Negotiating capture, resistance, errors, and identity: Confessions from the operating suite.

Conducting research in medical settings can pose particular challenges for research on adoption and adaptation to new technologies, especially when medical errors are a subject of the research, or the research necessitates capture of user behaviors and interactions. A case study of research in a clinical setting explores the experience of the researcher as they negotiate the practical challenges of research and research participants’ acts of resistance. The researcher’s identity, as constructed in the medical setting, serves to make this negotiation more complex. However, this case also illustrates the practical and theoretical approaches that can be applied to overcome these challenges

An Awfully Big Adventure: Killing Death in War Stories for Children

The increase of discourses dealing with death, violence or brutality in times of war, may be due to two factors. First there is a perception of a global increase of fields of war. This, in turn, may be dependent upon the second factor: the ready availability of images and information about war, from newspapers, histories of war events, and cinematic documentaries, to video games and, as I explore in this paper, fictional texts for children. In war stories for children death is usually at one remove because children do not normally fight as soldiers. For the child in war time, their position is usually that of the equivocal observer. This then reveals a basic problem of how to tell of the brutality of war, how to underline an apparent fundamental ideology of war stories for children; that is, to create a sense of anti-war ethos, when the child narrator and focaliser is not a combatant. Nevertheless it seems that war stories should, and do, attempt to show that war is about 'killing soldiers' and often others as well. But in so doing it is rarely this simple. There may be many reasons why this blunt and necessary aspect of war is re-shaped for the child reader; but in this paper I want to concentrate on the ways and means of this re-shaping

Minding your 'Ps and Qs': Poetry, Propaganda, Politics and Pictures

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Parallel Ideologies: An Exploration of the Ideologies of Childhood and Poetry

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Place in Poetry: Poetry in its Place

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Carotid artery stenosis

Carotid endarterectomy is currently the most effective intervention to prevent stroke in patients with recent symptoms of carotid stenosis.1 2 It also prevents future stroke in younger patients (under 75 years) who have not yet had symptoms, as long as the risk of stroke and death from surgery is not more than 3% Patients naturally prefer carotid artery stenting to open surgery, but stenting has not been shown to be acceptably safe in clinical trials. Carotid endarterectomy has been in widespread use for more than 50 years, but carotid artery stenting is a more recent development. In the linked systematic review (doi:10.1136/bmj.c467), Meier and colleagues assessed the short term safety and intermediate term efficacy of carotid endarterectomy versus carotid artery stenting. They found that the short term (30 day) hazards of stroke and death after stenting in recent trials of symptomatic patients have improved but are not yet as good as those seen after surgery.5 In the intermediate term, the two treatments did not differ significantly for stroke or death (hazard ratio 0.90, 95% confidence interval 0.74 to 1.1)

Correlates of knee bone marrow lesions in younger adults

Background: Subchondral bone marrow lesions (BMLs) play a key role in the pathogenesis of osteoarthritis (OA) and are associated with pain and structural progression in knee OA. However, little is known about clinical significance and determinants of BMLs of the knee joint in younger adults. We aimed to describe the prevalence and environmental (physical activity), structural (cartilage defects, meniscal lesions) and clinical (pain, stiffness, physical dysfunction) correlates of BMLs in younger adults and to determine whether cholesterol levels measured 5 years prior were associated with current BMLs in young adults. Methods: Subjects broadly representative of the Australian young adult population (n = 328, aged 31–41 years, female 48.7 %) underwent T1- and proton density-weighted fat-suppressed magnetic resonance imaging (MRI) in their dominant knee. BMLs, cartilage defects, meniscal lesions and cartilage volume were measured. Knee pain was assessed by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and physical activity was measured by the International Physical Activity Questionnaire (IPAQ). Cholesterol levels including high-density lipoprotein (HDL) were assessed 5 years prior to MRI. Results: The overall prevalence of BML was 17 % (grade 1: 10.7 %, grade 2: 4.3 %, grade 3: 1.8 %). BML was positively associated with increasing age and previous knee injury but not body mass index. Moderate physical activity (prevalence ratio (PR):0.93, 95 % CI: 0.87, 0.99) and HDL cholesterol (PR:0.36, 95 % CI: 0.15, 0.87) were negatively associated with BML, while vigorous activity (PR:1.02, 95 % CI: 1.01, 1.03) was positively associated with medial tibiofemoral BMLs. BMLs were associated with more severe total WOMAC knee pain (>5 vs ≤5, PR:1.05, 95 % CI: 1.02, 1.09) and WOMAC dysfunction (PR:1.75, 95 % CI: 1.07, 2.89), total knee cartilage defects (PR:2.65, 95 % CI: 1.47, 4.80) and total meniscal lesion score (PR:1.92, 95 % CI: 1.13, 3.28). Conclusions: BMLs in young adults are associated with knee symptoms and knee structural lesions. Moderate physical activity and HDL cholesterol are beneficially associated with BMLs; in contrast, vigorous physical activity is weakly but positively associated with medial tibiofemoral BMLs

The United Kingdom EVAR Trial Investigators. Endovascular Repair of Aortic Aneurysm in Patients Physically Ineligible for Open Repair

Background Few data are available on the long-term outcome of endovascular repair of abdominal aortic aneurysm as compared with open repair. Methods From 1999 through 2004 at 37 hospitals in the United Kingdom, we randomly assigned 1252 patients with large abdominal aortic aneurysms (≥5.5 cm in diameter) to undergo either endovascular or open repair; 626 patients were assigned to each group. Patients were followed for rates of death, graft-related complications, reinterventions, and resource use until the end of 2009. Logistic regression and Cox regression were used to compare outcomes in the two groups. Results The 30-day operative mortality was 1.8% in the endovascular-repair group and 4.3% in the open-repair group (adjusted odds ratio for endovascular repair as compared with open repair, 0.39; 95% confidence interval [CI], 0.18 to 0.87; P=0.02). The endovascular-repair group had an early benefit with respect to aneurysm-related mortality, but the benefit was lost by the end of the study, at least partially because of fatal endograft ruptures (adjusted hazard ratio, 0.92; 95% CI, 0.57 to 1.49; P=0.73). By the end of follow-up, there was no significant difference between the two groups in the rate of death from any cause (adjusted hazard ratio, 1.03; 95% CI, 0.86 to 1.23; P=0.72). The rates of graft-related complications and reinterventions were higher with endovascular repair, and new complications occurred up to 8 years after randomization, contributing to higher overall costs. Conclusions In this large, randomized trial, endovascular repair of abdominal aortic aneurysm was associated with a significantly lower operative mortality than open surgical repair. However, no differences were seen in total mortality or aneurysm-related mortality in the long term. Endovascular repair was associated with increased rates of graft-related complications and reinterventions and was more costly. (Current Controlled Trials number, ISRCTN55703451.