Navigating trans visibilities, trauma and trust in a new cervical screening clinic.

Trans and gender diverse people are globally recognised as being under-served in clinical services, with significant implications for their health. During a national reorientation of the Australian cervical screening programme - from Papanicolaou smears to human papillomavirus screening - we conducted interviews with 12 key informants in cancer policy, sexual and reproductive health and trans health advocacy to understand how trans people's needs and experiences were being accounted for and addressed in health policy and practice. Themes captured the complexities of increasing visibility for trans people, including men and non-binary people with a cervix. These complexities reflect the extensive system and cultural change required in asking policymakers and practitioners to think differently about who is at risk of a disease typically associated with cisgender women. Informants drew on the language of trauma to explain the resistance many trans people feel when engaging with clinical services, particularly relating to sexual and reproductive health. In doing so, they argued for increasing resources and processes to elicit trans people's willingness to put their trust in such services. Thinking critically about the relationship between the politics of trans visibilities, trauma and trust can support effective and inclusive approaches to transgender health.

Exploring the impact of COVID-19 on mobile dating: Critical avenues for research.

In this digitally mediated world, initiating sexual or romantic intimacy now frequently occurs on mobile dating apps, which both requires people to navigate new technologies, but also enables them to explore different possibilities for intimacy. The opportunities that mobile dating holds for creating intimacy, and how people take these up, is particularly relevant in light of the global pandemic of COVID-19, when human connection and contact are entangled with varying worries about viral contamination, risk and future uncertainty. But how does the pandemic impact on mobile dating? How are affect and risk intertwined-or even negotiated-by people in their search for intimacy in this pandemic? What possibilities do mobile dating apps hold for people in their search for connection with others? In this commentary, I provide a brief overview of how risk has been examined previously in mobile dating research and explore what future directions could be taken in this field. I argue for research that acknowledges and prioritises: the plurality of people's sociomaterial conditions; the interrelationship between people, digital technologies and COVID-19; and the discursive context that furnishes people's sense of risk and emotional possibility across different sociocultural contexts. These new directions in the field offer opportunities to conduct critical research that is responsive to this dynamic context, and that illuminates the various ways that people are navigating intimacy, risk and emotion across different living conditions during this pandemic.

Magnetic resonance imaging findings and antemortem cytologic diagnosis of intramedullary spinal cord ependymoma in a dog.

CASE DESCRIPTION: A 3-year-old 31.1-kg castrated male mixed-breed dog was evaluated because of a 1- to 2-week history of paraparesis, knuckling of the hind feet, and difficulty posturing to urinate or defecate. CLINICAL FINDINGS: The dog was paraparetic but weakly ambulatory with a kyphotic posture, a mildly decreased patellar reflex in the right pelvic limb, increased tone in both pelvic limbs, and marked hyperesthesia on paraspinal palpation of the lumbar region. The urinary bladder was enlarged and firm on palpation. Neuroanatomic findings were primarily consistent with localization to the T3-L3 spinal cord segments. Magenetic resonance imaging of the thoracolumbar spinal column revealed a discrete intramedullary spinal cord mass from the cranial aspect of L4 to the middle of L5. The mass was sampled by fine-needle aspiration, and on cytologic evaluation, the suspected diagnosis was an ependymoma. TREATMENT AND OUTCOME: Owing to poor prognosis and limited treatment options, the owner elected euthanasia. Postmortem examination of the spinal cord and histologic findings for samples of the mass supported a likely diagnosis of ependymoma. CLINICAL RELEVANCE: Ependymoma is a rare neoplasm in dogs but should be considered in young patients with evidence of a tumor in the CNS. Fine-needle aspiration of the spinal cord mass was possible in the dog of this report, and the cytologic findings provided useful diagnostic information.

Body Mapping in a Drug and Alcohol Treatment Program: Eliciting New Identity and Experience.

Arts-based approaches have not been widely used in the drug and alcohol treatment sector. In this study, we examined the utility of the arts-based method of Body Mapping in an Australian residential treatment centre. Two workshops were held to explore young people's strengths and support networks in order to improve understandings of young people's lives, identities and experiences of treatment. Semi-structured follow-up interviews were conducted and triangulated with observational notes and staff interviews. We identified four major themes: engaging through art; removing the mask; revealing strengths; and a sense of achievement. Overall, this study highlighted the value of Body Mapping as an approach to engage with young people, providing rich in-depth data about their lived experiences, including in the alcohol and other drug (AOD) treatment context.

Phylogenetics and genetic variation of Heligmosomoides thomomyos in Western pocket gophers (Thomomys spp.).

The host specificities and systematics of North American Heligmosomoides species remain particularly uncertain. The primary aim of this study was to verify that a species described previously based only on morphology, H. thomomyos, from pocket gopher (Rodentia: Geomyidae) hosts in Oregon represented a monophyletic lineage. In order to address this aspect, as well as to further understand relationships and geographic patterns, we carried out phylogenetic, genetic diversity, and population dynamic analyses using partial 18S rRNA and COI mtDNA sequences of Heligmosomoides specimens. Phylogenetic analyses suggested that there are likely multiple Heligmosomoides species present in these hosts. This was supported by the high degree of divergence and differentiation found among populations, significant population structure between locations, and a modest positive association between geographic and genetic distances. This study serves as the first molecular characterization and first phylogenetic report of H. thomomyos, and documents two new host records for this parasite. The relationship of H. thomomyos among pocket gopher hosts and to other Heligmosomoides species, however, warrants continued study.

Isolation of Angola-like Marburg virus from Egyptian rousette bats from West Africa.

Marburg virus (MARV) causes sporadic outbreaks of severe Marburg virus disease (MVD). Most MVD outbreaks originated in East Africa and field studies in East Africa, South Africa, Zambia, and Gabon identified the Egyptian rousette bat (ERB; Rousettus aegyptiacus) as a natural reservoir. However, the largest recorded MVD outbreak with the highest case-fatality ratio happened in 2005 in Angola, where direct spillover from bats was not  shown. Here, collaborative studies by the Centers for Disease Control and Prevention, Njala University, University of California, Davis USAID-PREDICT, and the University of Makeni identify MARV circulating in ERBs in Sierra Leone. PCR, antibody and virus isolation data from 1755 bats of 42 species shows active MARV infection in approximately 2.5% of ERBs. Phylogenetic analysis identifies MARVs that are similar to the Angola strain. These results provide evidence of MARV circulation in West Africa and demonstrate the value of pathogen surveillance to identify previously undetected threats.

"I Wasn't Gonna Let It Stop Me": Exploring Women's Experiences of Getting Through Chemotherapy for Ovarian Cancer.

BACKGROUND: Many women with ovarian cancer experience significant chemotherapy-related adverse effects during treatment and thus cannot complete it without dose reductions and/or delays. There is some indication that chemotherapy completion is associated with improved survival, although currently little is known about what helps women get through chemotherapy. OBJECTIVE: The aim of this study was to explore women's accounts of the factors they believed were helpful during their ovarian cancer treatment. METHODS: Using a qualitative approach within a critical realist framework, we conducted interviews with 18 women who had received chemotherapy for ovarian cancer and analyzed the data thematically. RESULTS: We identified 3 main themes related to women's experiences of dealing with chemotherapy: "optimistic tenacity," which illustrates a specific stoic identity that women assumed during treatment; "self-care," which reflects the health behaviors and activities women engaged in and lifestyle adjustments they made; and "support systems," which emphasizes the importance of social, emotional, and medical support and the specific needs shared by women undergoing treatment for ovarian cancer. CONCLUSIONS: Our findings contribute to a deeper understanding of women's unique experiences of treatment that may influence whether they complete chemotherapy for ovarian cancer. IMPLICATIONS FOR PRACTICE: This study highlights the central role of women's optimistic determination within a wider self-caring and well-supported context of treatment; we aim to provide feedback and guidance to health professionals caring for women with ovarian cancer.

The Imperative for a Triumph-Over-Tragedy Story in Women's Accounts of Undergoing Chemotherapy for Ovarian Cancer.

We aimed to examine how women construct their experiences of chemotherapy treatment for ovarian cancer. Through semistructured interviews, we explored the accounts of 18 Australian women about their experiences within a broader cultural imperative-or discourse-to "think positively." By applying a critical realist lens to the analysis, we identified two discursive themes that shaped women's accounts. The "feeling different and managing support" theme highlights the identity challenges women faced because of the lack of formal support for ovarian cancer. Conversely, the theme "women's reconstructions of difficult experiences" illustrates the imperative for women to present a positive story as a way of restoring their position of a lucky and stoic survivor. Such speaking served to mask some of the underlying difficulties that were part of these women's experiences. Health care professionals need to consider looking for the hidden stories of vulnerability that lie beneath the triumphant ones.

Medical authority, managerial power and political will: A Bourdieusian analysis of antibiotics in the hospital.

Antibiotic resistance poses a significant global threat, yet clinically inappropriate antibiotic use within hospitals continues despite the implementation of abatement strategies. Antibiotic use and the viability of existing antibiotic options now sit precariously at the nexus of political will, institutional governance and clinical priorities 'at the bedside'. Yet no study has hitherto explored the perspectives of managers, instead of focusing on clinicians. In this article, drawing on qualitative interviews with hospital managers, we explore accounts of responding to antimicrobial resistance, managing antibiotic governance and negotiating clinical and managerial priorities. We argue that the managers' accounts articulate the problematic nexus of measurement and accountability, the downflow effects of political will, and core tensions within the hospital between moral, managerial and medical authority. We apply Bourdieu's theory of practice to argue that an understanding of the logics of practice within the 'hospital management classes' will be critical in efforts to protect antibiotics for future generations.

Antibiotic optimisation in 'the bush': Local know-how and core-periphery relations.

The growing global concern around antimicrobial mis-use and proliferating resistance has resulted in increasing interest in optimising antibiotics, particularly in hospitals. While the agenda to tighten antibiotic use has been critically explored in metropolitan settings, the dynamics of rural and remote settings have remained largely unexplored. Drawing on 30 interviews with doctors, nurses, and pharmacists in a remote Australian hospital, we focus on the pertinence of setting, and its importance for contextualising and potentially achieving antibiotic optimisation. Building on previous work on the dynamics of locale and core-periphery relations, here we consider how antimicrobial practice is deeply embedded in experiences of being on the geographical periphery, and crucially, at the periphery of (established) knowledge.

Myth, Manners, and Medical Ritual: Defensive Medicine and the Fetish of Antibiotics.

Given the global crisis of antimicrobial resistance, the continued misuse of antibiotics is perplexing, particularly despite persistent attempts to curb usage. This issue extends beyond traditional "wastage" areas, of livestock and community medicine, to hospitals, raising questions regarding the current principles of hospital practice. Drawing on five focus group discussions, we explore why doctors act in the ways they do regarding antibiotics, revealing how practices are done, justified, and perpetuated. We posit that antibiotic misuse is better understood in terms of social relations of fear, survival and a desire for autonomy; everyday rituals, performances, and forms of professional etiquette; and the mixed obligations evident in the health sector. Moreover, that antibiotic misuse presents as a case study of the broader problematic of defensive medicine. We argue that the impending global antibiotic crisis will involve understanding how medicine is built around certain logics of practice, many that are highly resistant to change.

Clinical and social barriers to antimicrobial stewardship in pulmonary medicine: A qualitative study.

BACKGROUND: The treatment of pulmonary infections is one of the largest indications for antibiotics in human health care, offering significant potential for antibiotic optimization internationally. This study explores the perspectives of pulmonary clinicians on antibiotic use in hospital pulmonary infections. METHODS: Twenty-eight pulmonary doctors and nurses from 2 hospitals participated in semi-structured interviews focusing on their experiences of antibiotic use. RESULTS: Barriers to antibiotic optimization in pulmonary infections were identified. Clinical barriers are as follows. The first is differentiating pneumonia vs chronic obstructive pulmonary disease: differentiating pulmonary diagnoses was reported as challenging, leading to overtreatment. The second is differentiating viral vs bacterial: diagnostic differentiation was perceived to contribute to excess antibiotic use. The third is differentiating colonization vs pathogen: the interpretation of ambiguous results was reported to lead to under- or overprescribing depending on the perspective of the treating team. Social barriers are as follows. The first is the perception of resistance: antibiotic resistance was not perceived as an immediate threat. The second is the perceived value of antibiotic clinical guidelines: there was mistrust in antibiotic guidelines. The third is hospital hierarchies: hierarchical structures had a significant influence on prescribing. CONCLUSIONS: Substantial barriers to antibiotic optimization in pulmonary infections were identified. To facilitate change in antibiotic use there must be a systematic understanding and interventions to address specific clinical issues. In the case of pulmonary medicine, significant identified issues, such as mistrust in clinical guidelines and diagnostic challenges, need to be addressed.

The Social Reception of Women With Cancer.

Experiences of cancer are enmeshed with cultural understandings and social discourses around responsibility and causation. A cancer diagnosis can raise questions about its causation-including the role of the individual-whereas the disease and its treatment provide various social markers of illness. We present a sociological study of 81 women's accounts of living with cancer, with a focus on how women interpret their illness, in light of their interpersonal interactions and accounts of social relations. Our analysis reveals women's experiences of cancer diagnosis and treatment, the varied sociocultural meanings of cancer and the responses it elicits, the presence of moral assessments within everyday interactions, and the implications for the support and care they receive. We argue that the experience of cancer should be seen as intimately interwoven with its social reception and cultural sense-making practices, including normative constructs which promote ideas about (in)justice, responsibilization, and shame.

Evaluation of Subscription-based Culture Change Models in Care Settings: Findings From a Systematic Review.

PURPOSE OF THE STUDY: Person-centered culture change models to which aged care service providers subscribe are gaining increasing traction. It has been suggested that culture change initiatives broadly are subject to a range of issues. It is difficult, however, to draw out from the existing literature specific information about the scope and quality of evidence regarding subscription-based approaches. The purpose of this study was to identify and review the peer-reviewed literature regarding these subscription-based models. DESIGN AND METHODS: The review used the Joanna Briggs Institute process and tools. Studies reporting on subscription-based person-centered culture change models in health and aged care, published in peer-reviewed literature in English up to and including 2015 were identified and assessed. In all, 28 articles reporting on 33 studies were included in the review. RESULTS: There was no single model for which a significant body of evidence was identified, and approaches to outcomes were fragmented. Research approaches varied. Rigor and reporting were of concern; however, strengths of the evidence base included generally adequate sample sizes and the use of multiple methods including large data sets and standardized scales. IMPLICATIONS: Despite their structured approaches, research and evaluation for subscription-based models are limited, ad hoc, and fragmented. A more comprehensive program of research that is embedded in the implementation process is needed. Recommendations include use of longitudinal study designs, attention to implementation and contextual factors, and measurement of both process and outcomes across the full range of culture change domains.

What Health and Aged Care Culture Change Models Mean for Residents and Their Families: A Systematic Review.

PURPOSE OF THE STUDY: A range of commercialized programs are increasingly being adopted which involve broad culture change within care organizations to implement person-centered care. These claim a range of benefits for clients; however, the published evidence for client and family outcomes from culture change is inconclusive and the evidence for these specific models is difficult to identify. The purpose of this review was to identify and evaluate the peer-reviewed evidence regarding consumer outcomes for these subscription-based models. DESIGN AND METHODS: The review followed the Joanna Briggs Institute procedure. The review considered peer-reviewed literature that reported on studies conducted with health and aged care services, their staff, and consumers, addressed subscription-based person-centered culture change models, and were published in English up to and including 2015. The review identified 19 articles of sufficient quality that reported evidence relating to consumer outcomes and experience. RESULTS: Resident outcomes and family and resident satisfaction and experiences were mixed. Findings suggest potential benefits for some outcomes, particularly related to quality of life and psychiatric symptoms, staff engagement, and functional ability. Although residents and families identified some improvements in residents' lives, both also identified problematic aspects of the change related to staff adjustment and staff time. IMPLICATIONS: Outcomes for these models are at best comparable with traditional care with limited suggestions that they result in poorer outcomes and sufficient potential for benefits to warrant further investigation. Although these models may have the potential to benefit residents, the implementation of person-centered principles may affect the outcomes.

Beyond survivorship? A discursive analysis of how people with pancreatic cancer negotiate identity transitions in their health.

We explored how people negotiate, and respond to, identity transitions following a diagnosis of pancreatic cancer. Interviews with 19 people with pancreatic cancer were analysed using thematic discourse analysis. While discursively negotiating two transitions, 'moving from healthy to ill' and 'moving from active treatment to end-of-life care', participants positioned themselves as 'in control', 'optimistic' and managing their health and illness. In the absence of other discourses or models of life post-cancer, many people draw on the promise of survival. Moving away from 'survivorship' may assist people with advanced cancer to make sense of their lives in a short timeframe.

'We're in the sandwich': Aged care staff members' negotiation of constraints and the role of the organisation in enacting and supporting an ethic of care.

Aged care staff are often seen as holding power in care relationships, particularly in client engagement. Such a perception, however, may limit our understanding and analysis of the dynamics and politics within care spaces. This paper uses interview and focus group data from both staff and clients of an Australian aged care provider to identify the positions given to, and taken up by, staff in client engagement. Focusing on one of these positions, in which staff are seen as managing and negotiating constraints, the paper uses an ethic of care lens to examine the context in which engagement - and this position taking - occurs. Findings reflect the importance of the organisational and systemic context to the practice of care ethics and the potential vulnerability and disempowerment of care giving staff. Implications for the support of staff in client engagement and the role of care organisations beyond structures and processes to an active participant in an ethic of care are discussed.

Staff members' negotiation of power in client engagement: analysis of practice within an Australian aged care service.

With increasing focus on client control and active client roles in aged care service provision, client engagement is highlighted as fundamental to contemporary care practice. Client engagement itself, however, is complex and is impacted by a range of issues including the relationships and power dynamics inherent in the care context. These dynamics do not simply reflect the roles that are available to or taken up by clients; just as important are the roles and positions that staff of aged care services are offered, and take up, in client engagement. This paper presents the findings of a study that explored client engagement practice within a large Australian service provider. Analysis of interview and focus group discussions addressed the ways in which staff were positioned - by both themselves and by clients - in terms of the roles that they hold within engagement practice and the power relations inherent within these. Analysis of power from the dominant policy perspective of choice and control, and the alternative perspective of an ethic of care suggests that power relations within the care context are dynamic, complex and involve on-going negotiation and regulation by clients and staff members in aged care. The use of these two contrasting perspectives reveals a more dynamic and complex understanding of power in care practice than dominant uni-dimensional approaches to critique suggest.

Participation and power in care: exploring the "client" in client engagement.

Despite growing recognition in health and care services of the necessity for client engagement, it is still not easily put into practice. This is owing to a range of factors relating to participating staff and clients, as well as the broader institutional context. One of the central factors affecting client engagement is the challenge it poses to traditional power relations inherent in care relationships and contexts. This is particularly the case in aged care services, which have traditionally positioned older adults in passive roles as "recipients" of care, or as lacking capacity to participate in care decision making. This paper presents an exploration of client engagement practices within a large aged care service provider in Australia. Interviews and focus group discussions with clients and staff were analysed for the ways in which clients were positioned - by both themselves and by staff - in terms of the roles that they hold within engagement practices. Four positions were identified: "Passivity, disempowerment and bestowal of power", "Role of expert/consumer", "Resistance, compliance and manageability", and "Complexity, diversity and uniqueness". While clients were positioned at times in empowering roles, they were simultaneously limited by personal, relational, or organisational constraints, making opportunities for client engagement provisional. This reflects a tension between passive and empowered client roles in the context of aged care provision.