Human labour is associated with altered regulatory T cell function and maternal immune activation.

During human pregnancy, regulatory T cell (Treg ) function is enhanced and immune activation is repressed allowing the growth and development of the feto-placental unit. Here, we have investigated whether human labour is associated with a reversal of the pregnancy-induced changes in the maternal immune system. We tested the hypothesis that human labour is associated with a decline in Treg function, specifically their ability to modulate Toll-like receptor (TLR)-induced immune responses. We studied the changes in cell number, activation status and functional behaviour of peripheral blood, myometrial (myoMC) and cord blood mononuclear cells (CBMC) with the onset of labour. We found that Treg function declines and that Treg cellular targets change with labour onset. The changes in Treg function were associated with increased activation of myoMC, assessed by their expression of major histocompatibility complex (MHC) class II molecules and CBMC inflammatory cells. The innate immune system showed increased activation, as shown by altered monocyte and neutrophil cell phenotypes, possibly to be ready to respond to microbial invasion after birth or to contribute to tissue remodelling. Our results highlight changes in the function of the adaptive and innate immune systems that may have important roles in the onset of human labour.

The Hamilton SPE Evaluation Tool (HSET): is it any good?

Presents the Hamilton Supervised Pastoral Evaluation Tool (HSET). HSET is a self-report that evaluates student learning in a basic SPE unit utilizing six areas: supervisory relationship, personal growth, professional growth, theological reflection, learning context, and overall growth. Reviews statistics involving seven regional units consisting of 18 SPE units with 101 students. Utilizes methodological, investigator, and data triangulation by drawing on qualitative study and CAPPE accreditation review. Discusses strengths and weaknesses of HSET and makes recommendations for further use.

Equipoise and the ethics of the Canadian Lung Volume Reduction Surgery Trial study: should there be a randomized, controlled trial to evaluate lung volume reduction surgery?

The physical improvement is so great following lung volume reduction surgery that there is growing opinion that a randomized, controlled trial is unnecessary. A randomized, controlled trial, it is argued, would deprive those patients randomly assigned to the nonsurgical treatment arm the 'benefit' of lung volume reduction surgery. Entering a trial in which one arm leads to a surgical intervention and the other to best medical management also poses a variety of ethical difficulties. If one is to be offered surgery, there must be perceived benefit because the physician has an obligation to offer the best possible treatment for his or her patient. If a patient agrees to have surgery, the expectation is that surgery would help. Thus, a patient randomly assigned to the medical arm of a trial may easily believe that he or she is being deprived of surgery that may help them. This paper illustrates this dilemma using the Canadian Lung Volume Reduction Surgery Trial. The authors discuss the concept of 'equipoise' in three dimensions, adding community equipoise to theoretical equipoise and clinical equipoise earlier described by Freedman. The paper concludes that the Canadian Lung Volume Reduction Surgery Trial needs to continue because of the clinical equipoise that drives it.

Human doctoring: bringing authenticity to our care.

Increasingly, doctors are looking for ways to treat the whole patient--mind, body, and spirit, disease and illness. To accomplish this, doctors must establish authentic relationships with their patients--that is, relationships in which the life experiences and knowledge of both participants are acknowledged and respected. Physicians must be aware of everything they bring, both as persons and as professionals, to every clinical encounter. In this article, the authors discuss a hypothetical case of a teenaged girl suffering from recurrent coldsores and the possible ways her physician might handle her case. They analyze the differences among the three scenarios, using them to highlight ways physicians can work to achieve authentic and mutually beneficial relationships with the people in their care.