Publications by authors named "Srikant Sarangi"

37 Publications

Sex and race differences of cerebrospinal fluid metabolites in healthy individuals.

Metabolomics 2021 01 18;17(2):13. Epub 2021 Jan 18.

Department of Psychiatry & Behavioral Sciences, School of Medicine, Duke University, Box 3454 DUMC, Durham, NC, 27710, USA.

Introduction: Analyses of cerebrospinal fluid (CSF) metabolites in large, healthy samples have been limited and potential demographic moderators of brain metabolism are largely unknown.

Objective: Our objective in this study was to examine sex and race differences in 33 CSF metabolites within a sample of 129 healthy individuals (37 African American women, 29 white women, 38 African American men, and 25 white men).

Methods: CSF metabolites were measured with a targeted electrochemistry-based metabolomics platform. Sex and race differences were quantified with both univariate and multivariate analyses. Type I error was controlled for by using a Bonferroni adjustment (0.05/33 = .0015).

Results: Multivariate Canonical Variate Analysis (CVA) of the 33 metabolites showed correct classification of sex at an average rate of 80.6% and correct classification of race at an average rate of 88.4%. Univariate analyses revealed that men had significantly higher concentrations of cysteine (p < 0.0001), uric acid (p < 0.0001), and N-acetylserotonin (p = 0.049), while women had significantly higher concentrations of 5-hydroxyindoleacetic acid (5-HIAA) (p = 0.001). African American participants had significantly higher concentrations of 3-hydroxykynurenine (p = 0.018), while white participants had significantly higher concentrations of kynurenine (p < 0.0001), indoleacetic acid (p < 0.0001), xanthine (p = 0.001), alpha-tocopherol (p = 0.007), cysteine (p = 0.029), melatonin (p = 0.036), and 7-methylxanthine (p = 0.037). After the Bonferroni adjustment, the effects for cysteine, uric acid, and 5-HIAA were still significant from the analysis of sex differences and kynurenine and indoleacetic acid were still significant from the analysis of race differences.

Conclusion: Several of the metabolites assayed in this study have been associated with mental health disorders and neurological diseases. Our data provide some novel information regarding normal variations by sex and race in CSF metabolite levels within the tryptophan, tyrosine and purine pathways, which may help to enhance our understanding of mechanisms underlying sex and race differences and potentially prove useful in the future treatment of disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11306-020-01757-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8041469PMC
January 2021

Rapid single cell evaluation of human disease and disorder targets using REVEAL: SingleCell™.

BMC Genomics 2021 Jan 6;22(1). Epub 2021 Jan 6.

Paradigm4, Inc., Suite 360, 281 Winter Street, Waltham, MA, 02451, USA.

Background: Single-cell (sc) sequencing performs unbiased profiling of individual cells and enables evaluation of less prevalent cellular populations, often missed using bulk sequencing. However, the scale and the complexity of the sc datasets poses a great challenge in its utility and this problem is further exacerbated when working with larger datasets typically generated by consortium efforts. As the scale of single cell datasets continues to increase exponentially, there is an unmet technological need to develop database platforms that can evaluate key biological hypotheses by querying extensive single-cell datasets. Large single-cell datasets like Human Cell Atlas and COVID-19 cell atlas (collection of annotated sc datasets from various human organs) are excellent resources for profiling target genes involved in human diseases and disorders ranging from oncology, auto-immunity, as well as infectious diseases like COVID-19 caused by SARS-CoV-2 virus. SARS-CoV-2 infections have led to a worldwide pandemic with massive loss of lives, infections exceeding 7 million cases. The virus uses ACE2 and TMPRSS2 as key viral entry associated proteins expressed in human cells for infections. Evaluating the expression profile of key genes in large single-cell datasets can facilitate testing for diagnostics, therapeutics, and vaccine targets, as the world struggles to cope with the on-going spread of COVID-19 infections.

Main Body: In this manuscript we describe REVEAL: SingleCell, which enables storage, retrieval, and rapid query of single-cell datasets inclusive of millions of cells. The array native database described here enables selecting and analyzing cells across multiple studies. Cells can be selected using individual metadata tags, more complex hierarchical ontology filtering, and gene expression threshold ranges, including co-expression of multiple genes. The tags on selected cells can be further evaluated for testing biological hypotheses. One such example includes identifying the most prevalent cell type annotation tag on returned cells. We used REVEAL: SingleCell to evaluate the expression of key SARS-CoV-2 entry associated genes, and queried the current database (2.2 Million cells, 32 projects) to obtain the results in < 60 s. We highlighted cells expressing COVID-19 associated genes are expressed on multiple tissue types, thus in part explains the multi-organ involvement in infected patients observed worldwide during the on-going COVID-19 pandemic.

Conclusion: In this paper, we introduce the REVEAL: SingleCell database that addresses immediate needs for SARS-CoV-2 research and has the potential to be used more broadly for many precision medicine applications. We used the REVEAL: SingleCell database as a reference to ask questions relevant to drug development and precision medicine regarding cell type and co-expression for genes that encode proteins necessary for SARS-CoV-2 to enter and reproduce in cells.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12864-020-07300-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7785925PMC
January 2021

Medical Students' Perspectives on an Assessment of Reflective Portfolios [Response to Letter].

Adv Med Educ Pract 2020 16;11:495-496. Epub 2020 Jul 16.

Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, Doha, Qatar.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2147/AMEP.S270581DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7381774PMC
July 2020

Construct Validity of an Instrument for Assessment of Reflective Writing-Based Portfolios of Medical Students.

Adv Med Educ Pract 2020 3;11:397-404. Epub 2020 Jun 3.

Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, Doha, Qatar.

Purpose: Assessment of reflective writing for medical students is challenging, and there is lack of an available instrument with good psychometric properties. The authors developed a new instrument for assessment of reflective writing-based portfolios and examined the construct validity of this instrument.

Methods: After an extensive literature review and pilot testing of the instrument, two raters assessed the reflective writing-based portfolios from years 2 and 3 medical students (n=135) on three occasions. The instrument consists of three criteria: organization, description of an experience and reflection on the experience. We calculated the reliability of scores using generalizability theory with a fully crossed design and two facets (raters and occasions). In addition, we measured criterion validity by testing correlations with students' scores using other assessment methods.

Results: The dependability (Φ) coefficient of the portfolio scores was 0.75 using two raters on three occasions. Students' portfolio scores represented 46.6% of the total variance across all score comparisons. The variance due to occasions was negligible, while the student-occasion interaction was small. The variance due to student-rater interaction represented 17.7%, and the remaining 27.7% of the variance was due to unexplained sources of error. The decision (D) study suggested that an acceptable dependability (Φ = 0.70 and 0.72) can be achieved by using two raters for one and two occasions, respectively. Finally, we found moderate to large effect-size correlations between students' scores in reflective writing-based portfolios and communication skills (r = 0.47) and PBL tutorials (r = 0.50).

Conclusion: We demonstrated the presence of different sources of evidence that support construct validity of the study instrument. Further studies are warranted before utilizing this instrument for summative assessment of students' reflective writing-based portfolios in other medical schools.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2147/AMEP.S256338DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7276316PMC
June 2020

In Vivo Quasi-Elastic Light Scattering Eye Scanner Detects Molecular Aging in Humans.

J Gerontol A Biol Sci Med Sci 2020 09;75(9):e53-e62

Molecular Aging & Development Laboratory, Boston University School of Medicine, Massachusetts.

The absence of clinical tools to evaluate individual variation in the pace of aging represents a major impediment to understanding aging and maximizing health throughout life. The human lens is an ideal tissue for quantitative assessment of molecular aging in vivo. Long-lived proteins in lens fiber cells are expressed during fetal life, do not undergo turnover, accumulate molecular alterations throughout life, and are optically accessible in vivo. We used quasi-elastic light scattering (QLS) to measure age-dependent signals in lenses of healthy human subjects. Age-dependent QLS signal changes detected in vivo recapitulated time-dependent changes in hydrodynamic radius, protein polydispersity, and supramolecular order of human lens proteins during long-term incubation (~1 year) and in response to sustained oxidation (~2.5 months) in vitro. Our findings demonstrate that QLS analysis of human lens proteins provides a practical technique for noninvasive assessment of molecular aging in vivo.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/gerona/glaa121DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7494032PMC
September 2020

Diagnostic uncertainties, ethical tensions, and accounts of role responsibilities in genetic counseling communication.

J Genet Couns 2020 12 17;29(6):1159-1172. Epub 2020 Apr 17.

Department of Pathology and Medical Genetics, Trondheim University Hospital, Trondheim, Norway.

Diagnostic uncertainties are intricately associated with genomic testing-especially concerning new technologies such as exome sequencing-with test results being either inconclusive or generating secondary findings or showing variants of uncertain significance. In the process of genetic counseling, diagnostic uncertainties have to be managed even when test results for an individual client are either positive or negative because of differential implications for family members. Previous studies have investigated diagnostic uncertainties in relation to clients wanting to know or not know the test results; here, we extend this line of research by addressing how genetic counselors and clients account for the management of diagnostic uncertainties vis-à-vis the attendant ethical tensions in the complex communicative environment in the clinic setting. Our dataset from the Norwegian context is longitudinal, consisting of ten audio-recorded pre-test genetic counseling sessions. It involves one extended family with a high burden of colorectal cancer. Through theme-oriented discourse analysis, we demonstrate how diagnostic uncertainties give rise to tensions concerning risks and benefits of knowing in both professional and familial spheres, which then map onto accounts of various role responsibilities. For instance, in looking for certainty via advanced genomic testing to reduce diagnostic uncertainty for clients, genetic counselors are confronted with tensions regarding what can be communicated and made known because of their role responsibilities toward what may be regarded as scientific others and clinical others. Likewise, clients are faced with tensions concerning wanting to know/not know, which invokes various familial others and may align or not align with genetic counselors' preferences, especially relating to management of diagnostic uncertainties and secondary findings.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/jgc4.1282DOI Listing
December 2020

Editorial.

Authors:
Srikant Sarangi

Commun Med 2017 ;14(1):1-2

Aalborg University.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1558/cam.34443DOI Listing
November 2018

Editorial: Team work and team talk as distributed and coordinated action in healthcare delivery.

Authors:
Srikant Sarangi

Commun Med 2016 ;13(1):1-7

Aalborg University and Cardiff University.

This special issue of Communication & Medicine is dedicated to the theme of teamwork and team talk in healthcare delivery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1558/cam.32569DOI Listing
January 2016

Discourse types and (re)distribution of responsibility in simulated emergency team encounters.

Commun Med 2016 ;13(1):51-70

Aalborg University.

Successful teamwork, constitutive of team talk, depends largely on shared responsibility in the coordination of tasks in a goal-oriented way. This paper examines how specific modes of talk or 'discourse types' are utilised by a healthcare team in simulated emergency care. The data corpus comprises six video-recorded simulation training sessions in an emergency department at a large Norwegian hospital. Our analysis focuses on the critical moment when the original healthcare team is joined by other specialists in an ad hoc manner, which necessitates the (re)distribution of expert responsibility in the management of the patient's condition. We examine the interactional trajectories and, in particular, the discourse types surrounding the critical moment which marks the incorporation of the new team members. The analysis centres on three discourse types (online commentary, offline commentary and metacommentary) that are utilised in accomplishing the multiple tasks in a collaborative and coordinated fashion. We suggest that team talk overlays and overlaps with distributed medical work in highly charged decision-making contexts such as emergency care. The findings have relevance for how healthcare professionals and students are trained in multidisciplinary team talk and teamwork.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1558/cam.32148DOI Listing
January 2016

The management of diagnostic uncertainty and decision-making in genetics case conferences.

Commun Med 2016 ;13(1):37-50

University of Warwick.

In this paper we examine one type of intraprofessional collaborative activity, namely case conferences in a specialist genetics clinic. Our specific focus is on how clinical geneticists manage decision-making through team talk in the event of diagnostic uncertainty which is mainly attributable to limitations in the current state of genomic knowledge, 'uncertain significances' associated with genetic test results, and a lack of information/ evidence pertaining to cases under discussion. The case conference then becomes a means to minimise the uncertainty and arrive at decisions that optimise the significance of the results in terms of clients' life trajectories. Adopting theme-oriented activity analysis, we examine video-recorded data from five case conferences in Hong Kong. Beginning with a prototypical structural mapping of the case conference activity type, our analysis focuses on what we call 'uncertain cases'. Our findings highlight three discourse types constitutive of team talk: pedagogic talk, diagnostic talk and decisional talk. In paying particular attention to how uncertainty is formulated and negotiated, we suggest that access to and assessment of different kinds of evidence as well as the activity-specific expert role-positions of the participants are crucial with regard to establishing a correct diagnosis and/or striving towards a minimisation of current uncertainties.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1558/cam.18433DOI Listing
January 2016

Tenth anniversary of Communication & Medicine].

Authors:
Srikant Sarangi

Commun Med 2014 ;11(1)

View Article and Find Full Text PDF

Download full-text PDF

Source
October 2015

Genetic counseling/consultation in South-East Asia: a report from the workshop at the 10th Asia pacific conference on human genetics.

J Genet Couns 2013 Dec 19;22(6):917-24. Epub 2013 Sep 19.

School of English, The University of Hong Kong, Faculty of Arts, Centennial Campus, the University of Hong Kong, Room 738, 7/F, Run Run Shaw Tower (Building B, Arts) Pokfulam Road, Hong Kong SAR, China,

This paper reports on the workshop 'Genetic Counseling/Consultations in South-East Asia' at the 10(th) Asia Pacific Conference on Human Genetics in Kuala Lumpur, Malaysia, in December 2012. The workshop brought together professionals and language/communication scholars from South-East Asia, and the UK. The workshop aimed at addressing culture- and context-specific genetic counseling/consultation practices in South-East Asia. As a way of contextualizing genetic counseling/consultation in South-East Asia, we first offer an overview of communication-oriented research generally, drawing attention to consultation and counseling as part of a communicative continuum with distinctive interactional features. We then provide examples of genetic counseling/consultation research in Hong Kong. As other countries in South-East Asia have not yet embarked on communication-oriented empirical research, we report on the current practices of genetic counseling/consultation in these countries in order to identify similarities and differences as well as key obstacles that could be addressed through future research. Three issues emerged as 'problematic': language, religion and culture. We suggest that communication-oriented research can provide a starting point for evidence-based reflections on how to incorporate a counseling mentality in genetic consultation. To conclude, we discuss the need for creating a platform for targeted training of genetic counselors based on communication-oriented research findings.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10897-013-9646-7DOI Listing
December 2013

Promissory accounts of personalisation in the commercialisation of genomic knowledge.

Commun Med 2011 ;8(1):53-66

Cardiff School of Social Science, Cardiff University, Wales, UK.

As part of personalised medicine emerging from the human genomics revolution, many websites now offer direct-to-consumer genetic testing. Here, we examine three personal genomics companies--Navigenics, deCODEme and 23andMe--each of which represents contrasting registers of 'personalisation'. We identify three distinctive registers in these websites: a paternalistic (medical) register; a translational (scientific) register and a democratic (consumerist) register. We explore in detail the rhetorical and discourse devices employed in these websites to assess how personalised healthcare is promised to the public. Promising information that will empower prevention of common complex diseases and ensure better quality of life is conflated with promising greater access to personal information. The presence and absence of scientific legitimacy is related to concerns about accuracy and validity on the one side, and fears of paternalism and elitism on the other. Nevertheless, a common strategy uniting these different styles of personalisation is consumer empowerment. Finally, we consider the tension between the drive of translational medicine to make human genomic research practically relevant, and the intrinsic uncertainties of scientific research and show how, in the commercial domain, future risks are transformed into discourses of promise by concealing these uncertainties.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1558/cam.v8i1.53DOI Listing
June 2012

Voicing the lifeworld: Parental accounts of responsibility in genetic consultations for polycystic kidney disease.

Soc Sci Med 2011 Jun 29;72(11):1743-51. Epub 2010 Jul 29.

Institute of Medical Genetics, School of Medicine, Cardiff University, Cardiff, Wales, UK.

When parents, who are carriers of or are affected by a genetic disorder, make decisions about the health risks faced by their children, there may be multiple factors to consider. These may include the medical benefits, the parents' own experiences of learning about their genetic status, and the future autonomy of the child. Health professionals face the challenge of explaining the possible burdens as well as benefits of testing children, while promoting open communication within families about the risk of an inherited condition. While genetic consultations do not in themselves constitute decision making, parents nevertheless account for their actions and decisions in an attempt to display parental responsibility. In this paper we explore the accounting practices of parents in genetic consultations, focusing on how they articulate their responsibility with regard to testing their at-risk children for autosomal dominant polycystic kidney disease (PKD) and the communication issues surrounding the testing process and the disclosing of test results. Based on eight audio-recorded and transcribed genetic consultations from the UK, and drawing upon rhetorical discourse analysis, our findings suggest that (i) parents tend to foreground their practical 'lifeworld' considerations to justify their decisional actions; and (ii) there is considerable variation in the ways in which parents respond to information and advice offered by the professionals. The affected parent often presents their lifeworld concerns as outweighing, at least for the present moment, the longer term health benefits that might accrue to their children.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.socscimed.2010.06.040DOI Listing
June 2011

Communication & Medicine.

Authors:
Srikant Sarangi

Commun Med 2010 ;7(1):1-2

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1558/cam.v7i1.1DOI Listing
April 2011

The 7th COMET Conference.

Authors:
Srikant Sarangi

Commun Med 2009 ;6(1):1-2

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1558/cam.v6i1.1DOI Listing
October 2009

Professional ambivalence: accounts of ethical practice in childhood genetic testing.

J Genet Couns 2009 Apr 10;18(2):173-84. Epub 2009 Feb 10.

ESRC Centre for Economic and Social Aspects of Genomics, Cardiff University, Cardiff, Wales, UK.

Childhood genetic testing raises complex ethical and moral dilemmas for both families and professionals. In the family sphere, the role of communication is a key aspect in the transmission of 'genetic responsibility' between adults and children. In the professional sphere, genetic responsibility is an interactional accomplishment emerging from the sometimes competing views over what constitutes the 'best interests' of the child in relation to parental preferences on the one hand, and professional judgements on the other. In the present paper we extend our previous research into parental accounts of childhood genetic testing and explore the ethical accounts of professionals in research interviews. Interviews (n = 20) were conducted with professional practitioners involved in the genetic diagnosis and management of children and their families. We first identify four inter-related themes-juxtaposition of parental rights vis-à-vis child's autonomy, elicitation of the child's autonomy, avoidance of parental responsibility and recognition of professional uncertainty. Then, using Rhetorical Discourse Analysis, we examine the range of discourse devices through which ethical accounts are situationally illustrated: contrast, reported speech, constructed dialogue, character and event work. An overarching device in these ethical accounts is the use of extreme case scenarios, which reconstruct dilemmas as justifications of professional conduct. While acknowledging ambivalence, our analysis suggests that professional judgement is not a simple matter of implementing ethical principles but rather of managing the practical conditions and consequences of interactions with parents and children. We conclude that more attention is needed to understand the way professional practitioners formulate judgements about ethical practice.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10897-008-9201-0DOI Listing
April 2009

Contributions and, where possible, suggest avenues for future research.

Authors:
Srikant Sarangi

Commun Med 2009 ;6(2):107-8

View Article and Find Full Text PDF

Download full-text PDF

Source
August 2010

Humanizing HIV/AIDS and its (re)stigmatizing effects: HIV public 'positive' speaking in India.

Health (London) 2009 Jan;13(1):47-65

Cardiff University, UK.

Social stigma has been inextricably linked with HIV and AIDS since the epidemic erupted in the early 1980s. The stigma that has built up around HIV and AIDS is generally regarded as having a negative impact on the quality of life of HIV-positive people and on general prevention efforts. Current attempts to combat HIV-related stigma focus on increasing the acceptance of HIV among the stigmatizing public and stigmatized individuals alike. In this, the global HIV-positive community is being increasingly called upon to ;humanize' the virus, not least through public displays of HIV 'positive' health and public ;positive' speaking. This article critically explores the constitutive effects and inherent power relations of HIV Positive Speakers' Bureaus (PSBs) as a platform for such a display. Adopting a post-structuralist discourse analytic approach, we explore accounts of positive-speaking and HIV health from HIV-related non-government organizations in India and in PSB training manuals. In particular, we highlight ways in which positive-speaking in India can be seen to have significant (re)stigmatizing effects by way of ambivalent and hyper-real configurations of HIV 'positive' identity and life.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1363459308097360DOI Listing
January 2009

Real nursing? The development of telenursing.

J Adv Nurs 2008 Mar;61(6):631-40

Centre for Health Information, Research and Evaluation, Swansea University, UK.

Aim: This paper is a report of a study to understand the impact of telenursing from the perspective of nurses involved in its provision, and in more traditional roles.

Background: Nurse-led telephone helplines have recently been introduced across the United Kingdom, a major step in the development of nursing practice.

Method: A structured questionnaire was sent to all nurses working in the NHS Direct (National Health Service Direct) Wales telephone service (n = 111). Ninety-two completed questionnaires were returned (response rate 83 per cent). Two focus groups were conducted: one with telephone service nurses (n = 8) and one with other nurses (n = 5). The data were collected in 2002.

Findings: Respondents represented a highly educated workforce from a range of healthcare specialties. They reported that they joined the telephone service for improved salary and flexible working. Two-thirds reported improved job satisfaction. All focus group participants reported that the development of nursing skills was affected by the use of decision support software and the remote nature of the consultation. Participants reported opportunities for skill development, although the role could be stressful. All agreed that the service was popular with callers, but the nurses from outside raised concerns about whether telenursing was 'real' nursing and about the evidence base for the service and access by disadvantaged groups.

Conclusion: Differences between the groups reflect policy tensions between the need to develop new nursing skills, including the use of technology, to improve efficiency and recognition of the worth of hands-on nursing. These tensions must be addressed for the telephone service to function as part of an integrated healthcare system.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1365-2648.2007.04546.xDOI Listing
March 2008

The micropolitics of responsibility vis-à-vis autonomy: parental accounts of childhood genetic testing and (non)disclosure.

Sociol Health Illn 2008 Mar;30(2):255-71

ESRC Centre for Economic and Social Aspects of Genomics, Cardiff University, Cardiff CF10 3WT, UK.

Genetic testing and (non)disclosure of genetic information present ethical and moral dilemmas for the management of parental responsibility vis-à-vis the child's autonomy. Ethical guidelines aimed at professionals currently seek to defer childhood testing where there is no clear medical or psychosocial benefit. This version of autonomy is derived from a bioethical paradigm which brackets the individual rights and capacities of the child. In this paper we focus on situated parental accounts of responsibility/autonomy to understand the complex forms of relational work -i.e. the micropolitics of balancing rights and responsibilities - involving a range of inherited genetic disorders. Interviews (n= 20) were conducted with parents whose genetic condition may have had consequences for their children. Using rhetorical discourse analysis, we show how parents draw upon a number of rhetorical/discoursal devices to produce accounts where genetic responsibility is actually or potentially transmitted to the child. We identify three kinds of accounting practice: (1) aligned responsibility; (2) deferred responsibility; and (3) misaligned responsibility. Each of these practices demonstrates how parents position themselves responsibly by foregrounding figures and events onto which the child's autonomy is selectively mapped. Rather than simple representations, we regard these accounts as complex moral performances that seek alignment with broader bioethical discourses.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1467-9566.2007.01037.xDOI Listing
March 2008

Quality of life as a mode of governance: NGO talk of HIV 'positive' health in India.

Soc Sci Med 2008 Apr 30;66(7):1568-78. Epub 2008 Jan 30.

School of Social Sciences, Cardiff University, Cardiff, UK.

Quality of life (QOL) is being increasingly emphasized in healthcare research and practice around the world as a desirable and measurable outcome of health policy, health-seeking behaviour and overall life satisfaction. Drawing on F notions of governmentality and biopower, we take the position that the promotion of a universal and apolitical concept of QOL, as it pertains to individual health and well-being, can be seen as being tied to a neoliberal rationality of global socio-economic and health governance. In understanding non-government organizations (NGOs) as a prime catalyst for socio-economic change under neoliberalism, we highlight ways in which HIV-related NGOs in India can be seen to deploy aspects of the prescriptive and regulatory QOL discourse in their promotions of an empowered HIV 'positive' health and subjectivity. Implications are discussed in terms of the inevitable tensions involved for many under-resourced HIV-positive people in India who, in the name of QOL, are called upon to identify and act as entrepreneurial and (self)empowered individuals in particular normalizing terms.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.socscimed.2007.12.008DOI Listing
April 2008

Managing self-responsibility through other-oriented blame: family accounts of genetic testing.

Soc Sci Med 2008 Apr 28;66(7):1521-32. Epub 2008 Jan 28.

Cardiff University, Cardiff, South Glamorgan, UK.

'Genetic responsibility' has emerged as a key notion for understanding how genetic risk reshapes patterns of choice, identification and obligation within families. Where previous research has examined the difficulties of managing responsibility for genetic testing and disclosure of the testing process and results, there is little work that examines these themes when accounts of genetic responsibility involve blame. In this paper, we explore how forms of responsible selfhood are managed through accounts of other-oriented blame in the family sphere. Interviews (n=20) were conducted in the United Kingdom with parents whose genetic condition may have consequences for other family members. Using rhetorical discourse analysis we show that a key discursive resource for managing blame and responsibility is the use of contrast -- via constructed dialogue, character/event work and extreme case formulation -- to either endorse or contest versions of responsible/moral selfhood. We conclude that claims of personal responsibility manifest in open disclosure of genetic information often entail the blaming of others within the family. By extension, blaming others has moral and relational significance when competing views of genetic responsibility are at stake and when genetic understandings are incongruent.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.socscimed.2007.12.022DOI Listing
April 2008

An AICD-based functional screen to identify APP metabolism regulators.

Mol Neurodegener 2007 Aug 24;2:15. Epub 2007 Aug 24.

Department of Bioscience & Biotechnology, Drexel University, Philadelphia, PA, USA.

Background: A central event in Alzheimer's disease (AD) is the regulated intramembraneous proteolysis of the beta-amyloid precursor protein (APP), to generate the beta-amyloid (Abeta) peptide and the APP intracellular domain (AICD). Abeta is the major component of amyloid plaques and AICD displays transcriptional activation properties. We have taken advantage of AICD transactivation properties to develop a genetic screen to identify regulators of APP metabolism. This screen relies on an APP-Gal4 fusion protein, which upon normal proteolysis, produces AICD-Gal4. Production of AICD-Gal4 induces Gal4-UAS driven luciferase expression. Therefore, when regulators of APP metabolism are modulated, luciferase expression is altered.

Results: To validate this experimental approach we modulated alpha-, beta-, and gamma-secretase levels and activities. Changes in AICD-Gal4 levels as measured by Western blot analysis were strongly and significantly correlated to the observed changes in AICD-Gal4 mediated luciferase activity. To determine if a known regulator of APP trafficking/maturation and Presenilin1 endoproteolysis could be detected using the AICD-Gal4 mediated luciferase assay, we knocked-down Ubiquilin 1 and observed decreased luciferase activity. We confirmed that Ubiquilin 1 modulated AICD-Gal4 levels by Western blot analysis and also observed that Ubiquilin 1 modulated total APP levels, the ratio of mature to immature APP, as well as PS1 endoproteolysis.

Conclusion: Taken together, we have shown that this screen can identify known APP metabolism regulators that control proteolysis, intracellular trafficking, maturation and levels of APP and its proteolytic products. We demonstrate for the first time that Ubiquilin 1 regulates APP metabolism in the human neuroblastoma cell line, SH-SY5Y.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/1750-1326-2-15DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2071909PMC
August 2007

The causation of disease - the practical and ethical consequences of competing explanations.

Med Health Care Philos 2006 ;9(3):293-306

Health Communication Research Centre, Cardiff University, Cardiff, Wales, UK.

The prevention, treatment and management of disease are closely linked to how the causes of a particular disease are explained. For multi-factorial conditions, the causal explanations are inevitably complex and competing models may exist to explain the same condition. Selecting one particular causal explanation over another will carry practical and ethical consequences that are acutely relevant for health policy. In this paper our focus is two-fold; (i) the different models of causal explanation that are put forward within current scientific literature for the high and rising prevalence of the common complex conditions of coronary artery disease (CAD) and type 2 diabetes mellitus (T2D); and (ii) how these explanations are taken up (or not) within national health policy guidelines. We examine the causal explanations for these two conditions through a systematic database search of current scientific literature. By identifying different causal explanations we propose a three-tier taxonomy of the most prominent models of explanations: (i) evolutionary, (ii) lifecourse, and (iii) lifestyle and environment. We elaborate this taxonomy with a micro-level thematic analysis to illustrate how some explanations are semantically and rhetorically foregrounded over others. We then investigate the uptake of the scientific causal explanations in health policy documents with regard to the prevention and management recommendations of current National Service Frameworks for CAD and T2D. Our findings indicate a lack of congruence between the complexity and frequent overlap of causal explanations evident in the scientific literature and the predominant focus on lifestyle recommendations found in the mainstream health policy documents.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11019-006-9007-5DOI Listing
April 2007

Presentation of self and symptoms in primary care consultations involving patients from non-English speaking backgrounds.

Commun Med 2004 ;1(2):159-69

Department of Education and Professional Studies, King's College London, London, UK.

This paper draws on the PLEDGE research project (Patients with Limited English and Doctors in General Practice) 1 The Patients with Limited English and Doctors in General Practice (PLEDGE) project was funded by Sir Siegmund Warburg's Voluntary Settlement (2001-2003). The research team was: Celia Roberts, Roger Jones, Becky Moss, Srikant Sarangi and Val Wass. which has a database of 232 video-recorded interactions from GP surgeries in South East London. We focus on the opening episodes-the first opportunity the patient has to report on why they have come to see the doctor-to explore some of the contrasts in self presentation and the interactional work that doctors do when faced with the unexpected. Patients who speak a local London or standard variety of English present three aspects: a description of symptoms, the context in which they occurred, and an affective or epistemic stance. These 'micro discourse routines' are accomplished interactionally through the design of figure/ground relationships, framing and metacommunication and presentation of the 'moral self'. Although some patients from non-English speaking backgrounds use broadly similar 'micro discourse routines', the majority configure the relationship between medically salient facts, adequate contextual information and the stance which conveys the 'moral self' in different and apparently less 'orderly' ways. So openings often become protracted and harder work interactionally for both sides. While conversation analytic studies and communication skills textbooks represent the medical consultations as orderly, we suggest that such apparent orderliness must, at least, be partly the result of ironing out linguistic and cultural diversity. Interactional sociolinguistic analysis is used to shed light on the design of these routines and to provide analytic frameworks for doctors in reflecting on their own practice in ways which challenge patient-centred models.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1515/come.2004.1.2.159DOI Listing
July 2006