The Machinery of Authoritarian Care: Dramatising Breast Cancer Treatment in 1970s Britain

This article examines the professional and public response to the television play Through the Night, which aired on BBC1 in December 1975. One of the first British mass media portrayals of a woman's experience being treated for breast cancer, this play attracted a large audience and considerable attention from both critics and everyday viewers. My analysis of the play draws on sources documenting expert responses to the play in its production stages, as well as critics' and viewers' responses to what the play said about breast cancer treatment in particular, and about Britons' experiences of medical institutions more broadly. Together, I argue, these sources help us see how Through the Night's critique of what one expert called ‘the machinery of authoritarian care’ reverberated with and supported the efforts of professionals anxious to improve patient experience, and how it crystallised the concerns of activists and everyday viewers

Special issue—before translational medicine: laboratory clinic relations lost in translation? Cortisone and the treatment of rheumatoid arthritis in Britain, 1950–1960

From Springer Nature via Jisc Publications RouterHistory: received 2019-01-25, registration 2019-08-01, accepted 2019-08-01, pub-electronic 2019-11-07, online 2019-11-07, pub-print 2019-12Publication status: PublishedFunder: Wellcome Trust; doi: http://dx.doi.org/10.13039/100004440; Grant(s): WT 092782Abstract: Cortisone, initially known as ‘compound E’ was the medical sensation of the late 1940s and early 1950s. As early as April 1949, only a week after Philip Hench and colleagues first described the potential of ‘compound E’ at a Mayo Clinic seminar, the New York Times reported the drug’s promise as a ‘modern miracle’ in the treatment of rheumatoid arthritis (RA). Given its high profile, it is unsurprising that historians of medicine have been attracted to study the innovation of cortisone. It arrived at the end of a decade of ‘therapeutic revolutions’, kicked off by penicillin transforming the treatment of bacterial infections and ending with hopes of a revolution in the treatment of non-infectious, chronic inflammatory diseases. Despite these studies of cortisone’s introduction, few historians have taken the story forward and considered how cortisone was adopted and adapted into clinical practice. This article tells the longer of how the drug and its derivatives were taken from research laboratories and integrated into clinical practice; what has in recent decades become known as translational medicine (TM). In exploring cortisone’s first decade in Britain, we focus specifically on its role in the treatment of RA. Our approach is always to consider cortisone’s use in the context of other treatments available to clinicians, and at local and national institutional settings. We do not discuss the many other therapeutic uses of cortisone, which ranged for topical applications for skin diseases to the management of cancers, especially childhood leukaemia, nor do we discuss its close analogue ACTH—AdenoCorticoTropic Hormone. We think there are lessons in our study for TM policies today

Not only laboratory to clinic: the translational work of William S. C. Copeman in rheumatology

From Springer Nature via Jisc Publications RouterHistory: received 2019-01-25, registration 2020-07-19, accepted 2020-07-19, pub-electronic 2020-08-06, online 2020-08-06, pub-print 2020-09Publication status: PublishedFunder: Wellcome Trust; doi: http://dx.doi.org/10.13039/100004440; Grant(s): WT 09782Abstract: Since the arrival of Translational Medicine (TM), as both a term and movement in the late 1990s, it has been associated almost exclusively with attempts to accelerate the “translation” of research-laboratory findings to improve efficacy and outcomes in clinical practice (Krueger et al. in Hist Philos Life Sci 41:57, 2019). This framing privileges one source of change in medicine, that from bench-to-bedside. In this article we dig into the history of translation research to identify and discuss three other types of translational work in medicine that can also reshape ideas, practices, institutions, behaviours, or all of these, to produce transformations in clinical effectiveness. These are: (1) making accessible state-of-the-art knowledge and best practice across the medical profession; (2) remodelling and creating institutions to better develop and make available specialist knowledge and practice; and (3) improving public and patient understandings of disease prevention, symptoms and treatments. We do so by examining the work of William S. C. Copeman, a dominant figure in British rheumatology from the 1930 through the late 1960s. Throughout his long career, Copeman blended approaches to “translation” in order to produce transformative change in clinical medicine, making his work an exemplar of our expanded notion of TM

Impact of COVID-19 on health-related behaviours, well-being and weight management

Background: Weight management is complex for people even in times of stability. Supporting individuals to develop strategies to maintain a healthier weight when there are additional life challenges may prevent relapse. This mixed-methods study describes the impact the COVID-19 restrictions had on adults engaged in weight management before and during the pandemic in order to determine helpful strategies. Methods: Longitudinal data was captured from online surveys completed by Slimming World (SW) members 0–4 weeks after joining, October/November 2019, providing pre-joining and baseline (T0&T1), 3- (T2) and 6- month (T3-during COVID-19) data. Representatives from the general population, not attending a weight management service, completed the same questionnaires providing cross-sectional control data. All weights are self-reported. For this study, questions assessing the impact of the COVID-19 challenges on health-related behaviours and well-being are included comparing responses at T0/T1, T2 & T3. Longitudinal data were analysed using repeated measures ANOVA and cross-sectional data, one-way independent ANOVAs to compare means. Comparisons between SW members and controls were determined using z-proportion tests. Qualitative data generated was thematically analysed using a six-step approach to produce the key emerging themes. Results: 222 SW members completed all three surveys, achieving a weight loss of 7.7 ± 7.5%. They maintained positive health-related behaviour changes made since joining, including increased fruit and vegetables (p< 0.001), fewer sugary drinks (p< 0.001), cooking from scratch (p < 0.001) and increased activity levels (p < 0.001). Despite COVID-19 restrictions, they were still reporting improvements in all behaviours and had healthier scores than the controls on all but alcohol intake, although still within guidelines. Qualitative data indicated that the situation created various challenges to managing weight with fresh foods harder to access, comfort eating, drinking more alcohol, eating more sugary foods and snacking through boredom. However, some reported having more free time enabling better planning, more time to cook from scratch and increased physical activity. Conclusions: The findings highlight the value of peer, group and online support and guidance for individuals to develop sustainable behaviour changes and a level of resilience. These strategies can then be drawn upon enabling maintenance of lifestyle changes and management of weight even in challenging times

A New Ocean State After Nuclear War

Nuclear war would produce dire global consequences for humans and our environment. We simulated climate impacts of US-Russia and India-Pakistan nuclear wars in an Earth System Model, here, we report on the ocean impacts. Like volcanic eruptions and large forest fires, firestorms from nuclear war would transport light-blocking aerosols to the stratosphere, resulting in global cooling. The ocean responds over two timescales: a rapid cooling event and a long recovery, indicating a hysteresis response of the ocean to global cooling. Surface cooling drives sea ice expansion, enhanced meridional overturning, and intensified ocean vertical mixing that is expanded, deeper, and longer lasting. Phytoplankton production and community structure are highly modified by perturbations to light, temperature, and nutrients, resulting in initial decimation of production, especially at high latitudes. A new physical and biogeochemical ocean state results, characterized by shallower pycnoclines, thermoclines, and nutriclines, ventilated deep water masses, and thicker Arctic sea ice. Persistent changes in nutrient limitation drive a shift in phytoplankton community structure, resulting in increased diatom populations, which in turn increase iron scavenging and iron limitation, especially at high latitudes. In the largest US-Russia scenario (150 Tg), ocean recovery is likely on the order of decades at the surface and hundreds of years at depth, while changes to Arctic sea-ice will likely last thousands of years, effectively a “Nuclear Little Ice Age.” Marine ecosystems would be highly disrupted by both the initial perturbation and in the new ocean state, resulting in long-term, global impacts to ecosystem services such as fisheries.publishedVersio

Radiative Forcing From the 2014–2022 Volcanic and Wildfire Injections

Volcanic and wildfire events between 2014 and 2022 injected ∼3.2 Tg of sulfur dioxide and 0.8 Tg of smoke aerosols into the stratosphere. With injections at higher altitudes and lower latitudes, the simulated stratospheric lifetime of the 2014–2022 injections is about 50% longer than the volcanic 2005–2013 injections. The simulated global mean effective radiative forcing (ERF) of 2014–2022 is −0.18 W m−2, ∼40% of the ERF of the period of 1991–1999 with a large-magnitude volcanic eruption (Pinatubo). Our climate model suggests that the stratospheric smoke aerosols generate ∼60% more negative ERF than volcanic sulfate per unit aerosol optical depth. Studies that fail to account for the different radiative properties of wildfire smoke relative to volcanic sulfate will likely underestimate the negative stratospheric forcings. Our analysis suggests that stratospheric injections offset 20% of the increase in global mean surface temperature between 2014–2022 and 1999–2002

Text Mining the History of Medicine

Historical text archives constitute a rich and diverse source of information, which is becoming increasingly readily accessible, due to large-scale digitisation efforts. However, it can be difficult for researchers to explore and search such large volumes of data in an efficient manner. Text mining (TM) methods can help, through their ability to recognise various types of semantic information automatically, e.g., instances of concepts (places, medical conditions, drugs, etc.), synonyms/variant forms of concepts, and relationships holding between concepts (which drugs are used to treat which medical conditions, etc.). TM analysis allows search systems to incorporate functionality such as automatic suggestions of synonyms of user-entered query terms, exploration of different concepts mentioned within search results or isolation of documents in which concepts are related in specific ways. However, applying TM methods to historical text can be challenging, according to differences and evolutions in vocabulary, terminology, language structure and style, compared to more modern text. In this article, we present our efforts to overcome the various challenges faced in the semantic analysis of published historical medical text dating back to the mid 19th century. Firstly, we used evidence from diverse historical medical documents from different periods to develop new resources that provide accounts of the multiple, evolving ways in which concepts, their variants and relationships amongst them may be expressed. These resources were employed to support the development of a modular processing pipeline of TM tools for the robust detection of semantic information in historical medical documents with varying characteristics. We applied the pipeline to two large-scale medical document archives covering wide temporal ranges as the basis for the development of a publicly accessible semantically-oriented search system. The novel resources are available for research purposes, while the processing pipeline and its modules may be used and configured within the Argo TM platform

Targeting DNA Damage Response and Replication Stress in Pancreatic Cancer

Background and aims: Continuing recalcitrance to therapy cements pancreatic cancer (PC) as the most lethal malignancy, which is set to become the second leading cause of cancer death in our society. The study aim was to investigate the association between DNA damage response (DDR), replication stress and novel therapeutic response in PC to develop a biomarker driven therapeutic strategy targeting DDR and replication stress in PC. Methods: We interrogated the transcriptome, genome, proteome and functional characteristics of 61 novel PC patient-derived cell lines to define novel therapeutic strategies targeting DDR and replication stress. Validation was done in patient derived xenografts and human PC organoids. Results: Patient-derived cell lines faithfully recapitulate the epithelial component of pancreatic tumors including previously described molecular subtypes. Biomarkers of DDR deficiency, including a novel signature of homologous recombination deficiency, co-segregates with response to platinum (P &lt; 0.001) and PARP inhibitor therapy (P &lt; 0.001) in vitro and in vivo. We generated a novel signature of replication stress with which predicts response to ATR (P &lt; 0.018) and WEE1 inhibitor (P &lt; 0.029) treatment in both cell lines and human PC organoids. Replication stress was enriched in the squamous subtype of PC (P &lt; 0.001) but not associated with DDR deficiency. Conclusions: Replication stress and DDR deficiency are independent of each other, creating opportunities for therapy in DDR proficient PC, and post-platinum therapy

Hva nå? Livet etter infarktet.

Bakgrunn for valg av tema: Årlig utskriver omtrent 15 000 pasienter med diagnosen akutt hjerteinfarkt. Flere kilder påpeker at pasienters informasjonsbehov ikke blir godt nok dekket mens de er innlagt, og at dette får konsekvenser for pasientens videre liv. Problemstilling: Hvordan kan god informasjon i sykehus bidra til et bedre liv etter hjerteinfarkt? Oppgavens hensikt: Belyse pasienters behov for informasjon etter hjerteinfarkt og hvordan sykepleier kan ivareta dette behovet, med fokus på å bidra til et godt liv for pasienten. Metode: Oppgaven er en litteraturstudie. Søk etter forskningsartikler er gjort i CINAHL, Ovid Nursing, ProQuest, ISI Web of Science, Vård I Norden og Sykepleiens fag – og forskningsarkiv. Mest brukte søkeord er: information needs, myocardial infarction og hospital. 4 artikler er tatt med i oppgaven, hvorav 2 av studiene er gjort i Norge. Resultater: Pasienter er stort sett fornøyd med informasjonen i sykehus, men ønsker mer individuelt tilpasset informasjon. Informasjonen i sykehus får stor betydning for pasienters liv etter hjerteinfarkt. Oppsummering: Etter hjerteinfarkt har pasienter et stort informasjonsbehov. Forskning viser at pasienter etter utskrivelse fra sykehus opplever manglende kunnskaper om sykdommen, som kan få konsekvenser for hverdagen deres etter infarktet. Å sette seg inn i pasientens opplevelser av situasjonen er av stor betydning for å kunne imøtekomme og ivareta pasienters behov for informasjon mens de er innlagt i sykehus