bluuebunny/crossref_metadata_2025 huggingface dataset:
Dialogue, Positionality and the Legal Framing of Ethnographic Research
Authors: Roberts John
Published: March 2010

The question of positioning between the research Self and the research Other is a much discussed issue within qualitative research, especially within ethnographic approaches. Yet what is distinctive about many of these accounts is that they begin their respective analyses from a concrete level. In other words, many who champion placing their Self in the research process do so by focusing upon face-to-face encounters between their Self and the Other. This often entails a rejection of a positivist and objectivist informed accounts of social research in favour of a more humanist approach. This latter standpoint, humanism, is certainly interested in themes such as bias, power, regulation and domination constructed during the research process. But the structured, layered and ideological nature of the research context itself, namely its non-humanist properties, is often neglected in humanist explanations in favour of the more concrete interpretive moment. What this amounts to is a lack of sensitivity towards the positioning of Self and Other by the unobservable and ideological structures of a specific research context. As a result, discussion about the necessity of dialogue between all participants involved is one-sided. This closes down considerably the impact we, as researchers, have on a research context. In addition such a standpoint closes down the positioning effects of a research context upon our own research Self. By drawing upon the work of radical ethnographers and the discourse theorist Mikhail Bakhtin, this paper seeks to outline some of the problems that arise in humanist ethnographic accounts as regards positionality and dialogue. This opens the way for some observations about how ethnography might take into account ‘non-humanist’ structures such as the state, law and governance in capitalist societies in respect to the issues of positionality and dialogue. I flesh out these theoretical observations through a brief discussion of my own ethnographic experience researching Speakers’ Corner in London.
The Basic Elements of a Systematic Theory of Ethnic Relations
Authors: Rex John
Published: March 2010

The theory of ethnic relations has developed ad hoc on an interdisciplinary basis. It has dealt with ethnicity in small communities, larger ethnic groups or “ethnies”, ethnic nations, modernising nation states, subordinate nationalisms, the establishment of empires, post- imperial situations, transnational migrant communities and the political problems facing modernising nation states in dealing both with subordinate nationalisms and with migrant ethnic minorities. This paper seeks to deal with these various elements in an interconnected and systematic way setting out the nature of communities, small-scale self contained communities, the enlargement of these communities to form ethnic nations and the relationship between these and the institutions of the modernising nation state. It also seeks however to deal with what I call “The second project of ethnicity” which is migration and finally goes on to look at the complex problems of multi-nationality and multiculturalism in modern nation states
‘Superbrides’: Wedding Consumer Culture and the Construction of Bridal Identity
Authors: Boden Sharon
Published: March 2010

This paper examines the role of the media in articulating and sustaining the tension between romance, fantasy and reason as key dimensions of wedding consumption. Two types of media are analysed as evidence of the development of a popular wedding consumer culture in Britain. First, I cite examples of the coverage of celebrity and unconventional weddings in the popular presses to highlight the current media emphasis upon the wedding as a spectacular, within-reach consumer fantasy. I then provide a more sustained analysis of six British bridal magazines, part of the ideological output of the contemporary wedding industry, which do not exist in a vacuum from those other media sites transmitting wedding imagery. In doing so, I deconstruct the recently formed consumer identity of the ‘superbride’ to reveal two underpinning aspects of her personality: the rational ‘project manager’ existing alongside the emotional ‘childish fantasiser’. This leads me later in this paper into a more general discussion about the roles of reason and emotion, rationality and romance in wedding consumption.
The Lady Vanishes? Reflections on the Experiences of Married and Divorced Non- Heterosexual Fathers
Authors: Dunne Gillian A.
Published: March 2010

This paper draws on one of the first published studies of gay fatherhood to explore some experiences of those who were married or divorced. Focus on their stories reveals some of the complexity of our emotional and sexual landscapes, and provides interesting evidence of the socially constructed bases of sexuality. Mapping their parenting circumstances and relationships with ex/wives, I apply a feminist analysis in an attempt to understand the unusual patterns found. I suggest that in a contemporary context whereby increasing numbers of people are questioning and rejecting conventional forms of family life and gender practices, the exploration of non-heterosexual experience provides an important opportunity to consider alternative models of parenting, gender, and relations across and within gender categories.
‘Austro-Pop’ since the 1980s: Two Case Studies of Cultural Critique and Counter- hegemonic Resistance
Authors: Karner Christian
Published: March 2010

Recent political and social developments in Austria have been widely portrayed in simplistically metonymic terms, with controversial figures such as Waldheim and Haider being perceived to epitomise Austrian society as a whole. In this paper, I analyse the discursive/lyrical content of some of the songs by STS and Austria 3, two of the most successful bands within the genre of Austrian popular music. Approaching these two case studies from the theoretical perspectives of discourse analysis and cognitive anthropology, I will show that ‘Austro- Pop’ has - at important junctures in recent Austrian history - served as a tool of ideological resistance and created sites of social critique and cultural introspection. This paper thus illustrates that popular music analysed as discourse can draw attention to social heterogeneity and competing ideologies. The resulting sociological account challenges widespread portrayals - both journalistic and academic - of Austrian society as ideologically monolithic. Popular music will therefore be shown to offer valuable empirical data concerning some important sociological and social psychological issues such as the spread and contestation of ideas, the ‘nature’ of public opinion and the individual's agency in relation to it.
Signing your life away?: Why Research Ethics Committees (REC) shouldn't always require written confirmation that participants in research have been informed of the aims of a study and their rights - the case of criminal populations. (Commentary)
Authors: Coomber Ross
Published: March 2010

This brief commentary discusses the problematic incursion of Research Ethics Committees on social research, particularly on those groups who wish (and/or indeed it is vital for their safety) to remain anonymous. It is argued that REC's, often ignorant of social science methodology, commonly attempt to impose restrictions on research and researchers that contradict their own ethical guidelines and expose them to unreasonable risk. It is further pointed out that REC's are as yet not fully established within all UK institutions but fear of litigation will mean that those who do not already have them fully in place either have some form of REC in embryonic structure or are looking to implement REC's in the near future. It is in this context that it is argued we as social scientists should be helping to actively shape the workings of incumbent and emerging REC's in order to protect research, researchers, research participants and the integrity of what REC's actually do.
Religious Diversity and Multiculturalism in Southern Europe: The Italian Mosque Debate
Authors: Triandafyllidou Anna
Published: March 2010

In southern European countries, where immigration is a recent phenomenon, cultural and religious diversity brought into the host societies by non-EU immigrants has become an important public issue. The controversy over the construction of two new mosques in and around Milan, in October 2000, offers a suitable example for the study of attitudes and views on religious diversity in Italy, its recognition, acceptance or rejection. In the first part of the paper, I shall discuss briefly the size and composition of the immigrant community, the socio-economic position of immigrants in the host society and the legal provisions for naturalisation. In the second part of the paper, I shall concentrate on the ‘mosque issue’ and the dubious emergence of views and practices favouring a multicultural society and citizenship. The analysis is based on material collected from four major newspapers with both a regional and national circulation. The material will be analysed quantitatively with a view of identifying the main ‘voices’ involved in the debate and the thematic dimensions that organise it. A qualitative methodology of discourse analysis will be used to identify the prevailing discourse(s) and also how the different positions put forward by the dominant social and political actors are linked with specific features of the Italian political and party system. In the concluding section, I will discuss critically the Italian version of multiculturalism emerging in the mosque debate.
Degrees of Freedom: Do Graduate Women escape the Motherhood Gap in Pensions?
Authors: Ginn Jay , Arber Sara
Published: March 2010

British women's increasing levels of educational attainment have led to expectations of gender convergence in employment patterns and hence in lifetime earnings and pension income. However, it is not clear how far losses due to motherhood vary with educational qualifications. A polarisation in mothers’ employment is evident, according to whether women have high levels of educational and occupational capital and some writers have suggested that a young graduate mother is likely to maintain almost continuous full time employment, with minimal loss of lifetime earnings and no loss of pension income. This paper uses data from the British General Household Surveys from 1994-1996 to examine how the impact of childrearing on women's full and part time employment, earnings and private pension coverage varies according to educational level. Less than half of women with dependent children were employed full time in all educational groups, including graduates. Even among women graduates, only a third of those with a pre- school child were in full time employment. Motherhood substantially reduced women's earnings and private pension coverage at all educational levels, indicating the scale of losses in lifetime earnings and hence in private pension entitlements. The motherhood gap in private pension coverage was least for graduates and greatest for mid-skilled women but in view of the amount of the motherhood gap among graduates it is concluded that the pension protective effect of a degree for mothers has been overstated.
‘The Return of Assimilationism: Race, Multiculturalism and New Labour’
Authors: Back Les , Keith Michael , Khan Azra , Shukra Kalbir , Solomos John
Published: March 2010

This paper develops a critique of the politics of race and multiculturalism under New Labour. It argues that as a political formation New Labour is fraught with incommensurable impulses and commitment with regard to issues of multiculturalism, nationalism, racial justice and racism. While there have been palpable shifts and important new legislative initiatives, one of the consequences is that the project of assimilation has been reinvigorated under New Labour. This in turn leaves the normative whiteness that colonises British institutions and political life intact.
Following the Queen: The Place of the Royal Family in the Context of Royal Visits and Civil Religion
Authors: Rowbottom Anne
Published: March 2010

The starting point for this article, following Bocock (1985), is that rituals focusing on the royal family form a central component of a British civil religion. In this context events such as the Golden Jubilee celebrations and the public mourning for Diana need to be viewed within the context of a larger cycle of royal rituals, some of which are performed only once during a reign, some annually and others hundreds of times a year. In these latter events, the royal visits, the civil religion and the legitimacy of the monarchy are being routinely produced and reproduced. Drawing upon extensive ethnographic fieldwork amongst a network of “real royalists” my argument is that lack of awareness of these routine practices leads to the mistaken viewing of popular responses to royal events as something new and exotic in British culture.
‘For Better or Worse?’: Heterosexuality Reinvented
Authors: Hockey Jenny , Robinson Victoria , Meah Angela
Published: March 2010

Based upon a series of focus group discussions carried out in East Yorkshire, this article contributes to debates on both the nature and theorising of heterosexual relationships that have recently been investigated from diverse perspectives. These group discussions represent the launch of the first major empirical study of heterosexuality and ageing that has been undertaken in the UK. In drawing upon preliminary data from these focus groups, our findings reinforce and add to the challenging of a representation of heterosexuality which is both monolithic and inflexible, by exploring accounts of peoples’ actual lived experiences. Through this research we begin to generate a theoretical approach which highlights the complexity of these lived realities. We particularly explore the intersections of gender, age, class and family location. In doing so, we pinpoint differences, contradictions, but also continuities, in the ways in which people discuss and comment on their own and other people's perceptions and experiences of heterosexuality.
Social Exclusion of Pakistani and Bangladeshi Women
Authors: Dale Angela
Published: March 2010

This paper explores some of the processes that influence access to higher education and employment for Pakistani and Bangladeshi women in Britain. We ask what changes we can expect amongst younger Pakistani and Bangladeshi women who have grown up in the UK? How do we expect educational qualifications and family formation to influence labour market participation amongst these women? What barriers do these women face in obtaining qualifications and paid employment? To what extent are these barriers imposed by the family and community and to what extent are they imposed by the local labour market?

We find evidence of change across generations. By contrast with their mothers' generation, younger women who had been educated in the UK saw paid work as a means to independence and self- esteem. Women with higher level qualifications often showed considerable determination in managing to combine paid work and child-care. Whilst most women subscribed strongly to the centrality of the family, it is clear that the majority will follow very different routes through the life-course from their mothers. However, even with higher level qualifications, women are facing considerable barriers to employment. If the expected increase in economic activity amongst Pakistani and Bangladeshi women is not to lead to even higher unemployment, there is a pressing need to ensure that potential employers do not hold negative and out-dated stereotypes of traditional Muslim women.
Community Studies: Fifty Years of Theorization
Authors: Crow Graham
Published: March 2010

This paper reviews the ways in which sociologists in the second half of the twentieth century attempted to make sense of the major trends unfolding in their societies. It focuses in particular on the way in which sociologists have responded to the legacy of the founding figures in terms of their identification of trends such as rationalization, bureaucratization, and proletarianization. The proliferation of other trends captured by words ending with the suffix -ization (for example globalization, McDonaldization, and postmodernization) is noted, and the argument is developed that this style of theorising is valuable but problematic. It is valuable because it encourages sociologists to think comparatively, given that the trends identified necessarily have reference points in the past and that their uneven progress in different societies (or other social units) can be compared. It is problematic because there is no agreement on what constitutes evidence that these processes are unfolding, nor on the need for such evidence. A further problem relates to the issue of how these processes are considered to relate to each other. Research undertaken in the field of community in Britain and beyond over the period 1950-2000 is drawn upon to illustrate these points and to support the argument that concepts drawn from theorization at a general level are essential tools in the analysis of contemporary trends. It is also used to support the related argument that such theorization needs to be grounded in empirical evidence if it is to go beyond mere speculation.
‘Loved the Wedding, Invite Me to the Marriage’: The Secularisation of Weddings in Contemporary Britain
Authors: Walliss John
Published: March 2010

This article explores the extent to which weddings have been secularised within contemporary Britain at both the societal/institutional (objective) and personal (subjective) levels. Firstly, I present an extremely brief historical sketch of the changing nature of weddings within Britain over the course of the last thousand years. I will also draw on statistical evidence to discuss the trends relating to weddings over the course of the last 160 years. Following on from this, I draw on interview data to explore the reasons why non-church attendees still opt for a religious marriage service. Finally, I conclude by relating both sets of material to the question of whether weddings may be seen as a site of secularisation within contemporary Britain and exploring the nature of this situation.
Ethics and the Ruling Relations of Research Production
Authors: Truman Carole
Published: March 2010

The role of research ethics committees has expanded across the UK and North America and the process of ethical review has become re-institutionalised under proposals for research governance proposed by government. Ethics committees have gained a powerful role as gatekeepers within the research process. Underpinning the re-constitution of ethical guidelines and research governance, are a range of measures which protect institutional interests, without necessarily providing an effective means to address the moral obligations and responsibilities of researchers in relation to the production of social research. Discussion of research ethics from the standpoint of research participants who in this paper, are service users within health and social care, provides a useful dimension to current debate. In this paper I draw upon experiences of gaining ethical approval for a research study which focused on user participation within a community mental health service. I discuss the strategies used to gain ethical approval and the ‘formal concerns’ raised by the ethics committee. I then describe and discuss ethical issues which emerged from a participants’ perspective during the actual research as it was carried out. These experiences are analysed using aspects of institutional ethnography which provides a framework to explore how the experiences of research participants are mediated by texts which govern the processes of research production. The paper highlights incongruities between the formal ethical regulation of research, and the experiences of research participants in relation to ethical concerns within a research process.
Dealing with Dirt: Servicing and Repairing Cars
Authors: Dant Tim , Bowles David
Published: March 2010

This paper explores the significance of dirt in the work of technicians who service and repair private cars. Rather than being useful in understanding how dirt is dealt with, the historical and anthropological analyses of dirt are shown to be overly concerned with cultural significance and the idea that dirt is no more than ‘matter out of place’. Such accounts suppress the more common sense approach that dirt is unpleasant to human beings and is to be avoided if possible. In work such as garage servicing and repairs, dirt has to be confronted and dealt with pragmatically, according to the consequences of its presence, rather than symbolically according to its cultural meaning. The writing of Sartre on slime provides a more persuasive explanation both for the ambivalence towards ambiguous materials of slime and dirt and for the moral connotations that attach to them. Everett Hughes's account of a ‘moral division of labour’ in which distinctions are made concerning dirty work fits with some of the visible hierarchical distinctions in the garage setting. But it is the variability of practices, both between garages and between technicians in a similar setting, that suggests dealing with dirt is a practical matter that is not prescribed by ritual or cultural significance.
‘The Christian Right and Homophobic Discourse: A Response to ‘Evidence’ that Lesbian and Gay Parenting Damages Children’
Authors: Hicks Stephen
Published: March 2010

This ‘rapid response’ piece, submitted under the ‘Sexuality and the Church’ theme, examines claims by Christian writers that lesbian and gay parenting is bad for children. The author analyses aspects of what he terms a ‘Christian homophobic discourse’ in order to demonstrate the problematic claim to neutrality made by these writers. In addition, the author shows how the Christian writers’ view of research rests upon a series of positivist assumptions. Claims that research evidence shows children of lesbian or gay parents demonstrate gender or sexual identity confusion are disputed, and the author argues that the Christian writers present their own moral interpretations rather than the ‘facts of the matter’. The author argues that the Christian writers construct a version of homosexuality as highly diseased and dangerous, before concluding that it is both epistemologically and morally misguided to see ‘sexuality’ as an object or variable which influences the development of children.
Theory Building in Qualitative Research and Computer Programs for the Management of Textual Data
Authors: Kelle U.
Published: March 2010

This article refers to recent debates about the potential methodological costs and benefits of computer use in qualitative research and about the relationship between methodological approaches (eg. ‘Grounded Theory’) on the one hand and computer-aided methods of qualitative research on the other. It is argued that the connection between certain computer-aided strategies and methodological approaches is far more loose than is often assumed. Furthermore, the danger of methodological biases and distortion arising from the use of certain software packages is overemphasized in current discussions, as far as basic tasks of textual data management (‘coding and retrieval’) usually performed by this software are concerned. However, with the development of more advanced and complex coding and retrieval techniques, which are regarded by some authors as tools for ‘theory building’ in qualitative research, methodological confusion may arise if basic prerequisites of qualitative theory building are not taken into consideration. Therefore, certain aspects of qualitative theory building which are relevant for computer aided methods of textual data management are discussed in the paper.
‘Towards a Sociology of Organizational Space’
Authors: Halford Susan
Published: March 2010

This paper aims to contribute to, and extend, the emergent Sociology of organizational space. It engages critically with labour process approaches, which position space within a control-resistance paradigm, suggesting that the conceptualization of space embedded within these accounts is limited and limiting. Drawing on insights from cultural geography the paper uses a new empirical study to show the ways that spatial meanings and spatial practices in the micro-spaces of office life are constructed through diverse experiences, memories and identities operating at a range of spatial scales.
‘Global Visions and Globalizing Corporations: An Analysis of Images and Texts from Fortune Global 500 Companies’
Authors: Robbins Peter
Published: March 2010

Transnational corporations (TNCs) have a central role to play in globalization. At the same time, globalization carries risks for the corporation, and not all of those associated with TNCs may support globalization. While much of the globalization literature suggests that corporations are globalizing their production systems, or contributing to a global culture, there is little exploration of how globalization is framed and mediated within the corporate community itself. This article employs a semiotic analysis of images and texts from annual reports of Fortune Global 500 corporations. It argues that globalizing TNCs generate several narratives geared to persuading employees, shareholders, business partners and members of the financial community of the merits of globalization. They can be divided into at least three types geared to brand, industry leadership or organization. The narratives all have common themes to the extent that they are rooted in a customer focus, but they also demonstrate multiple and sometimes ambiguous global aspirations and expectations.
‘The Researcher, the Field and the Issue of Entry: Two Cases of Ethnographic Research concerning Asylums in Greece’
Authors: Savvakis Manos , Tzanakis Manolis
Published: March 2010

The way the researcher enters the research field can constitute a privileged mode of observing the structure and qualities of the research field, particularly in qualitative sociological inquiries. In the process of the initial contact of the researcher with a social place, especially in those cases when his/her physical presence is required, the structural features of the place gradually manifest themselves. Quite often, a strictly ‘technical’ approach to research-work tends to overlook the potential usefulness of this phase. In this article, we will put forward the hypothesis that by investigating the way research participants observe the researcher, especially during the initial stage of interaction, we can gain useful knowledge regarding particular structural aspects of the research field.
“It's as if you're some alien…’ Exploring Anti-English Attitudes in Scotland. ‘
Authors: McIntosh Ian , Sim Duncan , Robertson Douglas
Published: March 2010

English people are the largest national or ethnic minority within Scotland but remain under-researched. This is despite a view taken by many writers, and by the popular press, that anti-English attitudes within Scotland are a major social problem. Via 30 in-depth interviews, this paper explores the experiences of a group of English people living in Scotland and the extent and nature of any anti-Englishness they have encountered. The paper also focuses on the ways in which notions of race, ethnicity and essential differences between Scots and English people are regularly encountered by English people living in Scotland. The ‘racialisation’ of the English minority in Scotland is also discussed in this context.
Discursive Democracy and New Labour: Five Ways in Which Decision-Makers Manage Citizen Agendas in Public Participation Initiatives
Authors: Williams Mike
Published: March 2010

New Labour's conceptualisation of public participation in local government creates a tension in public participation practice. Government legislation and guidance require local authorities to develop and provide citizen-centred services, engage the public in policy-making and respond to the public's views. Seen in this light, New Labour policy draws from radical democratic discourse. However, local authority staff are also expected to act in accordance with the direction set by their line managers, the Council and the government and to inform, engage and persuade the public of the benefit of their authority's policies. In this respect, New Labour policy draws from the discursive model of civil society, conceptualising public participation as a method for engendering civil ownership of the formal structures of representative democracy. Tension is likely to arise when the ideas, opinions and values of the local authority differ from those expressed by the participating public. This paper uses a local ‘public participation’ initiative to investigate how the tension is managed in practice. The study shows how decision-makers dealt with the tension by using participatory initiatives to supply information, understand the views of the public and encourage public support around pre-existing organisational agendas. Problems occurred when citizens introduced new agendas by breaking or manipulating the rules of participation. Decision-makers responded by using a number of distinctive methods for managing citizens’ agendas, some of which were accompanied by strategies for minimising the injury done to citizens’ motivations for further participation. The paper concludes that New Labour policy fails to deal with the tensions between the radical and discursive models of participation and in the final analysis draws mainly from the discursive model of participation. Furthermore, whilst New Labour policy promotes dialogue between the public and local authority, it does not empower local authority staff to achieve the goal of citizen-centred policy-making.
‘Rappin’ on the Reservation: Canadian Mohawk Youth's Hybrid Cultural Identities
Authors: Hollands Robert
Published: March 2010

This study of Canadian Mohawk youth examines the complex construction of hybrid identities, by looking at the interaction between their consumption of western media/ culture and local Native traditions and customs. The article poses the question, to what extent does western youth culture as expressed in TV, film, music and sport get taken up and moulded around a more contemporary Native youth identity? Utilising theoretical notions of hybridity and hegemony, and a mixed methodology of questionnaire data and focus group interviews, the study argues that young Mohawks actively consume global youth and popular media cultures strategically in ways that both reinforce and extend their Native and youthful identities. Particularly popular is the appropriation of a range of black cultural forms drawn from the Afro-American experience, such as the adoption of rap music for instance. At the same time, issues of power reflected through gender relations, inequality and racism, and the domination of American over Canadian culture, also impact on the formation of Mohawk youth identities and pose challenges to building bridges between traditional customs and the modern world.
The Photograph in Theory
Authors: Chaplin Elizabeth
Published: March 2010

This article gives an account of an ethnographic project which relied on the use of photography: the project involved taking photographs, asking for responses to them, and then analysing both photos and responses. Anything that plays a central role in an ethnographic project requires theoretical consideration. So, as the account of the project proceeds, the photos are considered from different theoretical viewpoints; and an emerging and subsequently recurring theme is the tension between what a photo shows and what a photo means. Discussion of this tension develops into a more general critique of the ways photos are theorised in social science. I conclude that the photograph in social science theory is at present a sad phenomenon, and that in order to remedy this situation, we should seek help from outside social science.
A Profile of Fatherhood among Young Men: Moving Away from Their Birth Family and Closer to Their Child
Authors: Quéniart Anne
Published: March 2010

Have things changed all that much in terms of how fatherhood is conceptualized and exercised in daily life? That is the question underlying this article. The author compares the findings of a recent analysis on certain aspects of the lived experiences of young fathers (under 25 years of age) with the results of studies undertaken over the past ten years, and replies in the affirmative. First of all, when considering the representations held of fathers or mothers, most of these young fathers believe that their role is a multi-faceted one, and that it is often identical to that of their spouse. According to young fathers, fatherhood is a dual experience that requires them to be present on a daily basis while also casting their eye on the future. This is an experience that is constructed out of affectionate moments, child-care duties, education in the literal sense, and especially out of shared experiences with their spouse. In addition, they question the degree to which involvement in a career should take precedence over involvement in their child's life. In other words, the former ‘competes’ with their ability to be present in their child's daily life, which denotes a change from the attitudes of previous generations.
A 3-Year-Old With Gingival Hemorrhage and Musculoskeletal Pain
Authors: Trinh Khanh , Patel Rinil , Peters Scott M.
Published: May 2024

A 3-year-old had spontaneous gingival hemorrhage and bilateral limb weakness with inability to bear weight. He had no preceding oral trauma or recent infection, took no regular medications, and had no recent use of aspirin or nonsteroidal anti-inflammatory drugs; his diet was limited to primarily chicken nuggets and milk. What is the diagnosis and what would you do next?
Economic Evaluation of HLA-B*15:02 Genotyping for Asian Australian Patients With Epilepsy
Authors: Gu Yaron , Shih Sophy T. F. , Geevasinga Nimeshan , Chan Linda , Frew John W. , Sebaratnam Deshan F.
Published: May 2024

Importance

The HLA-B*15:02 allele has been associated with an increased risk of carbamazepine-induced Stevens-Johnson syndrome and toxic epidermal necrolysis in specific Asian populations (including Han Chinese, Malaysian, Thai, and Vietnamese individuals). While HLA-B*15:02 genotype testing in Asian populations is recommended by several international prescribing guidelines, it is not subsidized by the Medicare Benefits Schedule in Australia.

Objective

To evaluate the cost-effectiveness of HLA-B*15:02 genotyping in Asian Australian patients with epilepsy.

Design, Setting, and Participants

A model with components of decision analysis and Markov simulation was developed to simulate clinical trajectories of adult Asian Australian patients with newly diagnosed epilepsy being considered for carbamazepine treatment. Cost-effectiveness and cost-utility analyses over a lifetime time horizon were conducted from the perspective of the Australian health care sector. The study was conducted in May 2023 and data analysis was performed from August 2023 to November 2023.

Intervention

No HLA-B*15:02 genotyping and the empirical initiation of treatment with carbamazepine vs HLA-B*15:02 genotyping and the initiation of treatment with valproate in allele carriers.

Main Outcomes and Measures

Life-years (LYs), quality-adjusted life-years (QALYs), and costs in 2023 Australian dollars (A$); incremental cost-effectiveness ratios.

Results

HLA-B*15:02 screening was associated with an additional mean cost of A$114 (95% CI, −A$83 to A$374; US$76; 95% CI, −US$55 to US$248) and a reduction in 0.0152 LYs (95% CI, 0.0045 to 0.0287 LYs) but improvement by 0.00722 QALYs (95% CI, −0.0247 to −0.01210) compared with no screening, resulting in an incremental cost-effectiveness ratio of A$15 839 per QALY gained (US$10 523 per QALY). Therefore, universal genotyping for Asian Australian individuals was cost-effective compared with current standards of practice at the A$50 000 per QALY willingness-to-pay threshold. Sensitivity analyses demonstrated that the intervention remained cost-effective across a range of costs, utilities, transition probabilities, and willingness-to-pay thresholds. At the A$50 000 per QALY willingness-to-pay threshold, universal screening was the preferred strategy in 88.60% of simulations.

Conclusions and Relevance

The results of this economic evaluation suggest that HLA-B*15:02 screening represents a cost-effective choice for Asian Australian patients with epilepsy who are being considered for treatment with carbamazepine.
Hematologic Abnormalities in Patients With Hidradenitis Suppurativa Receiving Adalimumab
Authors: Gunter Simon J. , Holcomb Zachary E. , Lam Barbara D. , Porter Martina L. , Kimball Alexa B.
Published: May 2024

This post hoc analysis of PIONEER I and II randomized clinical trials assesses whether receiving adalimumab is associated with decreased hematologic abnormalities and increased clinical improvement in patients with hidradenitis suppurativa.
Keratosis Pilaris–Like Reaction Associated With Chromatin Remodeling Complex Inhibition in Uveal Melanoma
Authors: Seervai Riyad N. H. , Taylor Madison M. , Rahbar Ziba , Patel Sapna P. , Nelson Kelly C. , Prieto Victor G. , Curry Jonathan L.
Published: May 2024

This case series describes a constellation of novel adverse reactions in 3 of 9 patients with uveal melanoma receiving treatment targeting activity of the Brahma-associated factor chromatin remodeling complex.
Advancing the Blueprint to Mental Health Parity Reform
Authors: Kannarkat Jacob T. , Kannarkat Joseph T. , Presskreischer Rachel
Published: May 2024

This Viewpoint discusses the current state of mental health parity reform, proposed amendments, and the challenges and considerations in play.
Decision-Making Confidence of Clinical Competency Committees for Entrustable Professional Activities
Authors: Montgomery Kelsey B. , Mellinger John D. , McLeod M. Chandler , Jones Andrew , Zmijewski Polina , Sarosi George A. , Brasel Karen J. , Klingensmith Mary E. , Minter Rebecca M. , Buyske Jo , Lindeman Brenessa
Published: May 2024

Importance

A competency-based assessment framework using entrustable professional activities (EPAs) was endorsed by the American Board of Surgery following a 2-year feasibility pilot study. Pilot study programs’ clinical competency committees (CCCs) rated residents on EPA entrustment semiannually using this newly developed assessment tool, but factors associated with their decision-making are not yet known.

Objective

To identify factors associated with variation in decision-making confidence of CCCs in EPA summative entrustment decisions.

Design, Setting, and Participants

This cohort study used deidentified data from the EPA Pilot Study, with participating sites at 28 general surgery residency programs, prospectively collected from July 1, 2018, to June 30, 2020. Data were analyzed from September 27, 2022, to February 15, 2023.

Exposure

Microassessments of resident entrustment for pilot EPAs (gallbladder disease, inguinal hernia, right lower quadrant pain, trauma, and consultation) collected within the course of routine clinical care across four 6-month study cycles. Summative entrustment ratings were then determined by program CCCs for each study cycle.

Main Outcomes and Measures

The primary outcome was CCC decision-making confidence rating (high, moderate, slight, or no confidence) for summative entrustment decisions, with a secondary outcome of number of EPA microassessments received per summative entrustment decision. Bivariate tests and mixed-effects regression modeling were used to evaluate factors associated with CCC confidence.

Results

Among 565 residents receiving at least 1 EPA microassessment, 1765 summative entrustment decisions were reported. Overall, 72.5% (1279 of 1765) of summative entrustment decisions were made with moderate or high confidence. Confidence ratings increased with increasing mean number of EPA microassessments, with 1.7 (95% CI, 1.4-2.0) at no confidence, 1.9 (95% CI, 1.7-2.1) at slight confidence, 2.9 (95% CI, 2.6-3.2) at moderate confidence, and 4.1 (95% CI, 3.8-4.4) at high confidence. Increasing number of EPA microassessments was associated with increased likelihood of higher CCC confidence for all except 1 EPA phase after controlling for program effects (odds ratio range: 1.21 [95% CI, 1.07-1.37] for intraoperative EPA-4 to 2.93 [95% CI, 1.64-5.85] for postoperative EPA-2); for preoperative EPA-3, there was no association.

Conclusions and Relevance

In this cohort study, the CCC confidence in EPA summative entrustment decisions increased as the number of EPA microassessments increased, and CCCs endorsed moderate to high confidence in most entrustment decisions. These findings provide early validity evidence for this novel assessment framework and may inform program practices as EPAs are implemented nationally.
Alemtuzumab treatment for multiple sclerosis in Austria: An observational long‐term outcome study
Authors: Moser Tobias , Foettinger Fabian , Hitzl Wolfgang , Novotna Bianka , Berger Thomas , Bsteh Gabriel , Di Pauli Franziska , Hegen Harald , Kornek Barbara , Langenscheidt Dieter , Sellner Johann
Published: May 2024

Background/Objective

Observational real‐world study to analyze the clinical effects of alemtuzumab (ALEM) and subsequent disease‐modifying therapy (DMT) usage in multiple sclerosis (MS).

Methods

Data retrieved from the Austrian MS treatment registry (AMSTR) included baseline (BL) characteristics (at ALEM start), annualized relapse rate (ARR), 6‐month confirmed progression independent of relapse activity (PIRA; ≥ 0.5‐point Expanded Disability Status Scale (EDSS) score increase), 6‐month confirmed disability improvement (CDI; ≥ 0.5‐point EDSS decrease), and safety outcomes until initiation of a subsequent DMT. The EDSS was re‐baselined at 30 days from ALEM start (BL EDSS).

Results

Eighty‐seven ALEM‐treated patients (median age: 32 years, 72% female, 14% treatment‐naïve) were followed for a median of 55 (interquartile range 31–68) months. We found significant reductions in the ARR from 1.16 before ALEM to 0.15 throughout Years 1–9 (p < 0.001). Subsequent DMTs were initiated in 19 patients (22%, 74% anti‐CD20 monoclonal antibodies). At Year 5 (n = 53), more patients achieved CDI (58%, 95% confidence interval (CI) 45%–71%) than had experienced PIRA (14%, CI 7.5%–24%), and 58% remained relapse‐free. Shorter MS duration (p < 0.001, hazard ratio (HR) 0.86 (CI 0.80–0.93)) and no previous high‐efficacy treatment (p < 0.001, HR 5.16 (CI 2.66–10.0)) were the best predictors of CDI, while PIRA was associated with a higher number of previous DMTs (p = 0.04, HR 3.06, CI 1.05–8.89). We found no new safety signals.

Interpretation

ALEM had long‐lasting beneficial effects on the ARR and disability improvement, especially when initiated early in the course of the disease. Only a subset of patients received subsequent DMTs.
Decoding Organelle Interactions: Unveiling Molecular Mechanisms and Disease Therapies
Authors: Liu Ruixue , Hong Weilong , Hou Dongyao , Huang He , Duan Chenyang
Published: May 2024

Organelles, substructures in the cytoplasm with specific morphological structures and functions, interact with each other via membrane fusion, membrane transport, and protein interactions, collectively termed organelle interaction. Organelle interaction is a complex biological process involving the interaction and regulation of several organelles, including the interaction between mitochondria‐endoplasmic reticulum, endoplasmic reticulum‐Golgi, mitochondria‐lysosomes, and endoplasmic reticulum‐peroxisomes. This interaction enables intracellular substance transport, metabolism, and signal transmission, and is closely related to the occurrence, development, and treatment of many diseases, such as cancer, neurodegenerative diseases, and metabolic diseases. Herein, the mechanisms and regulation of organelle interactions are reviewed, which are critical for understanding basic principles of cell biology and disease development mechanisms. The findings will help to facilitate the development of novel strategies for disease prevention, diagnosis, and treatment opportunities.
Oxide Based Pentachromatic‐Vision Inspired Optoelectronic Synaptic Transistor with Large Conduction States Over 512
Authors: Jeong Jun Hyung , Ma Jin Hyun , Park Min Ho , Ha Hyoun Ji , Kang Seong Jae , Yun Jung Min , Kim Yu bin , Kim Eojin , Kang Seong Jun
Published: May 2024

Optoelectronic neuromorphic devices based on oxide semiconductors have been potentially investigated to mimic the functions of human visual synapses. However, the challenge comes from the wide bandgap characteristics of numerous oxide semiconductors, which restricts the response range of the device under ultra‐violet (UV) region. Strategies for widening the response range are mostly focused on artificially generating the defect states, however, most of them results in mimicking the tetrachromatic visual system from UV to visible light range. To be used for industries such as robotics, or autonomous vehicles, mimicking the tetrachromatic vision system should be overcome up to near‐infrared (NIR) region. Here, a facile solution processed indium‐gallium‐zinc‐oxide and silver oxide structured optoelectronic synaptic transistor is fabricated not only to mimic the function of human synapses, but to overcome the tetrachromatic human visual system up to the NIR region. The device not only showed photoresponse characteristics under the entire 405 to 830 nm wavelength region, but also showed significant synaptic behaviors with over 512 conduction states under a reasonable incident light power density of 4.5 mW cm−2. The results will offer a useful facile method for fabricating optoelectronic synaptic transistors that can overcome the tetrachromatic vision systems.
3D Printing of Maturable Tissue Constructs Using a Cell‐Adaptable Nanocolloidal Hydrogel
Authors: Li Li , Liu Haofan , Zhao Yongchao , Liu Xuan , Dong Yinchu , Luo Jing , Jiang Xuebing , Zhang Yi , Zhu Qi , Yuan Xin , Pei Xuan , Zhang Li , Li Boya , Yang Shuai , Gou Maling
Published: May 2024

3D‐printed cell‐laden hydrogels as tissue constructs show great promise in generating living tissues for medicine. Currently, the maturation of 3D‐printed constructs into living tissues remains challenge, since commonly used hydrogels struggle to provide an ideal microenvironment for the seeded cells. In this study, a cell‐adaptable nanocolloidal hydrogel is created for 3D printing of maturable tissue constructs. The nanocolloidal hydrogel is composed of interconnected nanoparticles, which is prepared by the self‐assembly and subsequent photocrosslinking of the gelatin methacryloyl solutions. Cells can get enough space to grow and migrate within the hydrogel through squeezing the flexible nanocolloidal networks. Meanwhile, the nanostructure can promote the seeded cells to proliferate and produce matrix proteins through mechanotransduction. Using digital light process‐based 3D printing technology, it can rapidly customize cartilage tissue constructs. After implantation, these tissue constructs efficiently matured into cartilage tissues for the articular cartilage defect repair and ear cartilage reconstruction in vivo. The 3D printing of maturable tissue constructs using the nanocolloidal hydrogel shows potential for future clinical applications.