"What Do You Think We Should Do?": Relationship and Reflexivity in Participant Observation.

This article uses three concepts as a framework by which to examine how the interrelational elements of ethnographic approaches to qualitative inquiry reflect dimensions of therapeutic engagement. Participant observation, reflexivity, and context are all widely and routinely included within research methods; however, they are less frequently attended to directly in their experiential capacity through the lens of the researcher, clinician turned investigator. A unique study design will be profiled to reflect the complicated juxtaposition between methods, questions, sample population, time, space, and identity. Studying occupational therapy students traveling abroad for a short-term immersion experience, this narrative study called on a necessary and attentive awareness of locality as the researcher traveled with the group. Conducting ethnographic research where the researcher's therapeutic skills aided and constrained relationships resulted in rich, guarded, and relevant insights that parallel the therapeutic use of self in occupational therapy practice.

Figured world of eating disorders: occupations of illness.

BACKGROUND: The biomedical diagnosis of eating disorders signifies a mental illness with complex physical symptomology. The socio-cultural determinants and impact of eating disorders on daily occupations are not adequately addressed in this classification. PURPOSE: This paper introduces the concept of a figured world as a framework for how eating disorders exist in daily activity and social discourse. How occupations become ascribed with meaning generated by an eating disorder will be proposed through the voice of a composite character in the figured world. KEY ISSUES: Central elements to contextualizing figured worlds include positional identity, self-authoring, and semiotic mediation. The generation of meaning in illness arises from the integration of these elements into this specific figured world. IMPLICATIONS: The competing agendas of the biomedical model and figured world permit a new understanding of the challenges associated with recovery. For occupational therapists, these challenges require the reattribution of meaning of daily occupations.

Adopting the Concept of 'Ba' and the 'SECI' Model in Developing Person-Centered Practices in Child and Adolescent Mental Health Services.

The concept of knowledge is divided into explicit and tacit knowledge; explicit knowledge refers to the knowledge that can be articulated, written and stored, while tacit knowledge refers to personal experiences, values, beliefs and emotions of an individual. By Nonaka's theory, explicit and tacit knowledge do not lie separately but interact together by interactions and relationships between human beings. Thus, the SECI model is based on the assumption that knowledge is created through the social interaction of tacit and explicit knowledge; known as knowledge conversion. The SECI model is based upon four modes of knowledge conversion; socialization, externalization, combination and internalization. 'Ba' is considered to be a shared platform for knowledge creation. 'Ba' is a shared space, be it physical, mental or a combination of both that serves as a foundation of knowledge creation. Ba involves sharing of tacit knowledge i.e. emotions, feelings, experiences and mental images. It also involves the formation of a collective relationship which is open to the sharing of practices, values, processes and culture. This concept focuses mainly on the individual as a person who holds the knowledge rather than just on the knowledge itself. It aims to create a common space to bring people together where they can dialogue to share and create knowledge. As in the relationships formed in person-centered practices, relationships formed in Ba are based on not just the sharing of objective knowledge but also on sharing values, beliefs, and emotions. It also reflects the formation of a person-centered environment as a basis for person-centered research where healthful relationships with the participants are formed. Furthermore, Ba will aid in creating a sense of connectiveness and dialogue, thus focusing on the idea that the development of new practices is done with others rather than to others. In this article we will discuss how these Eastern concepts can be adapted and used to develop person-centered practices within child and adolescent mental health services, specifically related to rehabilitation and recovery. The concepts of personhood will be discussed, followed by a reflection on current practices adopted when working with children and adolescents.

"It Is Not Wit, It Is Truth:" Transcending the Narrative Bounds of Professional and Personal Identity in Life and in Art.

Taking inspiration from the film Wit (2001), adapted from Margaret Edson's (1999) Pulitzer Prize-winning play, this article explores the particularities of witnessing a cinematic cancer narrative juxtaposed with the author's own cancer narrative. The analysis reveals the tenuous line between death and dying, illness and wellness, life and living and the resulting identities shaped in the process of understanding both from a personal and professional lens. By framing these representations of illness experience within the narrative constructions of drama, time, metaphor and morality, the personal stories of intellectual knowledge converging with intimate and embodied knowing are revealed.

Critical Ethnographic Analysis of "Doing Good" on Short-Term International Immersion Experiences.

Reciprocal partnerships are growing alongside the rise of international learning and "doing" experiences for students and clinicians. This paper questions how global citizenship, the acquisition of awareness and skills to sensitively navigate through a rapidly globalized social world, is cultivated amidst international partnerships focused on short-term immersion opportunities. Using an ethnographic methodology to examine the experiences of occupational therapy students abroad, this paper addresses the potential for competing agendas when the motivation to participate within these partnerships is driven in part by a desire to "do good." The empirical lens was directed towards the students' verbal, written and enacted narratives rather than the sociocultural realm of the sending institution, the host organization or the occupational realities of the local communities, therefore is limited in discursive scope. Nevertheless, the need is great for further critical appraisal of objectives and expectations by all parties to foster a partnership culture of reciprocity and equality and to diminish the neocolonial legacy of Western expertise dissemination. By examining how the stated and implied desire to do good exists alongside the risk to do harm to individuals and international networks, the conclusions can be extended locally to highlight the challenges to "partnering up" between clinicians and patients.

Simultaneous measurement of serum thrombopoietin and expression of megakaryocyte c-Mpl with clinical and laboratory correlates for myelofibrosis with myeloid metaplasia.

OBJECTIVES: We sought to investigate potential mechanisms of increased serum thrombopoietin (TPO) concentrations in myelofibrosis with myeloid metaplasia (MMM) by simultaneously measuring serum TPO, platelet and megakaryocyte (MK) numbers, and MK c-Mpl expression. METHODS: We studied 17 consecutive patients who had MMM and were not receiving therapy at the time of evaluation. Serum TPO was measured by a two-site immunochemiluminometric assay. Immunohistochemical staining of c-Mpl was accomplished with an immunoperoxidase method on simultaneously obtained bone marrow specimens. RESULTS: Our findings confirmed the presence of inappropriately increased serum TPO despite mostly normal or increased peripheral platelet counts and markedly increased bone marrow MK numbers. In addition, we found an inverse correlation between platelet count and serum TPO (P<0.03) and splenic size (P<0.04). However, serum TPO did not correlate with either bone marrow MK number or c-Mpl expression. The lack of correlation of serum TPO and bone marrow megakaryocyte number may be accounted for by the unavoidable inaccuracies in quantifying megakaryocytopoiesis in a disorder of known altered hematopoietic progenitor cell distribution, both intramedullary and extramedullary. The significant inverse correlation between serum TPO and spleen size suggests that this site of extramedullary megakaryocytopoiesis may assume a role in the dysfunctional TPO regulatory axis. CONCLUSIONS: These observations suggest some preservation of the negative feedback regulation that appears to be dysfunctional at the MK c-Mpl level. Consistent with previous observations in animal models, our observations suggest the possibility that altered TPO regulation resulting in sustained ligand excess may have pathogenetic relevance in MMM.