World Food Programme/Country Comparison

The student will use data from websites given to study hunger crisis locations, country statistics, and political conditions in needy regions. Students will organize and compare data, using results for debate

The Role of Instruments for Screening Cognitive Function and Alzheimer's disease: A Sociological Exploration

This qualitative ethnographic study examines how cognitive screening tools are used in clinical practice in the process of articulating a classification of Alzheimer’s disease (AD). An exploration of how these low-technological tools constitute AD is important because of their central role in detecting initial cognitive decline in the ‘ageing population’. The study draws upon fieldwork undertaken across a secondary healthcare memory service and a major teaching hospital in the UK. Focusing on the everyday practices and interactions between clinicians, patients and these technologies, the study shows how these tools were made provisional, and yet emerged as central mediators for producing knowledge about AD. I explore the uncertainties associated with measures of cognitive decline and consider how these were navigated and managed through the making of the tools as provisional devices. I continue by showing how the tools emerged as central mediators for negotiating how classification proceeded in medical practice: producing and reproducing professional hierarchies and identities. I also investigate how uncertainty was mobilised by clinicians to constitute the boundaries of classification; fuelled by the possibility that patients may go on to develop AD. Finally, I demonstrate how the adoption of the tools in the wider policy terrain translated into everyday clinical practice; increased efforts to quantify cognitive decline at earlier stages, produced uncertainty around patient futures. I reflect on how the making of these tools as provisional devices, relied upon and resulted in the portability of these devices and, in turn, constituted AD. Portability highlights the temporal and spatial aspects of classification processes involved in diagnosis/prognosis, as well as patient and professional identities and autonomy. I conclude by considering the implications of these findings for the diagnosis and management of patients with cognitive decline and AD locally in the clinic, and with respect to managing the ‘ageing population’

Laboratory Practices, Potentiality, and Material Patienthood in Genomic Cancer Medicine

Laboratory practitioners working in oncology are increasingly involved in implementing genomic medicine, operating at the intersection of the laboratory and the clinic. This includes molecular diagnostic work and molecular testing to direct entry into molecular-based clinical trials and treatment decision-making based on molecular profiling. In this article, we draw on qualitative interviews with laboratory practitioners in the United Kingdom to explore the role of laboratory work in genomic cancer medicine, focusing on the handling of patient tissue and making of potentiality to guide patients’ present and future care. With an increase in molecular testing to inform standard care and clinical trial participation, we show how practitioners “potentialized” the tissue by carefully negotiating what to test, how to test, and when. This included maximizing and managing small amounts of tissue in anticipation of possible future patient care. Tissue archives also took on new meaning, and potentiality, which practitioners negotiated alongside patient care. Potentiality was key to generating the “big” future of genomic medicine and also involved care work where the tissue emerged as an extension of the patient, as a form of “material patienthood,” to secure present and future care for patients through their involvement in genomic medicine

Accomplishing an adaptive clinical trial for cancer:Valuation practices and care work across the laboratory and the clinic

A new generation of adaptive, multi-arm clinical trials has been developed in cancer research including those offering experimental treatments to patients based on the genomic analysis of their cancer. Depending on the molecular changes found in patients’ cancer cells, it is anticipated that targeted and personalised therapies will be made available for those who have reached the end of standard treatment options, potentially extending survival time. Results from these trials are also expected to advance genomic knowledge for patients in the future. Drawing on data from a qualitative study of one such trial in the UK, comprising observations of out-patient clinic appointments, out-patient biopsy procedures, laboratory work, and interviews with practitioners, this paper explores how the clinical and research value of one such trial was accomplished in everyday practice by focussing on the work of clinical trials and laboratory staff across recruitment, laboratory analysis, and results management. In the face of numerous potential set-backs, disappointments and failure, we explore how practitioners worked to balance the need to meet established measures of value such as numbers of patients recruited into the trial, alongside cultivating the value of positive affects for patients by managing their expectations and emotions. This care work was performed primarily by practitioners whose roles have historically been devalued in healthcare practice and yet, as we show, were critical to this process. We conclude by arguing that as complex multi-arm adaptive trials become more commonplace, we need to attend to, and render visible, the dynamic and care-full valuation practices of backstage practitioners through which experimental biomedicine is accomplished, and in doing so show that care both achieves clinical and research value, and is also a series of practices and processes that tends to tissue, patients and staff in the context of ever-present possibility of failure

Translations and transformations in patienthood: cancer in the post-genomics era

A collection of interviews with patients, former patients, carers, advocates and professionals about their perspectives and experiences of targeted treatments for cancer

Personalised cancer medicine

What does it mean to personalise cancer medicine? Personalised cancer medicine explores this question by foregrounding the experiences of patients, carers and practitioners in the UK. Drawing on an ethnographic study of cancer research and care, we trace patients’, carers’ and practitioners’ efforts to access and interpret novel genomic tests, information and treatments as they craft personal and collective futures. Exploring a series of case studies of diagnostic tests, research and experimental therapies, the book charts the different kinds of care and work involved in efforts to personalise cancer medicine and the ways in which benefits and opportunities are unevenly realised and distributed. Investigating these experiences against a backdrop of policy and professional accounts of the ‘big’ future of personalised healthcare, the authors show how hopes invested and care realised via personalised cancer medicine are multifaceted, contingent and, at times, frustrated in the everyday complexities of living and working with cancer. Tracing the difficult and painstaking work involved in making sense of novel data, results and predictions, we show the different futures crafted across policy, practice and personal accounts. This is the only book to investigate in depth how personalised cancer medicine is reshaping the futures of cancer patients, carers and professionals in uneven and partial ways. Applying a feminist lens that focuses on work and care, inclusions and exclusions, we explore the new kinds of expertise, relationships and collectives involved making personalised cancer medicine work in practice and the inconsistent ways their work is recognised and valued in the process