Designing the past: the National Trust as a social-material agency

The National Trust was founded in 1895 for ‘the preservation of places of historic interest or natural beauty’. While the distinction between the cultural and the natural seemed obvious at that time and members and visitors were not even implicated actors, we argue that the National Trust may be better understood as a co-constructed network effect of the social and material, which in turn affords social-material agency. There are currently 3.5 million members of the National Trust and 50 million visitors every year to National Trust properties, which include the largest collection of gardens in the world and over 300 historic houses and open-air properties. While the notion of design itself may seem to be an exemplar of the humanist love of agency, we argue (following Latour) that traditional notions of agency, which were asymmetrically distributed to the human actors, take insufficient cognisance of evident occasions of ‘material agency’ (Pickering, 1995) and the site of conservation is one site whereby the agency produced by social-material assemblages seems interesting and revealing. Whereas the social-material practices of design may seem in some tension with those of conservation, we argue in this paper that a close analysis of a particular site of conservation shows a manifold of ‘designing’ actors. Whatever the National Trust conserves could be considered as an example of particular and situated designs condensed from the interactions of humankind and nature. Similarly the visitor experience is also designed. While conservation can imply a certain social-material agency, it is much less well understood how conservation co-produces agency, and how these network effects serve the purposes of conservation by the Trust, visitors and other actors through the agency of the social and material. This paper will reveal some of the social-material practices which afford a visit to a property and what such visits afford the social-material practices of the National Trust

Glucosamine and Chondroitin for Osteoarthritis

Glucosamine reduces pain and improves function in patients with knee or hip osteoarthritis. (Strength of recommendation: B, based on systematic reviews and a meta-analysis) Glucosamine may be beneficial in other forms of osteoarthritis as well. (Strength of recommendation: B, based on a randomized controlled trial [RCT]) Chondroitin has not consistently been found to improve pain or functional status. (Strength of recommendation: B, based on a systematic review and a meta-analysis

The Results of Treatment with Streptomycin Plus Pyrazinamide in Patients with Active Pulmonary Tuberculosis Despite Prolonged Treatment with Isoniazid Plus PAS

This report presents the findings during a year or more of observation of 20 South Indian patients who, after an initial course of isoniazid plus PAS, were treated with streptomycin plus pyrazinamide for active pulmonary tuberculosis. The combination of streptomycin plus pyrazinamide was chosen, first, because of its likely therapeutic effectiveness, since all the patients had streptomycin-sensitive strains of bacilli, secondly, because it presented an opportunity to study supervised drug administration in domiciliary patients in a community in which the selfadministration of antituberculosis drugs could not be depended on (Fox, 1958 ; Tuberculosis Chemotherapy Centre, 1959, 1960 ; Velu et al., 1960). The patients were either unsuitable for or unwilling to undergo surgery

Incidence of surgical site infection following mastectomy with and without immediate reconstruction using private insurer claims data

OBJECTIVE: The National Healthcare Safety Network classifies breast operations as clean procedures with an expected 1–2% surgical site infection (SSI) incidence. We assessed differences in SSI incidence following mastectomy with and without immediate reconstruction in a large, geographically diverse population. DESIGN: Retrospective cohort study. PATIENTS: Commercially-insured women aged 18–64 years with ICD-9-CM procedure or CPT-4 codes for mastectomy from 1/1/2004–12/31/2011. METHODS: Incident SSIs within 180 days after surgery were identified by ICD-9-CM diagnosis codes. The incidence of SSI after mastectomy +/− immediate reconstruction was compared by the chi-square test. RESULTS: From 2004–2011, 18,696 mastectomy procedures among 18,085 women were identified, with immediate reconstruction in 10,836 (58%) procedures. The 180-day incidence of SSI following mastectomy with or without reconstruction was 8.1% (1,520/18,696). Forty-nine percent of SSIs were identified within 30 days post-mastectomy, 24.5% between 31–60 days, 10.5% between 61–90 days, and 15.7% between 91–180 days. The incidence of SSI was 5.0% (395/7,860) after mastectomy-only, 10.3% (848/8,217) after mastectomy plus implant, 10.7% (207/1,942) after mastectomy plus flap, and 10.3% (70/677) after mastectomy plus flap and implant (p<0.001). The SSI risk was higher after bilateral compared with unilateral mastectomy with (11.4% vs. 9.4%, p=0.001) and without (6.1% vs. 4.7%, p=0.021) immediate reconstruction. CONCLUSIONS: SSI incidence was two-fold higher after mastectomy with immediate reconstruction than after mastectomy alone. Only 49% of SSIs were coded within 30 days after operation. Our results suggest stratification by procedure type will facilitate comparison of SSI rates after breast operations between facilities

The Diet, Physical Activity and Accommodation of Patients with Quiescent Pulmonary Tuberculosis in a Poor South Indian Community

A previous report from the Tuberculosis Chemotherapy Centre, Madras, has shown that, if standard chemotherapy is given for one year, the response of patients treated at home in very poor environmental circumstances is nearly as good as that of those treated in sanatorium under much more favourable conditions. This paper reports on a four-year follow-up of all the patients whose disease was bacteriologically quiescent at the end of the year’s treatment. During this period, all the patients were managed on a domiciliary basis : about a quarter of them received chemotherapy with isoniazid alone for two years, another quarter received the drug for one year and the rest received no specific chemotherapy. Despite adverse environmental factors (poor diet ; long hours of work often involving strenuous physical activity ; overcrowded living conditions ; and, for the sanatorium patients, the stresses of returning suddenly to the unfavourable home environment), the great majority of patients in both series maintained quiescent disease throughout the follow-up period. Furthermore, the few patients whose disease relapsed bacteriologically were at no special dietary disadvantage in comparison with those who maintained quiescent disease throughout, nor did they show any appreciable differences in occupation, physical activity or living accommodation. These findings, together with the earlier ones, indicate that, despite adverse environmental circumstances, standard chemotherapy for an adequate period of time is sufficient in the great majority of patients for the attainment of bacteriological quiescence and its maintenance thereafter

The Role of Diet in the Treatment of Pulmonary Tuberculosis: An Evaluation in a Controlled Chemotherapy Study in Home and Sanatorium Patients in South India

Before the advent of antituberculosis chemotherapy, a diet rich in calories, proteins, fats, minerals and vitamins was generally considered to be an important, if not essential, factor in the treatment of tuberculosis. The introduction of specific antituberculosis drugs, however, has so radically altered the management of the disease that the role of diet has to be reconsidered in the light of the recent advances in treatment. An evaluation of the influence of diet in the treatment of pulmonary tuberculosis with isoniazid plus p-aminosalicylic acid was recently undertaken by the Tuberculosis Chemotherapy Centre, Madras, in the course of a controlled comparison of home and sanatorium chemotherapy for tuberculous patients from a poverty-stricken community in Madras City. Despite the fact that during the year of treatment the home patients subsisted on a markedly poorer diet, were physically more active and, on the average, gained less weight than the sanatorium patients, the overall response to treatment in the home series closely approached that in the sanatorium series, although there was a tendency for tubercle bacilli to disappear earlier in the latter. Direct evidence has been presented that none of the dietary factors studied (calories, carbohydrates, total and animal proteins, fats, minerals and vitamins) appears to influence the attainment of quiescent disease among tuberculous patients treated for one year with an effective combination of antimicrobial drugs, and that initial chemotherapy of patients at home can be successful even if the dietary intake is low throughout the period of treatment

The Virulence in the Guinea-pig of Tubercle Bacilli Isolated before Treatment from South Indian Patients with Pulmonary Tuberculosis 3. Virulence related to Pretreatment Status of Disease and to Response to Chemotherapy

This is the last of a series of three reports from the Tuberculosis Chemotherapy Centre Madras, on a study undertaken with the object of finding out whether differences in the virulence in the guinea-pig of tubercle bacilli isolated from South Indian tuberculous patients before the start of chemotherapy are related to the severity of the patients’ disease on admission to treatment and to the subsequent response to chemotherapy. The 281 patients in this study were drawn from the patients admitted to a l-year comparison of four domiciliary chemotherapeutic regimens : (a) 3.9-5.5 mg/kg isoniazid plus 0.2-0.3 g/kg sodium PAS daily, divided into two doses (PH series) ; (b) 7.8-9.6 mg/kg isoniazid alone daily in one dose (HI-I series) ; (c) 7.8-9.6 mg/kg isoniazid alone daily, divided into two doses (HI-2 series) ; (d) 3.9-5.5 mg/kg isoniazid alone daily, divided into two doses (H series). No evidence was found of an association between the virulence of the organisms and any pretreatment condition of known prognostic importance. There was no association between pretreatment virulence and progress during treatment in the PH series (the most effective regimen). In the other series, however, the progress was more satisfactory in patients infected with organisms of low virulence than in those infected with organisms of high virulence, the association between virulence and progress attaining statistical significance in the combined HI-2 and H series (the least effective regimens) and only just failing to do so in the smaller HI-1 series. Possible explanations are put forward both for the absence of an association between virulence and severity of disease on admission and for the presence of an association between virulence and response in the patients treated with isoniazid alone

Should mobile learning be compulsory for preparing students for learning in the workplace?

From the contexts of current social, educational and health policy, there appears to be an increasingly inevitable “mobilisation” of resources in medicine and health as the use mobile technology devices and applications becomes widespread and culturally “normed” in workplaces. Over the past 8 years, students from the University of Leeds Medical School have been loaned mobile devices and smartphones and been given access to mobile-based resources to assist them with learning and assessments as part of clinical activity in placement settings. Our experiences lead us to suggest that educators should be focusing less on whether mobile learning should be implemented and more on developing mobile learning in curricula that is comprehensive, sustainable, meaningful and compulsory, in order to prepare students for accessing and using such resources in their working lives

A novel system to obtain addresses of out-patients-assessent in routine clinic practice in Madras

A novel method of obtaining accurate home addresses from out-patients was introduced as a routine procedure in 6 chest clinics of Madras City, following highly satisfactory results under study conditions. In this method, the patient is given a card (the address card), and asked to get his exact address entered on it by any knowledgeable person of his choice such as a landlord or neighbour. An assessment of the system was undertaken after it had been in operation for about 8 months. A complete and legible address was available for 82 % of 3956 patients, the range in the 6 clinics being 74 % to 91 %. The main causes for failure were : not giving address card to patient (7 %), patient not reattending the clinic (6 %), and patient reattending but not returning the address card (3%). Corrective measures have now been introduced, and a re-assessment will be undertaken in due course