Why the constituency work of MPs bears comparison with social work

Jo Warner reports on a qualitative study using semi-structured interviews with thirteen MPs. The aim of the research was to find out what characterises their constituency work and to understand why it apparently bears comparison with social work. MPs in the study engaged in face-to-face emotional labour in which they formed empathic relationships with people and places to represent them. They practised judgment under uncertainty, and were embedded in local organisational networks of risk and trust with local authorities and other agencies

Treflan and the Oxygen Consumption of Green Sunfish (Lepomis cyanellus)

Oxygen consumption rates of 51 green sunfish (Lepomis cyanellus, Rafinesque) were monitored over five hours exposure to Treflan E.C. concentrations of 0, 0.32, 0.56, 1.0, and 2.0 ppm. There was a great variation in the responses of the fish at each concentration; and Student\u27s t-tests revealed no significant differences. However, graphs of the mean hourly oxygen consumption rates showed certain trends. During the fifth hour of exposure, there appears to be an acclimation to the Treflan at concentrations of 0.32 and 0.56 ppm; but no such acclimation at the higher concentrations of 1.0 and 2.0 ppm. Hourly oxygen consumption rates at 2.0 ppm Treflan fluctuated less than at the other concentrations. Also, Treflan concentrations of 0.56, 1.0, and 2.0 ppm altered the consumption rates of the larger fish more than those of the smaller fish. Further tests with longer periods of exposure to Treflan are recommended to determine further reactions to the higher Treflan concentrations

BEYOND CLINICAL GUIDELINES: HOW CARE PATHWAYS AND QUALITY-IMPROVEMENT METHODS CAN SUPPORT BETTER ALLERGY CARE

The increasing prevalence of allergic disease has resulted in the recognition of allergy as a global public health concern. Yet health services worldwide appear to be ill-equipped to deliver high-quality allergy care. Clinical guidelines have been developed to describe what high-quality care looks like for most allergic diseases. However, allergy guidelines do not describe how the delivery of such care is organised across clinicians and provider organisations with varying degrees of access to allergy expertise and clinical resources. In this article, we describe how care pathways can be used to improve the organisation and delivery of allergy care in accordance with the characteristics of allergic disease and local constraints in the health service. We then describe how quality-improvement methods can support the successful realisation of allergy care pathways in practice. Realising care pathways involves a highly complex process of changing the way care is practised and organised. This could involve developing a new service, clinical training or other interventions. Qualityimprovement methods were developed as a guide to navigate and support the process of change and improvement

Autonomy vs beneficence: shared decision-making in allergy

Understanding the principles of ethical clinical practice is fundamental to making appropriate decisions. While ethical practice is a regulatory and legal obligation, it more importantly improves clinical judgement and the delivery of effective care. Traditionally, there are four principles: autonomy (giving choice to the patient); beneficence (paternalism); nonmaleficence (do no harm); and justice (confidentiality and equality). However, a fifth principle, fidelity, which constitutes fairness, truthfulness and advocacy, must be included. Balancing between autonomy and beneficence is like walking on a tight-rope, particularly when dealing with children and young people. However, competence to make sensible autonomous decisions is not linearly related to age. Adults sometimes make bad decisions and do not necessarily understand the long-term consequences of their actions. Nevertheless, whereas children are not, adults are legally considered to have autonomous rights. Irrespective of age, generating an accord between clinician and patient through empathetic consultation has the best chance of achieving favourable patient experience and consequent optimal clinical outcomes. In most situations honesty and full disclosure should be the rule; but, very occasionally, it may be necessary to modify approaches to avoid adverse consequences. The five principles are discussed and illustrated with case scenarios. It is not always possible to achieve consensus and sometimes there are no correct answers to ethical dilemmas. But discussion with colleagues, ethicists, patients and their representatives will improve ethical clinical practice

Issues in Distance Education

The world of education has undergone many changes in the past 100 years. Education was thought of as an orderly world where individual students learned discrete facts within separate courses that were organized into disciplines. One of the major changes that is currently taking place is one of physical space. In the past, students went to school. Today, school is coming to the students

Protective astrogenesis from the SVZ niche after injury is controlled by Notch modulator Thbs4.

Postnatal/adult neural stem cells (NSCs) within the rodent subventricular zone (SVZ; also called subependymal zone) generate doublecortin (Dcx)(+) neuroblasts that migrate and integrate into olfactory bulb circuitry. Continuous production of neuroblasts is controlled by the SVZ microenvironmental niche. It is generally thought that enhancing the neurogenic activities of endogenous NSCs may provide needed therapeutic options for disease states and after brain injury. However, SVZ NSCs can also differentiate into astrocytes. It remains unclear whether there are conditions that favour astrogenesis over neurogenesis in the SVZ niche, and whether astrocytes produced there have different properties compared with astrocytes produced elsewhere in the brain. Here we show in mice that SVZ-generated astrocytes express high levels of thrombospondin 4 (Thbs4), a secreted homopentameric glycoprotein, in contrast to cortical astrocytes, which express low levels of Thbs4. We found that localized photothrombotic/ischaemic cortical injury initiates a marked increase in Thbs4(hi) astrocyte production from the postnatal SVZ niche. Tamoxifen-inducible nestin-creER(tm)4 lineage tracing demonstrated that it is these SVZ-generated Thbs4(hi) astrocytes, and not Dcx(+) neuroblasts, that home-in on the injured cortex. This robust post-injury astrogenic response required SVZ Notch activation modulated by Thbs4 via direct Notch1 receptor binding and endocytosis to activate downstream signals, including increased Nfia transcription factor expression important for glia production. Consequently, Thbs4 homozygous knockout mice (Thbs4(KO/KO)) showed severe defects in cortical-injury-induced SVZ astrogenesis, instead producing cells expressing Dcx migrating from SVZ to the injury sites. These alterations in cellular responses resulted in abnormal glial scar formation after injury, and significantly increased microvascular haemorrhage into the brain parenchyma of Thbs4(KO/KO) mice. Taken together, these findings have important implications for post-injury applications of endogenous and transplanted NSCs in the therapeutic setting, as well as disease states where Thbs family members have important roles

Understanding the health-care experiences of people with sickle cell disorder transitioning from paediatric to adult services: This Sickle Cell Life, a longitudinal qualitative study

Background Transitions from paediatric to adult health-care services cause problems worldwide, particularly for young people with long-term conditions. Sickle cell disorder brings particular challenges needing urgent action. Objectives Understand health-care transitions of young people with sickle cell disorder and how these interact with broader transitions to adulthood to improve services and support. Methods We used a longitudinal design in two English cities. Data collection included 80 qualitative interviews with young people (aged 13–21 years) with sickle cell disorder. We conducted 27 one-off interviews and 53 repeat interviews (i.e. interviews conducted two or three times over 18 months) with 48 participants (30 females and 18 males). We additionally interviewed 10 sickle cell disease specialist health-care providers. We used an inductive approach to analysis and co-produced the study with patients and carers. Results Key challenges relate to young people’s voices being ignored. Participants reported that their knowledge of sickle cell disorder and their own needs are disregarded in hospital settings, in school and by peers. Outside specialist services, health-care staff refuse to recognise patient expertise, reducing patients’ say in decisions about their own care, particularly during unplanned care in accident and emergency departments and on general hospital wards. Participants told us that in transitioning to adult care they came to realise that sickle cell disorder is poorly understood by non-specialist health-care providers. As a result, participants said that they lack trust in staff’s ability to treat them correctly and that they try to avoid hospital. Participants reported that they try to manage painful episodes at home, knowing that this is risky. Participants described engaging in social silencing (i.e. reluctance to talk about and disclose their condition for fear that others will not listen or will not understand) outside hospital; for instance, they would avoid mentioning cell sickle disorder to explain fatigue. Their self-management tactics include internalising their illness experiences, for instance by concealing pain to protect others from worrying. Participants find that working to stay healthy is difficult to reconcile with developing identities to meet adult life goals. Participants have to engage in relentless self-disciplining when trying to achieve educational goals, yet working hard is incompatible with being a ‘good adult patient’ because it can be risky for health. Participants reported that they struggle to reconcile these conflicting demands. Limitations Our findings are derived from interviews with a group of young people in England and reflect what they told us (influenced by how they perceived us). We do not claim to represent all young people with sickle cell disorder. Conclusions Our findings reveal poor care for young people with sickle cell disorder outside specialist services. To improve this, it is vital to engage with young people as experts in their own condition, recognise the legitimacy of their voices and train non-specialist hospital staff in sickle cell disorder care. Young people must be supported both in and outside health-care settings to develop identities that can help them to achieve life goals. Future work Future work should include research into the understanding and perceptions of sickle cell disease among non-specialist health-care staff to inform future training. Whole-school interventions should be developed and evaluated to increase sickle cell disorder awareness. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 44. See the NIHR Journals Library website for further project information

Accumulation and dissemination of prion protein in experimental sheep scrapie in the natural host

<p>Abstract</p> <p>Background</p> <p>In order to study the sites of uptake and mechanisms of dissemination of scrapie prions in the natural host under controlled conditions, lambs aged 14 days and homozygous for the VRQ allele of the PrP gene were infected by the oral route. Infection occurred in all lambs with a remarkably short and highly consistent incubation period of approximately 6 months. Challenge of lambs at approximately eight months of age resulted in disease in all animals, but with more variable incubation periods averaging significantly longer than those challenged at 14 days.</p> <p>This model provides an excellent system in which to study the disease in the natural host by virtue of the relatively short incubation period and close resemblance to natural infection.</p> <p>Results</p> <p>Multiple sites of prion uptake were identified, of which the most important was the Peyer's patch of the distal ileum.</p> <p>Neuroinvasion was detected initially in the enteric nervous system prior to infection of the central nervous system. At end stage disease prion accumulation was widespread throughout the entire neuraxis, but vacuolar pathology was absent in most animals that developed disease at 6–7 months of age.</p> <p>Conclusion</p> <p>Initial spread of detectable PrP was consistent with drainage in afferent lymph to dependent lymph nodes. Subsequent accumulation of prions in lymphoid tissue not associated with the gut is consistent with haematogenous spread. In addition to macrophages and follicular dendritic cells, prion containing cells consistent with afferent lymph dendritic cells were identified and are suggested as a likely vehicle for carriage of prions from initial site of uptake to the lymphoreticular system, and as potential carriers of prion protein in blood. It is apparent that spongiform change, the characteristic lesion of scrapie and other prion diseases, is not responsible for the clinical signs in sheep, but may develop in an age dependent manner.</p