Diagnostic Pathways as Social and Participatory Practices: The Case of Herpes Simplex Encephalitis

Herpes simplex virus (HSV) encephalitis is a potentially devastating disease, with significant rates of mortality and co-morbidities. Although the prognosis for people with HSV encephalitis can be improved by prompt treatment with aciclovir, there are often delays involved in the diagnosis and treatment of the disease. In response, National Clinical Guidelines have been produced for the UK which make recommendations for improving the management of suspected viral encephalitis. However, little is currently known about the everyday experiences and processes involved in the diagnosis and care of HSV encephalitis. The reported study aimed to provide an account of the diagnosis and treatment of HSV encephalitis from the perspective of people who had been affected by the condition. Thirty narrative interviews were conducted with people who had been diagnosed with HSV encephalitis and their significant others. The narrative accounts reveal problems with gaining access to a diagnosis of encephalitis and shortfalls in care for the condition once in hospital. In response, individuals and their families work hard to obtain medical recognition for the problem and shape the processes of acute care. As a consequence, we argue that the diagnosis and management of HSV encephalitis needs to be considered as a participatory process, which is co-produced by health professionals, patients, and their families. The paper concludes by making recommendations for developing the current management guidelines by formalising the critical role of patients and their significant others in the identification, and treatment of, HSV encephalitis.     

From genome to proteome: back to the future. Report on the 7th Siena meeting, September 3-7, 2006

This report reviews the 7th Siena Meeting 'From Genome to Proteome: Back to the Future' which took place in Italy from 3-7 September, 2006. There was a significant rise in the number of delegates attending compared with previous Siena meetings. A diversity of speakers and presentations addressed the theme of the meeting in moving proteomics forward to integrate with biology as a whole entity rather than in isolated fractions. In addition, technological advancements in sample preparation and separation as well as identification were discussed.     

The effect of adjusting settings within a Computer-Assisted Sperm Analysis (CASA) system on bovine sperm motility and morphology results

Semen motility is the most widely recognized semen quality parameter used by Artificial Insemination (AI) centers. With the increasing worldwide export of semen between AI centers there is an increasing need for standardized motility assessment methods. Computer-Assisted Sperm Analysis (CASA) technology is thought to provide an objective motility evaluation; however, results can still vary between laboratories. The aim of present study was to verify the impact of different setting values of the CASA IVOS II on motility, concentration, and morphology of bovine semen samples frozen in an extender with or without egg yolk and then decide on optimal settings for a further validation step across AI centers. Semen straws from 30 different bulls were analyzed using IVOS II with twelve modified settings. No significant changes were observed in semen concentration, percentage of motile sperm or kinetic results for either extender type. However, increasing settings for both STR and VAP progressive (%) from Low, Medium, and High cut-off values significantly (p<0.05) reduced the percentage of detected progressive spermatozoa, in egg yolk extender from 49.5±15.2, 37.2±11.9 to 11.9±5.3%, and in clear extender from 51.9±9.1, 35.8±7.3 to 10.0±2.4%, respectively. In clear extender only, the modification of droplet proximal head length significantly affected the detection of normal sperm percentages (88.0± 4.7 to 95.0±0.6 and 96.0±0.6%) and of the percentage of detected proximal droplets (12.2±4.7, 2.5±2.7 to 0.6±0.2%) for Low, Medium and High values respectively (p<0.05). The identification of sensitivity within the CASA system to changes in set parameters then led to the determination of an optimal IVOS II setting. The existing variability among centers for these phenotypes was reduced when the standardized settings were applied across different CASA units. The results clearly show the importance of applied settings for the final CASA results and emphasize the need for standardized settings to obtain comparable data.     

Non-invasively determined multi-site variation in pine marten <Emphasis Type="Italic">Martes martes</Emphasis> density,a recovering carnivore in Europe

Pine martens (Martes martes) are subject to national and international conservation legislation throughout most of their European range. Yet population density and abundance estimates, which are a key component of effective conservation management, are lacking in many countries. In this study, a large-scale non-invasive survey was undertaken in 14 forested study sites throughout Ireland to assess variation in pine marten density and abundance. Pine marten hair samples were collected in each study site and analysed using genetic techniques to determine individual identity data. Density and abundance estimates were obtained using spatially explicit capture-recapture models and CAPWIRE. Across all study sites, a total of 93 individual pine marten were identified and captured 217 times. Estimated pine marten density varied from 0 to 2.60 individuals per km² of forested habitat, with all but a single site having estimated densities of ≤1 pine marten per km² of forest habitat. Mean population abundance estimates across all study sites ranged from 0 to 27 individuals. Spatially explicit capture-recapture models on combined data across all 14 study sites provided a mean density estimate of 0.64 (95% CI 0.49–0.81). Combining this with data on the current distribution and estimated area of forest habitat occupied by the species in Ireland, the total pine marten population abundance of pine marten in Ireland was estimated at 3043 (95% CI 2330–3852) individuals. This research has conducted the largest scale investigation of pine marten density and abundance in any part of its global distribution and provided an improved basis for future population assessment and monitoring of this species.     

A cytochrome P450 2B6 meditated gene therapy strategy to enhance the effects of radiation or cyclophosphamide when combined with the bioreductive drug AQ4N

BACKGROUND: AQ4N is metabolised in hypoxic cells by cytochrome P450s (CYPs) to the cytotoxin AQ4. Most solid tumours are known to contain regions of hypoxia whereas levels of CYPs have been found to vary considerably. Enhancement of CYP levels may be obtained using gene-directed enzyme prodrug therapy (GDEPT). We have therefore examined the potential of a CYP2B6-mediated GDEPT strategy to enhance the anti-tumour effect of the combination of AQ4N with radiation or cyclophosphamide (CPA). METHODS: In vitro and in vivo transient transfection of human CYP2B6 +/- CYP reductase (CYPRED) was investigated in RIF-1 mouse tumours. Efficacy in vitro was assessed using the alkaline comet assay (ACA). In vivo, the time to reach 4x the treatment volume (quadrupling time; VQT) was used as the end point. RESULTS: When CYP2B6 was transfected into RIF-1 cells and treated with AQ4N under hypoxic conditions there was a significant increase in DNA damage (measured by the ACA) compared with non-transfected cells. In vivo, a single intra-tumoural injection of a CYP2B6 vector construct significantly enhanced tumour growth delay in combination with AQ4N (100 mg/kg) and 10 Gy X-rays. AQ4N (100 mg/kg) and CPA (100 mg/kg) with CYP2B6 and CYPRED also enhanced tumour growth delay; this effect became significant when the schedule was repeated 14 days later (p = 0.0197). CONCLUSIONS: The results show the efficacy of a CYP2B6-mediated GDEPT strategy for bioreduction of AQ4N; this may offer an additional approach to target radiation- and chemo-resistant hypoxic tumours that should enhance overall tumour control.     

Narrating Kidney Disease: The Significance Of Sensation And Time In The Emplotment Of Patient Experience

Drawing on research conducted among patients in Ireland, this article examines the narrative constructions of chronic kidney failure and explores the ways in which patient narratives cross-cut and subvert modernist medical constructions of transplantation as a therapeutic outcome, an endgame, a “gift of life.” In experience, patients dismantle this construction structure by emplotting their stories around the painful lack of an ending, ardently brought to bear by the lived realities of immunosuppressant drug therapy, the silent fears of graft rejection, and the isolation of recipiency. They articulate, instead, stories that disclose a multi-directional flow between past and future therapeutic interventions, between the altering nature of the renal body and personal experience. These storied dimensions are phenomenologically embedded in the sensory and temporal aspects of this condition as essential elements of chronic illness and as organizational properties of patient narratives.