanding the Lived Experience of Vulnerability is Fundamental to Exploring the Value Base of Care

Vulnerability is a key quality that all health carers will encounter in the people they work with. Indeed to be a nurse, midwife or carer working with such individuals is to have a privileged role within society, a role which demands that we exercise that privilege with responsibility, care and compassion. Yet there have been a plethora of concerns raised about poor standards of care within the NHS (Francis 2009, 2010) leading to a national focus on the value base of health care professionals. Nurse education must debate and challenge these issues with students in a manner which allows them to reflect upon, challenge and develop their own value base. This oral paper will present a model of practice which has been used to educate adult student nurses, enabling them to not only review professional discourses and practices, but also to be moved to elegantly challenge such practices. A key aspect of this has been the involvement of individuals who would be deemed as “vulnerable” by health and social care practitioners. They share their “lived experience” of vulnerability, allowing students to enter their lived world and to ask questions, enabling them to view the world from the perspective of a service user or carer. In doing so, they have the opportunity to challenge the preconceptions and discourses that we as practitioners may have about traditionally labelled vulnerable groups. This approach is coupled with a theoretical exploration of issues such as power, stigma, labelling, oppression, compliance and conformity, together with use of case scenarios from practice. Student evaluation is overwhelmingly positive; identifying a clear relevance to their practice and empowerment or inspiration to make a difference. The approach clearly addresses the 6 C’s of compassionate care (Cummings and Bennett 2012). Cummings, J., and Bennett, V., (2012). Compassion in Practice, Nursing, Midwifery and Care Staff. Our Vision in Practice. Leeds: Commissioning Board Chief Nursing Officer and DH Chief Nursing AdviserC Francis, R., (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. Stationary Office, London. Francis, R., (2010) Independent Inquiry into care provided by Mid Staffordshire NHS Foundation Trust January 2005 – March 2009. Stationary Office, London

The Science Performance of JWST as Characterized in Commissioning

This paper characterizes the actual science performance of the James Webb Space Telescope (JWST), as determined from the six month commissioning period. We summarize the performance of the spacecraft, telescope, science instruments, and ground system, with an emphasis on differences from pre-launch expectations. Commissioning has made clear that JWST is fully capable of achieving the discoveries for which it was built. Moreover, almost across the board, the science performance of JWST is better than expected; in most cases, JWST will go deeper faster than expected. The telescope and instrument suite have demonstrated the sensitivity, stability, image quality, and spectral range that are necessary to transform our understanding of the cosmos through observations spanning from near-earth asteroids to the most distant galaxies.Comment: 5th version as accepted to PASP; 31 pages, 18 figures; https://iopscience.iop.org/article/10.1088/1538-3873/acb29

Sex-specific regulation of IL-10 production in human adipose tissue in obesity

Background: Obesity-associated metabolic complications display sexual dimorphism and can be impacted by cytokines. We previously showed that interleukin-10 (IL-10) was upregulated in white adipose tissue (WAT) of obese women with type 2 diabetes (T2D). Whether this pertains to men is unknown. The aim of this study was to compare the impact of obesity and T2D on WAT IL- 10 levels in men versus women. Methods: Plasma and subcutaneous WAT biopsies were obtained from 108 metabolically well-characterized individuals. WAT IL10 expression/secretion and WAT-resident IL-10-secreting macrophage number were measured. Circulating sex hormone levels were correlated toWAT IL10 expression in 22 individuals and sex hormone effects on macrophage IL10 expression were investigated in vitro. Results: Obese women with T2D showed increased IL10 expression/secretion and IL-10-secreting WAT macrophage number compared to other female groups. This difference was absent in men. Non-obese women and men with T2D showed similar IL-10 levels compared to healthy controls, indicating that T2D alone does not regulate IL-10. Although WAT IL10 expression correlated with serum estrone (E1) concentrations, recombinant E1 did not affect macrophage IL10 expression in vitro. Conclusion: WAT IL-10 levels are higher in women with obesity and T2D, but not in men and this effect is primarily attributed to obesity per se. This is less likely to be driven by circulating sex hormones. We propose that the WAT IL-10 might exert protective effects in obesity-associated chronic inflammation in women which could be one of the contributing factors for the decreased morbidity observed in women during obesity than men

Sex-specific regulation of IL-10 production in human adipose tissue in obesity

Background: Obesity-associated metabolic complications display sexual dimorphism and can be impacted by cytokines. We previously showed that interleukin-10 (IL-10) was upregulated in white adipose tissue (WAT) of obese women with type 2 diabetes (T2D). Whether this pertains to men is unknown. The aim of this study was to compare the impact of obesity and T2D on WAT IL- 10 levels in men versus women. Methods: Plasma and subcutaneous WAT biopsies were obtained from 108 metabolically well-characterized individuals. WAT IL10 expression/secretion and WAT-resident IL-10-secreting macrophage number were measured. Circulating sex hormone levels were correlated toWAT IL10 expression in 22 individuals and sex hormone effects on macrophage IL10 expression were investigated in vitro. Results: Obese women with T2D showed increased IL10 expression/secretion and IL-10-secreting WAT macrophage number compared to other female groups. This difference was absent in men. Non-obese women and men with T2D showed similar IL-10 levels compared to healthy controls, indicating that T2D alone does not regulate IL-10. Although WAT IL10 expression correlated with serum estrone (E1) concentrations, recombinant E1 did not affect macrophage IL10 expression in vitro. Conclusion: WAT IL-10 levels are higher in women with obesity and T2D, but not in men and this effect is primarily attributed to obesity per se. This is less likely to be driven by circulating sex hormones. We propose that the WAT IL-10 might exert protective effects in obesity-associated chronic inflammation in women which could be one of the contributing factors for the decreased morbidity observed in women during obesity than men