Stoking the fires of professional resistance: Trainees' efforts across time.

INTRODUCTION: Researchers who study acts of resistance largely focus on efforts when they are at their peak, giving the impression that those who resist are in a constant state of arousal. What is missing in such studies is the variable of time, which is theorised to be intimately connected to power and resistance. To explore this aspect, we followed a group of trainees engaged in professional resistance against social injustice over the period of 1 year to understand how their efforts shifted across time. This longitudinal approach was meant to capture the temporality of resistance, specifically how time affects resistance efforts. METHODS: Using a constructivist grounded theory approach for data collection and analysis, we conducted follow-up interviews with 13 trainees approximately 10 months apart. Interviews were analysed using holistic narrative analysis, in which we analysed contexts, subjectivities and interactions across the two time points. We then conducted a cross-case analysis and restoried the data to develop an understanding of how resistance shifts across time. Finally, we contextualised the data using the metaphor of open and zombie wildfires. RESULTS: The findings demonstrate that when trainees transition to new institutions or professional positions, their access to power and interactions with colleagues shift, thus making it challenging for them to resist in ways they had done so earlier. In transitions where trainees were given power, the flames of resistance continued to blaze visibly. In other cases, without an appreciable change in power, resistance resembled more of a 'zombie fire', smouldering quietly underfoot. DISCUSSION: Examining trainees' acts of resistance across time demonstrates that the work of advocacy and resistance is extremely taxing for trainees. Therefore, when they experience shifts in their context or subjectivity, they conserve energy and strategise their next move. This study provides new insight on the relationship between time and resistance.

Neurobehavioral Symptom Inventory Item-Level Change Complements the Reliable Change Method.

OBJECTIVE: To determine correspondence between the statistically derived 8-point reliable change index for the Neurobehavioral Symptom Inventory (NSI) against clinically significant item-level change in symptom severity from intake to discharge for mild traumatic brain injury (mTBI). SETTING: Brain Injury Rehabilitation Service at Brooke Army Medical Center, Fort Sam Houston, San Antonio, Texas. PATIENTS: In total, 655 active-duty service members with a diagnosis of mTBI who received treatment and completed self-report measures between 2007 and 2020. DESIGN: Observational retrospective analysis of outpatient clinical outcomes data. MAIN MEASURES: NSI total score change was used to divide patients into responder and nonresponders based on whether they met an 8-point decrease between intake and discharge. In addition, patients who had at least one NSI item that changed from a rating of 3 (severe) or 4 (very severe) at intake to a rating of 0 (none) or 1 (mild) at discharge were coded as an individual with significant item-level change. RESULTS: Forty-five percent of the sample had significant item-level change and were classified as responders according to the reliable change method. Eight percent of the sample had significant item-level change but did not meet the 8-point reliable change threshold. Fifteen percent of the sample did not experience significant item-level change but were classified as responders according to reliable change. Thirty-one percent did not meet either method's criterion for change. Classification agreement between the reliable change and item-level change methods was 76%, which was statistically significant ( = 181.32, P < .001). CONCLUSION: There is good correspondence between reliable change and item-level change on the NSI in this population. Reliable change is easily calculated and thus much more accessible than the item-level change method. There may be some situations where calculating item-level change may be helpful.

Microglia priming by interleukin-6 signaling is enhanced in aged mice.

During peripheral infection, excessive production of pro-inflammatory cytokines in the aged brain from primed microglia induces exaggerated behavioral pathologies. While the pro-inflammatory cytokine IL-6 increases in the brain with age, its role in microglia priming is not known. This study examined the functional role of IL-6 signaling on microglia priming. Our hypothesis is that IL-6 signaling mediates primed states of microglia in the aged. An initial study assessed age-related alteration in IL-6 signaling molecules; sIL-6R and sgp130 were measured in cerebrospinal fluid of young and aged wild-type animals. Subsequent studies of isolated microglia from C57BL6/J (IL-6+/+) and IL-6 knock-out (IL-6-/-) mice showed significantly less MHC-II expression in aged IL-6-/- compared to IL-6+/+ counterparts. Additionally, adult and aged IL-6+/+ and IL-6-/- animals were administered lipopolysaccharide (LPS) to simulate a peripheral infection; sickness behaviors and hippocampal cytokine gene expression were measured over a 24 h period. Aged IL-6-/- animals were resilient to LPS-induced sickness behaviors and recovered more quickly than IL-6+/+ animals. The age-associated baseline increase of IL-1ß gene expression was ablated in aged IL-6-/- mice, suggesting IL-6 is a key driver of cytokine activity from primed microglia in the aged brain. We employed in vitro studies to understand molecular mechanisms in priming factors. MHC-II and pro-inflammatory gene expression (IL-1ß, IL-10, IL-6) were measured after treating BV.2 microglia with sIL-6R and IL-6 or IL-6 alone. sIL-6R enhanced expression of both pro-inflammatory genes and MHC-II. Taken together, these data suggest IL-6 expression throughout life is involved in microglia priming and increased amounts of IL-6 following peripheral LPS challenge are involved in exaggerated sickness behaviors in the aged.