bluuebunny/crossref_metadata_2025 huggingface dataset:
Who knows best? Negotiations of knowledge in clinical decision making
Authors: Jacobsen Charlotte Bredahl , Martin Helle Max , Baker Vibe Hjelholt
Published: September 2016

This article examines the conflicts which arise when patients with chronic disease engage in decision making with health professionals about their medication. These are conflicts in the sense of discrepancies or incompatibilities between perceptions or opinions of different people engaged in a common endeavour. The paper is based on three qualitative research studies and presents one case from each study to illustrate analytical findings. Data collected in the original studies consisted of observations of clinical encounters and semi-structured interviews; in total 45 interviews with patients and 23 with health professionals. The analysis shows different conflicts, which arise during the process of making decisions about medication. These conflicts arise when: 1) Patients deliberately hold back information about their medication for fear of challenging clinicians’ authority; 2) The decision making process takes place in an environment, which does not support patient involvement; and 3) Patients refer to pharmacological knowledge, but are considered ill-equipped to understand and apply this knowledge by health professionals. The article shows that these conflicts typically revolve around the legitimate access to and use of pharmacological knowledge. These results have important implications for the current discussions of shared decision making. In shared decision making, knowledge about medication is typically regarded as the domain of the doctor. We argue that there is a need for a widening of the concept of partnership, which is central to shared decision making, to encompass breadth of patient knowledge about his/her situation, disease and treatment. Patients with chronic diseases need to be actively invited to disclose the extensive clinical knowledge they acquire over time, thereby creating a legitimate space for this knowledge in clinical consultations, and avoiding that conflicts over knowledge domains lead to unnecessary suffering and wasted resources.
Hvad er ledelse af brugerinddragelse? En gennemgang af mål og tre individuelle brugerinddragelsesmodeller
Authors: Holm-Petersen Christina , Navne Laura Emdal
Published: September 2016

Brugerinddragelse i det danske sundhedsvæsen står højt på den politiske dagsorden, men det er stadig en udfordring at implementere visionen i klinisk praksis. Ledelse af brugerinddragelse bliver aktuelt udpeget som en central nøgle til at føre visionen ud i livet. Samtidig er der kun relativt lidt forskning om ledelse af brugerinddragelse i sundhedsvæsenet og på det empiriske plan er det uklart, hvad det er lederne skal implementere. Artiklen identificerer syv forskellige italesatte mål med brugerinddragelse, hvoraf nogle potentielt kan være i konflikt med hinanden. Herudover peges der på, at brugerinddragelse skal implementeres i en verden, hvor der allerede er en række andre mål tilstede. En central ledelsesudfordring er derfor, at nogle af målene med brugerinddragelse forudsætter nye måder at organisere ikke bare arbejdet og kompetencer på, men også relationer til patienter og pårørende. En væsentlig opgave i ledelse af brugerinddragelse vil derfor være at fremme en gentænkning af de etablerede roller og identiteter i sundhedsvæsenet. Artiklen opstiller tre forskellige inddragelsesmodeller, der hver organiserer relationer mellem sundhedsprofessionelle og sundhedsvæsenets brugere på forskellige måder.Artiklen bygger dels på en gennemgang af dansk og international litteratur og policy dokumenter, dels på en empirisk best practice undersøgelse af ledelse af brugerinddragelse, som i perioden 2012-2013 blev gennemført på tre danske hospitalsafdelinger.
Sygdommens rum
Authors: Risør Torsten
Published: September 2016

Antropologien har menneskers praksis i fysiske og sociale rum som en integreret del af sit forskningsprojekt (Bourdieu, 2000; Ingold, 2000b). Et etnografisk feltar- bejde er en omfattende affære, hvor en principielt endeløs række af forskellige aspekter af menneskelivets mange aspekter analyseres og fortolkes – boformer og livsformer, kommunikation og handel, de fysiske objekter og sprogets kategorier, slægtskaber og fællesskaber, udveksling og konflikt, status og økonomi etc.Men medicinske antropologer har beskrevet – og kritiseret - at antropologien traditionelt har sat grænsen for udforskningen af mennesket ved kroppens over- flade og overladt menneskets biologi og patologi til andre fag; mens medicinen nok har set ydre faktorer som betydningsfulde for sygdom, men fortsat som ad- skilte fra ”den egentlige” sygdom (Baer, Singer & Susser, 2003). Disse skel er nu ikke blot til diskussion, de bliver direkte udfordret og gjort til genstand for un- dersøgelse. Det er denne udfordring, som vi ønsker at give en platform med dette temanummer af Sygdom & Samfund.
Can caesarean section be ‘natural’? The hybrid nature of the nature-culture dichotomy in mainstream obstetric culture
Authors: Maffi Irene
Published: September 2016

Reflecting on the recent creation of the surgical technique of ‘natural caesarean’, this paper investigates how caesarean section, a major abdominal surgery, can be associated with ‘natural childbirth’ To understand the paradoxical creation of this concept, I look back at the history of obstetrics and at the evolution of the nature/culture dichotomy in European modern thought. The multiple meanings of these two concepts and the epistemological and social premises underpinning the formation of modern obstetrics are examined to unravel the complexity of current medical practices applied to women’s bodies as well as women’s attitudes. In light of these historical elements, natural caesarean is understood as a notion born from cultural and professional negotiations and fraught with contradictory meanings originating from different medical and cultural discursive traditions.
Hvorfor akut kræft? Et bud på en epidemisk forståelse af tid og kræft-tendenser i Danmark
Authors: Tørring Marie Louise
Published: September 2016

I 2007 blev den danske regering og Danske Regioner enige om, at kræft skulle behandles som en akut sygdom. Aftalen er beskrevet som en kolossal præstation og succeshistorie, og den udvikling, der gik forud, omtales gerne som en forbrødring, en kulturændring, ja sågar et mirakel.Det rejser interessante antropologiske spørgsmål om kulturel fortid og kulturel forskel i måden at opfatte og behandle sygdomme på. I denne artikel undersøges derfor, hvad der gjorde det muligt at rammesætte kræft som akut sygdom i Danmark i nullerne.Artiklen analyserer en række udbredte almene, politiske og videnskabelige argumenter om akut kræft baseret på læsning af litteratur fra perioden samt erfaringer fra forfatterens eget ph.d.-projekt, der startede i 2007 og indskrev sig direkte ind i den centrale diskussion om tid og kræft ved at undersøge sammenhængen mellem ventetid og dødelighed blandt kræftpatienter.For at forstå de komplicerede biologiske, kulturelle og sociale processer, der tilsammen skabte et øget fokus på tid og kræft, anlægger artiklen et relationelt antropologisk perspektiv, der ser praksis som resultatet af ulige vektorers indflydelse i et bestemt felt. Analysen peger således på, at akut kræft i Danmark var resultatet af øget digital tydelighed (en eksponentiel vækst i numeriske repræsentationer som overlevelsesestimater og ventetidsfrekvenser), magtfulde minder om kræft og øget levealder i en kontekst af kulturel polaritet karakteriseret ved bobleøkonomi og frygtpolitik.
Medikalisering av cancerfamiljer ger framtida skuggor
Authors: Sachs Lisbeth
Published: September 2016

När nu det genetiska arvet framstår alltmer som en förklaring till sjukdom och mänskligt beteende i allmänhet behöver man ställa frågan hur sådana förklaringar påverkar människors uppfattningar om familj och släktskap över tid och i framtiden och i vilken utsträckning genetiska förklaringar strider mot vidare social utveckling. Idéer om genetiskt arv och cancersjukdom sätter familj och släktgrupper i fokus. När en person informeras om anlag för cancersjukdom blir frågan om alla medlemmar i en släktgrupp bör informeras och undersökas. Det kan gälla såväl från en medicinetisk utgångspunkt som från en känslomässig och ansvarskännande utgångspunkt bland diagnostiserade enskilda. Forskning kring ärftliga sjukdomar innebär en medikalisering av släktskap något som kan innebära stora förändringar för enskilda personer. Under en tid då familjestrukturer är mera flytande och mindre bestämda genom blodsband än tidigare kan man ställa frågan vilken betydelse en betoning av genetiskt arv som överförare av mänskligt beteende och släktskap kan få. Inbyggt i begreppet genetiskt arv finns en betoning av familj och släkt som medier genom vilka ärftlighet flyter. Ett fall från en antropologisk studie illustrerar hur genetisk kargtläggning leder till medikalisering av släktskap[1].[1] En tidigare version finns publicerad i Scand.J of Publ.Health 2004 men är här uppdaterad och reviderad.
Det er da unge, der dør af kræftsygdomme og gamle som dør af andre livstruende sygdomme? - Professionelles forestillinger om palliativ indsats i relation til sygdomme
Authors: Raunkiær Mette
Published: September 2016

Professionelles kategoriseringer og retorik har betydning for de konkrete tilbud, som patienter oplever og modtager i sundhedssystemet. I Sundhedsstyrelsens nye anbefaling for den palliative indsats fremgår det, at indsatsen overfor alle mennesker med livstruende sygdomme skal udvikles. Det kan blive en udfordring, når professionelle er bærer af en kultur, hvor kræft og palliation placeres i samme kategori. En måde at bidrage til ændringer i praksis eller grundlag for ændringer er at få øjnene op for kategoriseringsprocessernes logik og tilblivelse. Denne artikel undersøger spørgsmålet: Hvordan begrunder og taler professionelle om deres muligheder for at udøve palliativ indsats til mennesker med kræft og andre livstruende sygdomme som fx kronisk obstruktiv lungelidelse (KOL) og hjertekarsygdomme? Metoden er fokusgruppeinterviews med praktiserende læger, sygeplejersker, social- og sundhedsassistenter samt social- og sundhedshjælpere. Interviewene er analyseret ud fra en socialkonstruktionistisk tilgang og med afsæt i Potters kategoriseringstemaer: a) Ontologiske manipulation, b) hvordan noget gøres ekstremt (stort) eller minimeres (lille), og c) hvordan noget kan normaliseres. Resultaterne viser, hvordan palliation og kræft forbindes med alvor, død og unge mennesker, mens andre livstruende sygdomme forbindes med noget fredeligt, livet, ældre og i mindre grad med palliation. Dette får bl.a. den betydning, at de professionelle oplever, at de møder mennesker med kræftsygdomme med større opmærksomhed og stiller sig fagligt og personligt mere til rådighed. Med henblik på ændring af praksis og udvikling af en mere nuancerede forståelse af kræft, andre livstruende sygdomme og palliation, bliver det væsentligt at påvirke de sundhedsprofessionelle gennem uddannelser, i klinikken og via patientforeninger.
Kræft og Håbsarbejde
Authors: Hansen Helle Ploug , Tjørnhøj-Thomsen Tine
Published: September 2016

Flere undersøgelser viser, at en kræftdiagnose kan afstedkomme en eksistentiel chokbølge med angst, fremtidsbekymringer og revidering af livsplaner som følge. Håb er en vigtig komponent af livet med en kræftsygdom, men der mangler viden om, hvordan håb udspiller sig konkret i hverdagslivet med kræft, og hvordan håb påvirker og påvirkes af sociale relationer. En indsigt heri vil kunne bane vej for, at rehabilitering tilrettelægges, således at håb, livsplaner og livsorienteringer bliver en integreret del heraf. Artiklen bygger på etnografisk materiale fra forfatternes antropologiske studier blandt mennesker med kræft i Danmark. Cheryl Mattinglys begreb håbsarbejde og Barbara Adams begreber om tid benyttes til at sætte fokus på nogle overordnede tidsorienteringer eller temporaliteter. Vi viser, at et liv med kræft analytisk kan anskues som et ophold i en lobby, hvor fremtiden er usikker og forbundet med konkrete ny-orienteringer, handlinger og praksis.
Introduction
Authors: Ostenfeld-Rosenthal Ann , Johannessen Helle
Published: September 2016

Introduction for "Placebo"
Patients, pharmacists, and the placebo in France: From iatrogenic to ethical risks
Authors: Fainzang Sylvie
Published: September 2016

Placebos have attracted widespread interest amongst anthropologists who have sought to explain the placebo dimension of medicines or healing rituals prescribed by health professionals or traditional healers by emphasizing aspects relating to symbolic healing. Very little investigation has been done however into the perceptions individuals hold of placebos, and their reasons for resorting to placebos and/or the placebo effect within the framework of family medication, on one hand, and the perception pharmacists have on this issue and the uses they make of it in their responses to the demands of users, on the other. This article addresses their uses of placebos and the placebo effect within the context of medicinal risk management in France; it also examines the perception actors have of placebos (whether ‘pure’ or ‘impure’) in the light of their ethical positions.
Sygdomsopfattelse - et sundhedspsykologisk perspektiv
Authors: Frostholm Lisbeth
Published: September 2016

I det følgende vil jeg præsentere en kognitionspsykologisk model af sygdomsopfattelse. Med udgangspunkt i en undersøgelse, jeg foretog hos 38 praktiserende læger og 1785 patienter i Århus Amt år 2002-20021, undersøges, om denne model er anvendelig i almen praksis, og om patienter med funktionelle fysiske symptomer (FSS) i deres sygdomsopfattelse adskiller sig fra andre patientgrupper i almen praksis.
Om metodologi
Authors: Risør Mette Bech
Published: September 2016

Intet resume
Epistemologi, evidensbasering og patientperspektiver
Authors: Thorgaard Keld
Published: September 2016

Betydningen af patientperspektivet fremhæves i adskillige sammenhænge i sundhedsvæsnet (i klinisk praksis, i sundhedspolitik m.m.) af bl.a. medicinske filosoffer og i humanistisk sundhedsforskning. Fra et epistemologisk perspektiv er det imidlertid ofte uklart, hvad der menes med ’patientens perspektiv’. I denne artikel argumenteres for, at vi må udfordre patientperspektiver forstået som præferencer og som spontane subjektive udtryk, hvis vi skal lykkes med en redegørelse for patientperspektivernes epistemologi. Dele af den humanistiske sundhedsforskning kan bidrage til at analysere, hvorledes patientperspektiver konstitueres som en vigtig kilde til viden, og den kan ligeledes udfordre antagelser og forståelser i praksiser.
Teknologi Skaper Sykdom - Om teknologi, sykdom og verdier
Authors: Hofmann Bjørn
Published: September 2016

Teknologien har endret helsevesenet radikalt de siste 200 år. Den har ikke bare endret mulighetene til å diagnostisere og behandle sykdom. Teknologien har også formet våre oppfatninger av sykdom: Teknologien etablerer de grunnelementer som definerer sykdom (ontologi) og bestemmer sykdommenes tegn (semiologi). Den former vår kunnskap om sykdom (epistemologi), og den genererer sykdommenes praksiser (pragmatikk). Ved å øke den diagnostiske følsomheten, blir flere syke, og sykdommer med avansert teknologibruk har høyere status enn sykdommer uten. Teknologien trekker søkelyset mot det den lar oss måle og manipulere og influerer dermed våre mål. Teknologien påvirker altså ikke bare sykdom gjennom pasienters behov og industriens interesser, men gjennom formingen av helsefagenes rasjonalitet. Ved å forme våre oppfatninger av sykdom, formes våre forestillinger av godt og (v)ondt. Denne artikkelen undersøker hvordan teknologi skaper sykdom og presenterer et rammeverk for å forstå hvordan verdier er involvert i (sam)spillet mellom teknologi og sykdom. Samtidig som teknologien har blitt en stor hjelp i kampen mot lidelse og død, har den blitt en del av vår rasjonalitet og vår vurdering av sykdom, av lidelse og vår død – ja oss selv.
Screening: En mulighed versus en risiko
Authors: Østergaard Elisabeth Bomholt
Published: September 2016

I denne artikel udforskes og diskuteres screeningers mulige implikationer for individer og samfund – her med udgangspunkt i screening for brystkræft, livmoderhalskræft, forhøjet kolesterol og knogleskørhed. Der fokuseres på screeningers mulige betydninger for følelsen af krop og selv med henblik på at diskutere, hvilken rolle screening kan have set i et forebyg­gelses- og sundhedsfremmeperspektiv. Formålet med artiklen er at skabe diskussion om screeningers positive og negative betydninger. I artiklen argumenteres for at screening ud­over at redde liv og give tryghed også medvirker til usikkerhed og ængstelse. Derudover kan screening muligvis medvirke til risikotænkning, afhængighed af eksperter og til at kropslige signaler overhøres. Screening er en forbyggende foranstaltning der ikke nødvendigvis giver mulighed for et sundt liv. Artiklen foreslår at fokus på kropsbevidsthed styrkes i takt med, at antallet af screeninger stiger – samt bidrager til diskussionen om det etisk forsvarlige i, at raske mennesker i stigende grad screenes for mulige fremtidige sygdomme.
Indsatsen overfor alvorligt syge og døende set fra et sundhedsfagligt perspektiv
Authors: Vejlgaard Tove
Published: September 2016

Palliativ indsats er den helhedsorienterede, tværfaglige, sundhedsfaglige indsats, hvis overordnede mål er at lindre lidelsen hos patienter med alvorlig, uhelbredelig og livstruende sygdom. Palliativ indsats blev først defineret af WHO i 1990, definitionen blev revideret i 2002. Dame Cicely Saunders grundlagde i 1967 St. Christopher's Hospice i Sydlondon, og var grundlæggeren af den moderne palliative indsats. I artiklen beskrives udviklingen af den palliative indsats i England, som på mange måder har været inspirerende for den langt senere udvikling i Danmark. Først i 1986 kom den første publikation fra Sundhedsstyrelsen om terminal pleje og omsorg for alvorligt syge og døende. Det første hospice åbnede i 1992, og den samlede udvikling i Danmark beskrives i artiklen. Der gøres status over den aktuelle situation i Danmark, hvor der er en stor spredning i tilbuddene og i de professionelles uddannelsesmæssige baggrund. Den nylige oprettelse af en national klinisk database for palliation, en DMCG (Danish Multidisciplinary Cancer Group) for palliation og et Palliativt Videncenter er meget lovende for den fremtidige udvikling. Fremtidsperspektiver omfatte betydningen af at udvikle palliativ indsats til patienter med anden alvorlig, livstruende sygdom end kræft, nødvendigheden af en tidlig indsats med udnyttelse af patientens rehabiliteringspotentiale, og endelig at udvikle indsatsen overalt i sundhedsvæsenet, ikke mindst på de mange sygehusafdelinger, hvor en stor del af patienterne fortsat dør.
Lack of motivation as suffering
Authors: Møller Jane Ege
Published: September 2016

This paper investigates how the concept of motivation functions in health promotion practice. It provides an analysis of the understandings and articulations of motivation at the levels of the state, health professionals, and citizens. It finds that motivation takes on different meanings and functions depending on the perspective; thus the general agreement on the importance of motivation in health promotion does not correspond to a mutual understanding of what motivation actually is: motivation works variously as technology, a statistically created collective informed consent, and a moral imperative. It is conceived of as an instrumentalized psychological entity but also expressed as a complex and context-bound phenomenon. The paper concludes by arguing that motivation must be seen as the latter: a relational concept, relating to concrete social and situational contexts rather than an instrumental psychological entity within the individual.
Det sure med det søde; diabetiske liv og moralske måltider i Vietnam
Authors: Bræmer Marie Højlund
Published: September 2016

Denne artikel er baseret på etnografisk feltarbejde og fokuserer på mad og spisning i relation til patienter med type 2 diabetes i Vietnams hovedstad Hanoi. Jeg tager udgangspunkt i to konkrete fortællinger om informanterne Mrs. Sau og Viet, hvis liv som velregulerede diabetikere kommer i konflikt med andre måder at investere mening i mad på. I artiklen sætter jeg fokus på officielle, nationale og internationale retningslinjer for diabetesbehandling, ernæring og det at ”være moderne”. Jeg diskuterer efterfølgende hvordan mine informanter forsøger at forholde sig til divergerende moralske og medicinske regimer i hverdagslivet i Vietnam. I denne sammenhæng er mad helt central og jeg viser hvordan den betydning, der knyttes til måltidet kan være mangfoldig, tvetydig og til tider kontrastfuld og krævende. Ydermere foreslår jeg at et teoretisk perspektiv på menneskers moraliteter, ´signifikante rutiner´ og hverdagserfaringer har et anvendelsespotentiale indenfor sundhedsfremme i Vietnam.
Madmagi: at spise sig ud af en adfærdsforstyrrelse
Authors: Ryborg Alexandra Brandt
Published: September 2016

Artiklen handler om hvordan en gruppe forældre til børn med adfærdsforstyrrelser forsøger at lade deres barn spise sig ud af diagnoser som ADHD og autisme. Gennem en særlig diæt udelukkes mad der menes at forårsage adfærdsforstyrrelserne, og dermed opstår muligheden for helbredelse som alternativ til det offentlige sygehusvæsens klassifikation af diagnoserne som livsvarige og uhelbredelige. I artiklen argumenterer jeg for at kostbehandling ikke bare skal fungere som en behandling af adfærdsforstyrrelsen, men at den, ud over at være en løsningsmodel som vedrører helbredsproblemet, også er en familieteknologi og fungerer som en metode for forældrene til at kontrollere usikkerheden omkring barnets adfærdsforstyrrelse. Dette ligner på mange måder hvad, antropologer beskriver som magi. Jeg introducerer derfor begrebet madmagi, i et forsøg på at åbne for en analyse af forældrene som aktive subjekter, der også bruger kostbehandling til at navigere i en situation præget af usikkerhed. Madmagi tager afsæt i klassiske antropologiske tekster hvor magi er en særlig viden, der bruges i situationer med afmagt og mangel på kontrol. Artiklen giver en empirisk baseret diskussion af de tre aspekter af kostbehandling der tilsammen udgør madmagi; kostbehandling som løsningsmodel, som en form for familieteknologi og som usikkerhedshåndtering. Artiklen forsøger derved at bidrage til forståelsen af, hvordan kostbehandling bruges til at skabe en særlig meningsgivende og -skabende fortolkningsramme, der giver et handlerum med mulighed for aktiv de tagelse og kontrol. Det er således artiklens hensigt, ved at anvende madmagi-begrebet i analysen, at åbne op for en mere nuanceret forståelse af familier der kostbehandler deres børn med adfærdsforstyrrelser.
Antropologiske evalueringer af misbrugsbehandling - viden om kompleksitet, relationer og hverdagspraksis
Authors: Johansen Katrine Schepelern , Ludvigsen Kathrine Louise Bro
Published: September 2016

Med udgangspunkt i en række konkrete, antropologisk funderede evalueringsprojekter indenfor misbrugsbehandling diskuteres det, hvad der kendetegner sådanne evalueringer. Antropologiske evalueringer afdækker, hvordan en given praksis tager sig ud, men også hvorfor praksis tager sig ud som den gør, og hvordan denne praksis skabes og formidles i sociale relationer og forskellige kontekster. En sådan viden er ikke bare en gengivelse af empiri, men en analytisk fortolkning af denne. Det vises, hvordan den antropologisk metode er velegnet til at afdække den kompleksitet som findes på området. Artiklen viser, hvordan antropologiske evalueringer kan føre til afdækning af tavs viden i misbrugsbehandlingen, og kan bygge bro mellem forskellige forestillinger og forventninger, niveauer og positioner, samt forskellige aktører. Den antropologisk funderede evaluering kan således siges at frembringe indsigter mellem outcome (resultater og effekt), output (hvad der er udført) og processer (udviklingen i forhold til et givent projekt eller indsats). Artiklen peger dog også på en række problemer og dilemmaer indenfor den antropologiske tilgang, som man bør være opmærksom på, blandt andet den tætte relation til feltet.
Om livets kunst: en vitalistisk læsning af medicinsk humanisme
Authors: Greco Monica
Published: September 2016

In a seminal and much-cited paper, Rita Charon has described narrative medicine - and, more broadly, the opening of medicine to education in the humanities - in terms of a mission to develop skills of empathy, reflection, professionalism and communication. In this paper I propose that Canguilhem's concept of vitalism and Alfred North Whitehead's concept of the 'art of life' provide a lens through which we can read the propositions of narrative medicine and medical humanities in the context of a much broader historico-scientific problematic, and connect them with a wider set of ethical and political implications.  After setting out the relevant concepts by drawing on Canguilhem and Whitehead's work, in the latter part of the paper I explore the ethico-political question of how medicine might best serve the perfectibility of human beings, or the 'art of life'.  I do this via a historical excursus, by revisiting a debate between Viktor Von Weizsäcker and Karl Jaspers on the merits and dangers of the 'introduction of the subject within medicine'.  In their different historical context, Weizsäcker and Jaspers were able to articulate questions that remain relevant today, and that are implicit in the propositions of narrative medicine.
Træning af kontrolleret empati i accelererede kræftbehandlingsforløb
Authors: Obling Anne Roeslagaard
Published: September 2016

This paper takes departure from sociology of emotions to explore the training of empathy and empathic response in accelerated cancer care. The paper focuses on a training workshop in empathic communication during which doctors from a cancer clinic learn to recognise and control the emotional frame of doctor-patient interactions. Through a descriptive analysis, it addresses how communication techniques are rehearsed and it discusses the effects of this training. It is shown that the performance of communicating empathically relies on standardised scripts, which direct and cultivate the conduct of doctors. The paper concludes that contemporary reforming drives in public health care insert a renewed focus on humanistic values in medical interaction between doctors and patients, such as a focus on doctors’ modes of engagement in these interactions. However, these values increasingly become the aim of techniques of micro-management such as qualitative measurement and performance audit. In other words, attempts to improve softer dimensions of medical services entail a further standardisation of these dimensions.
From Rupert’s Land to Canada West: Hudson’s Bay Company Families and Representations of Indigeneity in Small-Town Ontario, 1840–1980
Authors: Barclay Krista
Published: September 2016

By the mid-nineteenth century, Hudson’s Bay Company (HBC) officers were retiring in greater numbers with their Indigenous families outside Rupert’s Land. Much work has been done to uncover the experiences of fur trade families who remained at HBC trading posts or settled in what became the American and Canadian Wests, but there has been little research on those families who left for Britain or colonial Canada. In Canada West, the racial and gendered terrains of their new home communities were complex ones for Indigenous women and their children to navigate. They played roles in both the reification and subversion of racial and gendered imperial hierarchies, and thus came to occupy unexpected and even contradictory positions in family and local historical narratives.
‘Have you any recollection of what occurred at all?’: Davis v. Colchester County Hospital and Medical Negligence in Interwar Canada
Authors: Brown R. Blake , Hudak Magen
Published: September 2016

The history of medical malpractice in Canada has received little attention from legal or medical historians. Through a contextualized study of a Nova Scotia case from the 1930s, Davis v. Colchester County Hospital, this article demonstrates how changes in technology and surgical procedures both created situations that spurred malpractice claims, and made it difficult for injured patients to prove medical negligence. In addition, developments in tort law concerning the liability of hospitals, and the doctors and nurses working within them, provided medical defendants ample opportunity to avoid legal liability, even in cases in which the existence of negligent treatment was obvious. The testimony at trial, the legal strategies utilized by the lawyers, and the judicial rulings also shed light on attitudes of the medical profession toward personal responsibility and ethics, and demonstrates how the interests of patients were weighed against those of medical institutions and professionals by lawyers and judges.
Clearing the Plains and Changing the National Conversation: James Daschuk’s Clearing the Plains as a Work of Popular and Public History
Authors: Mosby Ian
Published: September 2016

This essay assesses the impressive public reaction to James Daschuk’s Clearing the Plains and offers some possible explanations for its success as a work of both academic and popular history.
‘The Ill-name of the Old Country’: London’s Assisted Emigrants, British Unemployment Policy, and Canadian Immigration Restriction, 1905-1910
Authors: Scott Elizabeth A.
Published: September 2016

Between 1906 and 1910, Canada passed two increasingly restrictive Immigration Acts to, among other reasons, reduce charitable assisted emigration from London. These acts were passed in response to Britain’s Unemployed Workmen Act in 1905, which contained an emigration clause designed to move London’s unemployed to Canada. Canada deemed these emigrants to be unsuitable largely because they hailed from the impoverished East End of London. Emigration charities felt an imperial betrayal in the wake of the restrictions. Although an exception allowed for a limited degree of charitable emigration to continue, assisted English emigrants were now unreservedly lumped together with other undesirables in the British World. Despite Canadian displeasure, charities continued to send London’s unemployed to Canada until World War I. A more direct relationship between British unemployment policy and Canadian immigration policy is emphasized, opening a space wherein to examine transnational and imperial legal tensions in the early twentieth century British World. This space reveals a nexus of poverty, migration, and restriction that pitted Britain’s needs against Canada’s; it also complicates the concept of loyal nations belonging to a cooperative British World, becoming particularly relevant to the evolution of restrictive Canadian attitudes towards British immigrants after 1905.
Hypothalamic transcriptomes of 99 mouse strains reveal trans eQTL hotspots, splicing QTLs and novel non-coding genes
Authors: Hasin-Brumshtein Yehudit , Khan Arshad H , Hormozdiari Farhad , Pan Calvin , Parks Brian W , Petyuk Vladislav A , Piehowski Paul D , Brümmer Anneke , Pellegrini Matteo , Xiao Xinshu , Eskin Eleazar , Smith Richard D , Lusis Aldons J , Smith Desmond J
Published: September 2016

Previous studies had shown that the integration of genome wide expression profiles, in metabolic tissues, with genetic and phenotypic variance, provided valuable insight into the underlying molecular mechanisms. We used RNA-Seq to characterize hypothalamic transcriptome in 99 inbred strains of mice from the Hybrid Mouse Diversity Panel (HMDP), a reference resource population for cardiovascular and metabolic traits. We report numerous novel transcripts supported by proteomic analyses, as well as novel non coding RNAs. High resolution genetic mapping of transcript levels in HMDP, reveals both local and trans expression Quantitative Trait Loci (eQTLs) demonstrating 2 trans eQTL 'hotspots' associated with expression of hundreds of genes. We also report thousands of alternative splicing events regulated by genetic variants. Finally, comparison with about 150 metabolic and cardiovascular traits revealed many highly significant associations. Our data provide a rich resource for understanding the many physiologic functions mediated by the hypothalamus and their genetic regulation.
Origin of a folded repeat protein from an intrinsically disordered ancestor
Authors: Zhu Hongbo , Sepulveda Edgardo , Hartmann Marcus D , Kogenaru Manjunatha , Ursinus Astrid , Sulz Eva , Albrecht Reinhard , Coles Murray , Martin Jörg , Lupas Andrei N
Published: September 2016

Repetitive proteins are thought to have arisen through the amplification of subdomain-sized peptides. Many of these originated in a non-repetitive context as cofactors of RNA-based replication and catalysis, and required the RNA to assume their active conformation. In search of the origins of one of the most widespread repeat protein families, the tetratricopeptide repeat (TPR), we identified several potential homologs of its repeated helical hairpin in non-repetitive proteins, including the putatively ancient ribosomal protein S20 (RPS20), which only becomes structured in the context of the ribosome. We evaluated the ability of the RPS20 hairpin to form a TPR fold by amplification and obtained structures identical to natural TPRs for variants with 2–5 point mutations per repeat. The mutations were neutral in the parent organism, suggesting that they could have been sampled in the course of evolution. TPRs could thus have plausibly arisen by amplification from an ancestral helical hairpin.
The C9ORF72 GGGGCC expansion forms RNA G-quadruplex inclusions and sequesters hnRNP H to disrupt splicing in ALS brains
Authors: Conlon Erin G , Lu Lei , Sharma Aarti , Yamazaki Takashi , Tang Timothy , Shneider Neil A , Manley James L
Published: September 2016

An expanded GGGGCC hexanucleotide in C9ORF72 (C9) is the most frequent known cause of amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD). It has been proposed that expanded transcripts adopt G-quadruplex (G-Q) structures and associate with proteins, but whether this occurs and contributes to disease is unknown. Here we show first that the protein that predominantly associates with GGGGCC repeat RNA in vitro is the splicing factor hnRNP H, and that this interaction is linked to G-Q formation. We then show that G-Q RNA foci are more abundant in C9 ALS patient fibroblasts and astrocytes compared to those without the expansion, and more frequently colocalize with hnRNP H. Importantly, we demonstrate dysregulated splicing of multiple known hnRNP H-target transcripts in C9 patient brains, which correlates with elevated insoluble hnRNP H/G-Q aggregates. Together, our data implicate C9 expansion-mediated sequestration of hnRNP H as a significant contributor to neurodegeneration in C9 ALS/FTD.
Distinctive personality profiles of fibromyalgia and chronic fatigue syndrome patients
Authors: Ablin Jacob N. , Zohar Ada H. , Zaraya-Blum Reut , Buskila Dan
Published: September 2016

Objective

The current study is an innovative exploratory investigation, aiming at identifying differences in personality profiles within Fibromyalgia Syndrome (FMS) and Chronic Fatigue Syndrome (CFS) patients.

Method

In total, 344 participants (309 female, 35 male) reported suffering from FMS and/or CFS and consented to participate in the study. Participants were recruited at an Israeli FM/CFS patient meeting held in May 2013, and through an announcement posted on several social networks. Participants were asked to complete a research questionnaire, which included FMS criteria and severity scales, and measures of personality, emotional functioning, positivity, social support and subjective assessment of general health. In total, 204 participants completed the research questionnaire (40.7% attrition rate).

Results

A cluster analysis produced two distinct clusters, which differed significantly on psychological variables, but did not differ on demographic variables or illness severity. As compared to cluster number 2 (N = 107), participants classified into cluster number 1 (N = 97) showed a less adaptive pattern, with higher levels of Harm Avoidance and Alexithymia; higher prevalence of Type D personality; and lower levels of Persistence (PS), Reward dependence (RD), Cooperation, Self-directedness (SD), social support and positivity.

Conclusion

The significant pattern of results indicates at least two distinct personality profiles of FM and CFS patients. Findings from this research may help improve the evaluation and treatment of FM and CFS patients, based on each patient’s unique needs, psychological resources and weaknesses, as proposed by the current trend of personalized medicine.
Canopy position has a profound effect on soybean seed composition
Authors: Huber Steven C. , Li Kunzhi , Nelson Randall , Ulanov Alexander , DeMuro Catherine M. , Baxter Ivan
Published: September 2016

Although soybean seeds appear homogeneous, their composition (protein, oil and mineral concentrations) can vary significantly with the canopy position where they were produced. In studies with 10 cultivars grown over a 3-yr period, we found that seeds produced at the top of the canopy have higher concentrations of protein but less oil and lower concentrations of minerals such as Mg, Fe, and Cu compared to seeds produced at the bottom of the canopy. Among cultivars, mean protein concentration (average of different positions) correlated positively with mean concentrations of S, Zn and Fe, but not other minerals. Therefore, on a whole plant basis, the uptake and allocation of S, Zn and Fe to seeds correlated with the production and allocation of reduced N to seed protein; however, the reduced N and correlated minerals (S, Zn and Fe) showed different patterns of allocation among node positions. For example, while mean concentrations of protein and Fe correlated positively, the two parameters correlated negatively in terms of variation with canopy position. Altering the microenvironment within the soybean canopy by removing neighboring plants at flowering increased protein concentration in particular at lower node positions and thus altered the node-position gradient in protein (and oil) without altering the distribution of Mg, Fe and Cu, suggesting different underlying control mechanisms. Metabolomic analysis of developing seeds at different positions in the canopy suggests that availability of free asparagine may be a positive determinant of storage protein accumulation in seeds and may explain the increased protein accumulation in seeds produced at the top of the canopy. Our results establish node-position variation in seed constituents and provide a new experimental system to identify genes controlling key aspects of seed composition. In addition, our results provide an unexpected and simple approach to link agronomic practices to improve human nutrition and health in developing countries because food products produced from seeds at the bottom of the canopy contained higher Fe concentrations than products from the top of the canopy. Therefore, using seeds produced in the lower canopy for production of iron-rich soy foods for human consumption could be important when plants are the major source of protein and human diets can be chronically deficient in Fe and other minerals.
Regional drivers of clutch loss reveal important trade-offs for beach-nesting birds
Authors: Maslo Brooke , Schlacher Thomas A. , Weston Michael A. , Huijbers Chantal M. , Anderson Chris , Gilby Ben L. , Olds Andrew D. , Connolly Rod M. , Schoeman David S.
Published: September 2016

Coastal birds are critical ecosystem constituents on sandy shores, yet are threatened by depressed reproductive success resulting from direct and indirect anthropogenic and natural pressures. Few studies examine clutch fate across the wide range of environments experienced by birds; instead, most focus at the small site scale. We examine survival of model shorebird clutches as an index of true clutch survival at a regional scale (∼200 km), encompassing a variety of geomorphologies, predator communities, and human use regimes in southeast Queensland, Australia. Of the 132 model nests deployed and monitored with cameras, 45 (34%) survived the experimental exposure period. Thirty-five (27%) were lost to flooding, 32 (24%) were depredated, nine (7%) buried by sand, seven (5%) destroyed by people, three (2%) failed by unknown causes, and one (1%) was destroyed by a dog. Clutch fate differed substantially among regions, particularly with respect to losses from flooding and predation. ‘Topographic’ exposure was the main driver of mortality of nests placed close to the drift line near the base of dunes, which were lost to waves (particularly during storms) and to a lesser extent depredation. Predators determined the fate of clutches not lost to waves, with the depredation probability largely influenced by region. Depredation probability declined as nests were backed by higher dunes and were placed closer to vegetation. This study emphasizes the scale at which clutch fate and survival varies within a regional context, the prominence of corvids as egg predators, the significant role of flooding as a source of nest loss, and the multiple trade-offs faced by beach-nesting birds and those that manage them.
Resilience does not explain the dissociation between chronic pain and physical activity in South Africans living with HIV
Authors: Wadley Antonia L. , Mitchell Duncan , Kamerman Peter R.
Published: September 2016

Pain burden is high in people living with HIV (PLWH), but the effect of this pain on functionality is equivocal. Resilience, the ability to cope with adversity, may promote adaptation to pain, so we hypothesised that higher resilience would correlate with less pain-related impairment of activity. We recruited 197 black South African PLWH, 99 with chronic pain (CP) and 98 patients without. We measured pain intensity and interference using the Brief Pain Inventory, and resilience using the Resilience Scale. Participants were generally highly resilient. Greater resilience correlated with better health-related quality of life, but not with pain intensity or interference. We also measured physical activity objectively, by actigraphy, in a subset of patients (37 with chronic pain and 31 without chronic pain), who wore accelerometers for two weeks. There was no difference in duration or intensity of activity between those with and without pain, and activity was not associated with resilience. In this sample, pain was not associated with altered physical activity. Resilience did not explain differences in pain intensity or pain interference but was associated with improved quality of life. Financial stresses and the fear of HIV stigma may have driven patients to conceal pain and to suppress its expected impairment of activity.
Climatology of contribution‐weighted tropical rain rates based on TRMM 3B42
Authors: Venugopal V. , Wallace J. M.
Published: September 2016

The climatology of annual mean tropical rain rate is investigated based on merged Tropical Rainfall Measuring Mission (TRMM) 3B42 data. At 0.25° × 0.25° spatial resolution, and 3‐hourly temporal resolution, half the rain is concentrated within only ∼1% of the area of the tropics at any given instant. When plotted as a function of logarithm of rain rate, the cumulative contribution of rate‐ranked rain occurrences to the annual mean rainfall in each grid box is S shaped and its derivative, the contribution‐weighted rain rate spectrum, is Gaussian shaped. The 50% intercept of the cumulative contribution R50 is almost equivalent to the contribution‐weighted mean logarithmic rain rate
based on all significant rain occurrences. The spatial patterns of R50 and
are similar to those obtained by mapping the fraction of the annual accumulation explained by rain occurrences with rates above various specified thresholds. The geographical distribution of R50 confirms the existence of patterns noted in prior analyses based on TRMM precipitation radar data and reveals several previously unnoticed features.
Estimating crustal thickness using SsPmp in regions covered by low‐velocity sediments: Imaging the Moho beneath the Southeastern Suture of the Appalachian Margin Experiment (SESAME) array, SE Atlantic Coastal Plain
Authors: Parker Jr. E. Horry , Hawman Robert B. , Fischer Karen M. , Wagner Lara S.
Published: September 2016

Deconvolved waveforms for two earthquakes (Mw: 6.0 and 5.8) show clear postcritical SsPmp arrivals for broadband stations deployed across the coastal plain of Georgia, allowing mapping of crustal thickness in spite of strong reverberations generated by low‐velocity sediments. Precritical SsPmp arrivals are also identified. For a basement in which velocity increases linearly with depth, a bootstrapped grid search suggests an average basement velocity of 6.5 ± 0.1 km/s and basement thickness of 29.8 ± 2.0 km. Corresponding normal‐incidence Moho two‐way times (including sediments) are 10.6 ± 0.6 s, consistent with times for events interpreted as Moho reflections on coincident active‐source reflection profiles. Modeling of an underplated mafic layer (Vp = 7.2–7.4 km/s) using travel time constraints from SsPmp data and vertical‐incidence Moho reflection times yields a total basement thickness of 30–35 km and average basement velocity of 6.35–6.65 km/s for an underplate thickness of 0–15 km.
Mapping lightning in the sky with a mini array
Authors: Füllekrug Martin , Liu Zhongjian , Koh Kuang , Mezentsev Andrew , Pedeboy Stéphane , Soula Serge , Enno Sven‐Erik , Sugier Jacqueline , Rycroft Michael J.
Published: September 2016

Mini arrays are commonly used for infrasonic and seismic studies. Here we report for the first time the detection and mapping of distant lightning discharges in the sky with a mini array. The array has a baseline to wavelength ratio ∼4.2·10−2 to record very low frequency electromagnetic waves from 2 to 18 kHz. It is found that the mini array detects ∼69 lightning pulses per second from cloud‐to‐ground and in‐cloud discharges, even though the parent thunderstorms are ∼900–1100 km away and a rigorous selection criterion based on the quality of the wavefront across the array is used. In particular, lightning pulses that exhibit a clockwise phase progression are found at larger elevation angles in the sky as the result of a birefringent subionospheric wave propagation attributed to ordinary and extraordinary waves. These results imply that long range lightning detection networks might benefit from an exploration of the wave propagation conditions with mini arrays.
A statistical survey of ultralow‐frequency wave power and polarization in the Hermean magnetosphere
Authors: James Matthew K. , Bunce Emma J. , Yeoman Timothy K. , Imber Suzanne M. , Korth Haje
Published: September 2016

We present a statistical survey of ultralow‐frequency wave activity within the Hermean magnetosphere using the entire MErcury Surface, Space ENvironment, GEochemistry, and Ranging magnetometer data set. This study is focused upon wave activity with frequencies <0.5 Hz, typically below local ion gyrofrequencies, in order to determine if field line resonances similar to those observed in the terrestrial magnetosphere may be present. Wave activity is mapped to the magnetic equatorial plane of the magnetosphere and to magnetic latitude and local times on Mercury using the KT14 magnetic field model. Wave power mapped to the planetary surface indicates the average location of the polar cap boundary. Compressional wave power is dominant throughout most of the magnetosphere, while azimuthal wave power close to the dayside magnetopause provides evidence that interactions between the magnetosheath and the magnetopause such as the Kelvin‐Helmholtz instability may be driving wave activity. Further evidence of this is found in the average wave polarization: left‐handed polarized waves dominate the dawnside magnetosphere, while right‐handed polarized waves dominate the duskside. A possible field line resonance event is also presented, where a time‐of‐flight calculation is used to provide an estimated local plasma mass density of ∼240 amu cm−3.