title: Clitoral surgery on minors: an interview study with clinical experts of differences of sex development

authors: Liao, Lih-Mei

subjects: Science & Technology

abstract: Objectives Clitoral surgery on minors diagnosed with differences of sex development is increasingly positioned as a violation of human rights. This qualitative study identified how health professionals (HPs) navigate the contentious issues as they offer care to affected families.

Design Qualitative analysis of audio-recorded semistructured interviews with HPs. All of the interviews were transcribed verbatim for theoretical thematic analysis.

Setting Twelve specialist multidisciplinary care centres for children, adolescents and adults diagnosed with a genetic condition associated with differences of sex development.

Participants Thirty-two medical, surgical, psychological and nursing professionals and clinical scientists in 12 specialist centres in Britain and Sweden formed the interview sample.

Results All interviewees were aware of the controversial nature of clitoral surgery and perceived themselves and their teams as non-interventionist compared with other teams. Data analyses highlighted four strategies that the interviewees used to navigate their complex tasks: (1) engaging with new thinking, (2) holding on to historical assumptions, (3) reducing the burden of dilemmas and (4) being flexible. In response to recent reports and debates that challenge clitoral surgery on minors, HPs had revised some of their opinions. However, they struggled to reconcile their new knowledge with the incumbent norms in favour of intervention as they counsel care users with variable reactions and expectations. The flexible approach taken may reflect compromise, but the interviewees were often trapped by the contradictory values and assumptions.

Conclusions If the pathology-based vocabularies and narratives about genital diversity could be modified, and normative assumptions are questioned more often, clinicians may be more adept at integrating their new knowledge into a more coherent model of care to address the psychosocial concerns that genital surgery purports to overcome.

text: Clitoral surgery on minors: an interview study with clinical experts of differences of sex development Objectives Clitoral surgery on minors diagnosed with differences of sex development is increasingly positioned as a violation of human rights. This qualitative study identified how health professionals (HPs) navigate the contentious issues as they offer care to affected families.

Design Qualitative analysis of audio-recorded semistructured interviews with HPs. All of the interviews were transcribed verbatim for theoretical thematic analysis.

Setting Twelve specialist multidisciplinary care centres for children, adolescents and adults diagnosed with a genetic condition associated with differences of sex development.

Participants Thirty-two medical, surgical, psychological and nursing professionals and clinical scientists in 12 specialist centres in Britain and Sweden formed the interview sample.

Results All interviewees were aware of the controversial nature of clitoral surgery and perceived themselves and their teams as non-interventionist compared with other teams. Data analyses highlighted four strategies that the interviewees used to navigate their complex tasks: (1) engaging with new thinking, (2) holding on to historical assumptions, (3) reducing the burden of dilemmas and (4) being flexible. In response to recent reports and debates that challenge clitoral surgery on minors, HPs had revised some of their opinions. However, they struggled to reconcile their new knowledge with the incumbent norms in favour of intervention as they counsel care users with variable reactions and expectations. The flexible approach taken may reflect compromise, but the interviewees were often trapped by the contradictory values and assumptions.

Conclusions If the pathology-based vocabularies and narratives about genital diversity could be modified, and normative assumptions are questioned more often, clinicians may be more adept at integrating their new knowledge into a more coherent model of care to address the psychosocial concerns that genital surgery purports to overcome.

year: 2019

title: The Viscometric determination of somatic cell levels in cows' milk

authors: Milne, John Ross

abstract: The California Mastitis Test (CMT) is a test used for estimating the number of somatic cells in a milk sample. A reagent (secondary alkyl sulphate) is added to the milk and the number of somatic cells estimated from the resultant viscosity of the mixture. 
The Ruakura rolling ball viscometer has been developed to measure the viscosity of the CMT gel. It consists of a tube mounted horizontally so that the milk-reagent mixture can be introduced into it. After a holding time of 26 seconds the tube tips through an angle of 25° allowing a stainless steel ball to roll through the mixture for a standard time before returning to the horizontal. The distance the ball has rolled is inversely related to the viscosity developed. The physical function of the viscometer follows Stokes' Law. 
The range of the instrument is suited to reading the viscosity developed by the CMT reaction in New Zealand herd milks. 
The viscous reaction in milk is caused by somatic cell nuclei forming a fibrillar network. The reaction intensity is related to the DNA content of the milk sample. Proteins can modify the viscosity developed. Bacterial DNA does not enter the reaction. The network is fragile and rheomalaxic in nature. The reaction intensity in milk varies with time. An approximate 25 second holding time is required before determining the viscosity. After this holding time the reaction intensity progressively decreases. Milk to be tested should be under 24 hours old although refrigeration or boric acid preservative can extend this time. Different operators can rank milk samples by somatic cell count in a similar order with the Ruakura rolling ball viscometer. 
There is a significant correlation (r = 0.92***) between Ruakura rolling ball viscometer and somatic cell count of herd milk samples.

text: The Viscometric determination of somatic cell levels in cows' milk The California Mastitis Test (CMT) is a test used for estimating the number of somatic cells in a milk sample. A reagent (secondary alkyl sulphate) is added to the milk and the number of somatic cells estimated from the resultant viscosity of the mixture. 
The Ruakura rolling ball viscometer has been developed to measure the viscosity of the CMT gel. It consists of a tube mounted horizontally so that the milk-reagent mixture can be introduced into it. After a holding time of 26 seconds the tube tips through an angle of 25° allowing a stainless steel ball to roll through the mixture for a standard time before returning to the horizontal. The distance the ball has rolled is inversely related to the viscosity developed. The physical function of the viscometer follows Stokes' Law. 
The range of the instrument is suited to reading the viscosity developed by the CMT reaction in New Zealand herd milks. 
The viscous reaction in milk is caused by somatic cell nuclei forming a fibrillar network. The reaction intensity is related to the DNA content of the milk sample. Proteins can modify the viscosity developed. Bacterial DNA does not enter the reaction. The network is fragile and rheomalaxic in nature. The reaction intensity in milk varies with time. An approximate 25 second holding time is required before determining the viscosity. After this holding time the reaction intensity progressively decreases. Milk to be tested should be under 24 hours old although refrigeration or boric acid preservative can extend this time. Different operators can rank milk samples by somatic cell count in a similar order with the Ruakura rolling ball viscometer. 
There is a significant correlation (r = 0.92***) between Ruakura rolling ball viscometer and somatic cell count of herd milk samples.

year: 1973

title: Bicultural challenges for educational professionals in Aotearoa

authors: Glynn, Ted

abstract: As educational professionals in New Zealand at the approach of the twenty-first century, some 158 years after the Treaty of Waitangi, we face some major challenges in examining our bicultural goals and achievements. In this paper I explore some of these goals and achievements which I believe must be addressed in our pedagogical practice and in our educational research.

text: Bicultural challenges for educational professionals in Aotearoa As educational professionals in New Zealand at the approach of the twenty-first century, some 158 years after the Treaty of Waitangi, we face some major challenges in examining our bicultural goals and achievements. In this paper I explore some of these goals and achievements which I believe must be addressed in our pedagogical practice and in our educational research.

year: 2015