Revisiting digital technologies: envisioning biodigital bodies

In this paper the contemporary practices of human genomics in the 21st century are placed alongside the digital bodies of the 1990s. The primary aim is to provide a trajectory of the biodigital as follows: First, digital bodies and biodigital bodies were both part of the spectacular imaginaries of early cybercultures. Second, these spectacular digital bodies were supplemented in the mid-1990s by digital bodywork practices that have become an important dimension of everyday communication. Third, the spectacle of biodigital bodies is in the process of being supplemented by biodigital bodywork practices, through personal or direct-to-consumer genomics. This shift moves a form of biodigital communication into the everyday. Finally, what can be learned from putting the trajectories of digital and biodigital bodies together is that the degree of this communicative shift may be obscured through the doubled attachment of personal genomics to everyday digital culture and high-tech spectacle.Keywords: genomics, biodigital, bodies, spectacle, everyda

Have we seen the geneticisation of society? Expectations and evidence

Abby Lippman’s geneticization thesis, of the early 1990s, argued and anticipated that with the rise of genetics, increasing areas of social and health related activities would come to be understood and defined in genetic terms leading to major changes in society, medicine and health care. We review the considerable literature on geneticization and consider how the concept stands both theoretically and empirically across scientific, clinical, popular and lay discourse and practice. Social science scholarship indicates that relatively little of the original claim of the geneticization thesis has been realised, highlighting the development of more complex and dynamic accounts of disease in scientific discourse and the complexity of relationships between bioscientific, clinical and lay understandings. This scholarship represents a shift in social science understandings of the processes of sociotechnical change, which have moved from rather simplistic linear models to an appreciation of disease categories as multiply understood. Despite these shifts, we argue that a genetic imaginary persists, which plays a performative role in driving investments in new gene-based developments. Understanding the enduring power of this genetic imaginary and its consequences remains a key task for the social sciences, one which treats ongoing genetic expectations and predictions in a sceptical yet open way

Protocol for a randomised controlled trial of standard wound management versus negative pressure wound therapy in the treatment of adult patients with an open fracture of the lower limb : UK wound management of open lower limb fractures (UK WOLFF)

Introduction: Patients who sustain open lower limb fractures have reported infection risks as high as 27%. The type of dressing applied after initial debridement could potentially affect this risk. In this trial, standard dressings will be compared with a new emerging treatment, negative pressure wound therapy, for patients with open lower limb fractures. Methods and analysis: All adult patients presenting with an open lower limb fracture, with a Gustilo and Anderson (G&A) grade 2/3, will be considered for inclusion. 460 consented patients will provide 90% power to detect a difference of eight points in the Disability Rating Index (DRI) score at 12 months, at the 5% level. A randomisation sequence, stratified by trial centre and G&A grade, will be produced and administered by a secure web-based service. A qualitative substudy will assess patients’ experience of giving consent for the trial, and acceptability of trial procedures to patients and staff. Patients will have clinical follow-up in a fracture clinic up to a minimum of 12 months as per standard National Health Service (NHS) practice. Functional and quality of life outcome data will be collected using the DRI, SF12 and EQ-5D questionnaires at 3, 6, 9 and 12 months postoperatively. In addition, information will be requested with regards to resource use and any late complications or surgical interventions related to their injury. The main analysis will investigate differences in the DRI score at 1 year after injury, between the two treatment groups on an intention-to-treat basis. Tests will be two sided and considered to provide evidence for a significant difference if p values are less than 0.05. Ethics and dissemination: Ethical approval was given by NRES Committee West Midlands—Coventry & Warwickshire on 6/2/2012 (ref: 12/WM/0001). The results of the trial will be disseminated via peer-reviewed publications and presentations at relevant conferences

Effect of negative pressure wound therapy vs standard wound management on 12-month disability among adults with severe open fracture of the lower limb : the WOLLF randomised clinical trial

Importance Open fractures of the lower limb occur when a broken bone penetrates the skin. There can be major complications from these fractures, which can be life-changing. Objectives To assess the disability, rate of deep infection, and quality of life in patients with severe open fracture of the lower limb treated with negative pressure wound therapy (NPWT) vs standard wound management after the first surgical debridement of the wound. Design, Setting, and Participants Multicenter randomized trial performed in the UK Major Trauma Network, recruiting 460 patients aged 16 years or older with a severe open fracture of the lower limb from July 2012 through December 2015. Final outcome data were collected through November 2016. Exclusions were presentation more than 72 hours after injury and inability to complete questionnaires. Interventions NPWT (n = 226) in which an open-cell solid foam or gauze was placed over the surface of the wound and connected to a suction pump, creating a partial vacuum over the dressing, vs standard dressings not involving application of negative pressure (n = 234). Main Outcomes and Measures Disability Rating Index score (range, 0 [no disability] to 100 [completely disabled]) at 12 months was the primary outcome measure, with a minimal clinically important difference of 8 points. Secondary outcomes were complications including deep infection and quality of life (score ranged from 1 [best possible] to −0.59 [worst possible]; minimal clinically important difference, 0.08) collected at 3, 6, 9, and 12 months. Results Among 460 patients who were randomized (mean age, 45.3 years; 74% men), 88% (374/427) of available study participants completed the trial. There were no statistically significant differences in the patients’ Disability Rating Index score at 12 months (mean score, 45.5 in the NPWT group vs 42.4 in the standard dressing group; mean difference, −3.9 [95% CI, −8.9 to 1.2]; P = .13), in the number of deep surgical site infections (16 [7.1%] in the NPWT group vs 19 [8.1%] in the standard dressing group; difference, 1.0% [95% CI, −4.2% to 6.3%]; P = .64), or in quality of life between groups (difference in EuroQol 5-dimensions questionnaire, 0.02 [95% CI, −0.05 to 0.08]; Short Form–12 Physical Component Score, 0.5 [95% CI, −3.1 to 4.1] and Mental Health Component Score, −0.4 [95% CI, −2.2 to 1.4]). Conclusions and Relevance Among patients with severe open fracture of the lower limb, use of NPWT compared with standard wound dressing did not improve self-rated disability at 12 months. The findings do not support this treatment for severe open fractures. Trial Registration isrctn.org Identifier: ISRCTN3375665

The ethics of uncertainty for data subjects

Modern health data practices come with many practical uncertainties. In this paper, I argue that data subjects’ trust in the institutions and organizations that control their data, and their ability to know their own moral obligations in relation to their data, are undermined by significant uncertainties regarding the what, how, and who of mass data collection and analysis. I conclude by considering how proposals for managing situations of high uncertainty might be applied to this problem. These emphasize increasing organizational flexibility, knowledge, and capacity, and reducing hazard

A view through a window: Social relations, material objects and locality

In this article the authors ask what it would mean to think sociologically about the window as a specific material and symbolic object. Drawing on qualitative analysis of a series of comparative interviews with residents in three different streets in a diverse local area of Glasgow, they explore what the use and experience of windows tells us about their respondents’ very different relationships to the places where they live. On the one hand, the window, as a material feature of the home, helps us grasp the lived reality of class inequality and how such inequality shapes people’s day-to-day experience. On the other hand, windows are symbolically charged objects, existing at the border of the domestic and public world. For this reason, they feature in important ways in local debates over the appearance, ownership and conservation of the built environment. The article explores these struggles, and shows what they reveal about the construction of belonging in the neighbourhood, a process which is both classed and racialised at one and the same time.ESR

Co-producing a multi-stakeholder core outcome set for distal tibia and ankle fractures (COSTA) : a study protocol

Background: Ankle fracture is a common injury with a strong evidence base focused on effectiveness of treatments. However, there are no reporting guidelines on distal tibia and ankle fractures. This has led to heterogeneity in outcome reporting and consequently, restricted the contribution of evidence syntheses. Over the past decade, core outcome sets have been developed to address this issue and are available for several common fractures, including those of the hip, distal radius, and open tibial fractures. This protocol describes the process to co-produce – with patient partners and other key stakeholders – a multi-stakeholder derived Core Outcome Set for distal Tibia and Ankle fractures (COSTA). The scope of COSTA will be for clinical trials. Methods: The study will have five-stages which will include: i) systematic reviews of existing qualitative studies and outcome reporting in randomised controlled trial studies to inform a developing list of potential outcome domains; ii) qualitative interviews (including secondary data) and focus groups with patients and healthcare professionals to explore the impact of ankle fracture and the outcomes that really matter; iii) generation of meaningful outcome statements with the study team, international advisory group and patient partners; iv) a multi-round, international e-Delphi study to achieve consensus on the core domain set; v) and an evidence-based consensus on a core measurement set will be achieved through a structured group consensus meeting, recommending best assessment approaches for each of the domains in the core domain set. Discussion: Development of COSTA will provide internationally endorsed outcome assessment guidance for clinical trials for distal tibia and ankle fractures. This will enhance comparative reviews of interventions, potentially reducing reporting bias and research waste

A social licence for science: capturing the public or co-constructing research?

The “social licence to operate” has been invoked in science policy discussions including the 2007 Universal Ethical Code for scientists issued by the UK Government Office for Science. Drawing from sociological research on social licence and STS interventions in science policy, the authors explore the relevance of expectations of a social licence for scientific research and scientific contributions to public decision-making, and what might be involved in seeking to create one. The process of seeking a social licence is not the same as trying to create public or community acceptance for a project whose boundaries and aims have already been fully defined prior to engagement. Such attempts to “capture” the public might be successful from time to time but their legitimacy is open to question especially where their engagement with alternative research futures is “thin”. Contrasting a national dialogue on stem cells with the early history of research into bioenergy, we argue that social licence activities need to be open to a “thicker” engagement with the social. Co-constructing a licence suggests a reciprocal relationship between the social and the scientific with obligations for public and private institutions that shape and are shaped by science, rather than just science alone

Prostaglandin E2 stimulates progression-related gene expression in early colorectal adenoma cells

Upregulation of cyclooxygenase-2 (COX-2) and prostaglandin-dependent vascularisation in small adenomatous polyps is an essential part of colon carcinogenesis. To study the underlying cellular mechanisms, LT97 and Caco2 human colorectal tumour cells not expressing endogenous COX-2 were exposed to 1 μM prostaglandin E2 (PGE2) in their medium. At 30 min after addition, expression of c-fos was stimulated 5-fold and 1.3-fold, respectively, depending on the activation of both extracellular signal-regulated kinase and p38. The amount of c-jun in nuclear extracts was increased 20% in LT97 cells. Expression of COX-2 was upregulated 1.7-fold in LT97 cells and 1.5-fold in Caco2 2 h after prostaglandin (PG) addition by a p38-mediated pathway. The known PGE2 target gene vascular endothelial growth factor (VEGF) was not modulated. Effects of sustained PGE2 production were studied in VACO235 cells that have high endogenous COX-2 and in LT97 cells infected with an adenovirus expressing COX-2. Prostaglandin E2 secretion into the medium was 1–2 nM and 250 pM, respectively. Expression of both VEGF and c-fos was high in VACO235 cells. In LT97 cells, COX-2 upregulated c-fos expression and c-jun content in nuclear extracts 1.7- and 1.2-fold, respectively, in a PG-dependent way. This shows that exogenous PGE2 as well as COX-2 overexpression affect signalling and gene expression in a way that enhances tumour progression