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This paper examines a central image in UK academic clinical research – the patient as altruistic research subject – by means of an interpretive review of social science, bioethical and bioscience research and development policy literatures. The review examines this image as it is indicted in discussions about the nature of clinical science; is consolidated in the ethical regulation of this science; and is articulated in recent bioscience research and development government initiatives. Drawing on Strathern's notion of the virtual (public-sector) subject, the review identifies the anticipation of NHS patients as alternatively 'available' or 'entitled' to the expanding translational medicine industry.

Background: Politicians, societies, stakeholders, health care systems, patients, their relatives, their employers, and the general population need to know what they can expect from clinical psychologists. Even more, for our self-definition as a professional group, we should share a common understanding of the competence profile that characterises our qualifications. This understanding of the competence profile of clinical psychology leads directly to the content that should be taught in university curricula and postgraduate trainings for clinical psychology. The following discussion paper attempts to offer a general European framework for defining the competence profile of clinical psychologists. Method: A group of European specialists developed this discussion paper under the umbrella of the European Association of Clinical Psychology and Psychological Treatment (EACLIPT). Representatives with different treatment orientations, of basic science and clinical applications, and from East to Western European countries, were part of the group. Results: We present a list of competences that should be acquired during regular studies of psychology with a clinical specialisation. Additionally, further competences should be acquired either during studying, or during postgraduate trainings. Conclusion: Clinical psychologists are experts in mental and behavioural disorders, their underlying psychological, social and neurobiological processes, corresponding assessments/diagnostic tools, and evidence-based psychological treatments. While we provide a list with all competences of clinical psychologists, we do not consider this proposal as a final list of criteria, but rather as a living discussion paper that could be updated regularly. Therefore, we invite our colleagues to contribute to this discussion, and to submit comments via email to the corresponding author. People need to know what they can expect from clinical psychologists. We present a list of competences that clinical psychologists acquire during their training. ...

This book analyzes the individual and collective experience of and response to trauma from a wide range of perspectives including basic neuroscience, clinical science, and cultural anthropology. Each perspective presents critical and creative challenges to the other. The first section reviews the effects of early life stress on the development of neural systems and vulnerability to persistent effects of trauma. The second section of the book reviews a wide range of clinical approaches to the treatment of the effects of trauma. The final section of the book presents cultural analyses of personal, social, and political responses to massive trauma and genocidal events in a variety of societies. This work goes well beyond the neurobiological models of conditioned fear and clinical syndrome of post-traumatic stress disorder to examine how massive traumatic events affect the whole fabric of a society, calling forth collective responses of resilience and moral transformation

Trade in animals and animal products is a key factor in the transmission of infectious diseases. Livestock traders play an important role in this process, yet there is little knowledge of traders' perceptions of animal disease or their associated actions. The aim of this study was to investigate perceptions and practices of Zambian small ruminant traders with regard to sheep and goat health and disease. It also analysed how existing perceptions and practices might affect risks of disease transmission through trade. A case study was performed at the two largest small livestock markets in Zambia: the Lusaka market in the capital and the Kasumbalesa market near the border with the Democratic Republic of Congo. Semi-structured interviews with 47 traders performed in April-May and September 2018 represent the core material. Zambian small ruminant traders frequently trade animals that have clinical signs of disease, either because they appear unaware or indifferent to the associated risks, experience financial constraints or assign responsibility for disease prevention to other value chain actors. In their decision about whether or not to sell a visibly sick small ruminant, traders appear to consider whether the clinical sign is perceived as 'natural' or the result of an illness, whether the buyer is aware of the animal's health condition, and whether the animal is sold for consumption or breeding purposes. Traders appear to regard the veterinary certificate required to transport small ruminants in Zambia as proof of health, placing the responsibility for potential disease in traded animals on the veterinary authorities. In their description of a model trader, taking good care of and being sensitive to customer needs was emphasized, indicating that an efficient way to encourage traders to change their behaviour is to influence customer demands. In contrast to the focus in previous studies on identifying and filling knowledge gaps, the present study show that lack of knowledge is not central to why traders engage in disease-transmitting behaviour. Greater awareness of other reasons for certain perceptions and practices could lead to the formulation of risk communication strategies and mitigation measures that are relevant for the local context, as well as alternative strategies for changing trader behaviour.

Lower genitourinary tract trauma comprises a substantial portion of the trauma burden in the USA. Some key trends and findings are described. Mortality is relatively high in patients with bladder trauma due to associated injuries. Urethral injuries should be suspected in patients presenting with the triad of blood at the urethral meatus, suprapubic fullness indicative of a full bladder, and urinary retention. Urethral injury is common in penetrating penile trauma, and stab wounds to the penis are more likely to involve the urethra than gunshot wounds. Penile fracture is largely a clinical diagnosis and suspicion of fracture requires urgent surgical exploration. Zipper injuries are the most common cause of presentation to the emergency department for penile trauma in adults. Toilet seat injuries are the leading cause of penile pediatric trauma presenting to the emergency department. In the setting of testicular trauma, rates of testicular salvage are excellent when exploration is prompt. Trauma in the form of animal or human bites requires treatment with broad-spectrum antibiotics in addition to repair of the injury. Military trauma has seen an increase in explosive injuries to the lower urinary tracts due to evolution of warfare tactics. Increasing awareness of presentation and context of lower genitourinary tract trauma can reduce delay of diagnosis and morbidity associated with such injuries. © 2015, SAGE Publications. All rights reserved.

Lower genitourinary tract trauma comprises a substantial portion of the trauma burden in the USA. Some key trends and findings are described. Mortality is relatively high in patients with bladder trauma due to associated injuries. Urethral injuries should be suspected in patients presenting with the triad of blood at the urethral meatus, suprapubic fullness indicative of a full bladder, and urinary retention. Urethral injury is common in penetrating penile trauma, and stab wounds to the penis are more likely to involve the urethra than gunshot wounds. Penile fracture is largely a clinical diagnosis and suspicion of fracture requires urgent surgical exploration. Zipper injuries are the most common cause of presentation to the emergency department for penile trauma in adults. Toilet seat injuries are the leading cause of penile pediatric trauma presenting to the emergency department. In the setting of testicular trauma, rates of testicular salvage are excellent when exploration is prompt. Trauma in the form of animal or human bites requires treatment with broad-spectrum antibiotics in addition to repair of the injury. Military trauma has seen an increase in explosive injuries to the lower urinary tracts due to evolution of warfare tactics. Increasing awareness of presentation and context of lower genitourinary tract trauma can reduce delay of diagnosis and morbidity associated with such injuries. © 2015, SAGE Publications. All rights reserved.

AIM: The purpose of this study was to determine the level of significance of markers in the development of intra-abdominal hypertension in patients with acute surgical diseases of the abdominal cavity. METHODS: The authors surveyed 100 patients who were monitored at the Regional Clinical Hospital, Karaganda. The criterion for inclusion in the study was the informed consent of patients to participate in the study, the presence of acute surgical pathology, and the monitoring of intra-abdominal pressure over time. The exclusion criteria for patients from the study is the presence of sub and decompensation of associated diseases: trauma (hematoma of the bladder), bladder tumour and impaired integrity of the pelvic ring. The design of the study was by the legislation of the Republic of Kazakhstan, international ethical norms and normative documents of research organizations, approved by the ethics committee of the Karaganda State Medical University. RESULTS: According to the world scientific literature, there are 4 indicators that change their value in response to increases in pressure in the abdominal cavity: fibrinogen and prothrombin index (the main indicators of the coagulogram); marker of blood clots D-dimer; early marker of translocation of bacterial flora into the bloodstream sCD14 (presepsin). CONCLUSION: The authors concluded that the obtained data indicate that an increase in intra-abdominal pressure in acute surgical diseases of the abdominal cavity causes hypercoagulation and an increase in presepsin. Monitoring IAP with simultaneous measurement of the level of presepsin significantly improves the stratification of critical patients in need of emergency surgery.

This study reflects on the recognised need for more joined-up, high-quality research on phytotherapy that addresses the current societal challenges in finding alternatives to the use of antibiotics. The study applied a multidisciplinary participatory approach in an expert workshop exercise within the FP7 EU IMPRO project. Prior to this study, a literature review was elaborated on research in the field of phytotherapy as applied to farm animals, cooperation between research bodies and initiatives to reduce the use of antibiotics by using phytotherapeutic remedies. The review was delivered to the participants of the workshop so as to receive feedback on it and enrich the discussion. Different expertise, background in research or veterinary practice, and varying positions regarding phytotherapy were the criteria in targeting participants. A structured workshop was subsequently organised, with questions to experts addressing scientific validation of phytotherapy, effective treatment under farm conditions and necessary developments for the future. Challenges identified by the experts were as follows: poor study designs, lack of reproducibility of studies, poor standardisation of products, cost-benefit concerns, lack of veterinarian training and poor data availability. To overcome obstacles, the need for improved study designs for clinical trials was given priority in order to prove the efficacy of remedies and to implement a monitoring system which enables the assessment of the effectiveness of treatments in farm practice. Reflections in this report are intended to be a resource for scientists, policy makers and end users for an effective use of phytotherapy at farm level.

Simple Summary: Abdominal pain, colic, is a common clinical sign in horses, sometimes reflecting life-threatening disease. One cause of colic is parasitic infection of the gut. Various drugs, anthelmintics, can be used to reduce or eliminate such parasites. However, frequent use has led to problems of drug resistance, whereby many countries now allow anthelmintics to be used on a prescription-only basis. In Sweden, this has led to a concern that parasitic-related colic in horses is increasing. This study aimed to investigate whether horses with colic differed in parasitological status compared to horses without colic. A secondary aim was to collect information regarding current parasite control measures used by horse owners. Exposure to S. vulgaris, a parasite with the potential to cause life-threatening disease, appeared high as determined by the presence of antibodies in the blood. Horses with inflammation in the abdominal cavity had higher antibody levels than other causes of colic. Despite new legislation, 29% of owners did not use fecal analyses for parasites and the use of extended methods to diagnose specific parasites was low. Also, owners rarely used alternative methods to reduce the pasture parasite burden. The study suggests a need for education in the use of both fecal analyses and pasture management.Abstract All grazing horses are exposed to intestinal parasites, which have the potential to cause gastrointestinal disease. In Sweden, there is a concern about an increase in parasite-related equine gastrointestinal disease, in particular Strongylus vulgaris, since the implementation of prescription-only anthelmintics approximately 10 years ago. In a prospective case-control study, parasitological status, using fecal analyses for strongyle egg counts, the presence of Anoplocephala perfoliata eggs and S. vulgaris Polymerase chain reaction (PCR) as well as serology for S. vulgaris, were compared between horses presenting with or without gastrointestinal disease at a University hospital during a one-year period. Information regarding anthelmintic routines and pasture management was gathered with an owner-filled questionnaire. Although the prevalence of S. vulgaris PCR was 5.5%, 62% of horses were positive in the enzyme-linked immunosorbent assay (ELISA) test and horses with peritonitis showed higher antibody levels for S. vulgaris, as compared to other diagnoses or controls. Overall, 36% of the horse owners used only fecal egg counts (FEC), 32% used FEC combined with specific diagnostics for S. vulgaris or A. perfoliata, and 29% dewormed routinely without prior parasite diagnostics. Effective management methods to reduce the parasitic burden on pastures were rare and considering exposure to S. vulgaris appears high; the study indicates a need for education in specific fecal diagnostics and pasture management.

BackgroundGreater use of computerized decision support (DS) systems could address continuing safety and quality problems in healthcare, but the healthcare field has struggled to implement DS technology. This study surveys DS experience across multiple non-healthcare disciplines for new insights that are generalizable to healthcare provider decisions. In particular, it sought design principles and lessons learned from the other disciplines that could inform efforts to accelerate the adoption of clinical decision support (CDS).MethodsOur systematic review drew broadly from non-healthcare databases in the basic sciences, social sciences, humanities, engineering, business, and defense: PsychINFO, BusinessSource Premier, Social Sciences Abstracts, Web of Science, and Defense Technical Information Center. Because our interest was in DS that could apply to clinical decisions, we selected articles that (1) provided a review, overview, discussion of lessons learned, or an evaluation of design or implementation aspects of DS within a non-healthcare discipline and (2) involved an element of human judgment at the individual level, as opposed to decisions that can be fully automated or that are made at the organizational level.ResultsClinical decisions share some similarities with decisions made by military commanders, business managers, and other leaders: they involve assessing new situations and choosing courses of action with major consequences, under time pressure, and with incomplete information. We identified seven high-level DS system design features from the non-healthcare literature that could be applied to CDS: providing broad, system-level perspectives; customizing interfaces to specific users and roles; making the DS reasoning transparent; presenting data effectively; generating multiple scenarios covering disparate outcomes (e.g., effective; effective with side effects; ineffective); allowing for contingent adaptations; and facilitating collaboration. The article provides examples of each feature. The DS ...

Some European countries have successfully implemented country-specific control programs (CPs) for infectious cattle diseases that are not regulated or are regulated only to a limited extent at the European Union (EU) level. Examples of such diseases include bovine viral diarrhea (BVD), infectious bovine rhinotracheitis (IBR), and Johne's disease (JD). The CPs vary between countries in the design and quality of collected data as well as methods used to detect infection and estimate prevalence or probability of freedom from infection. Differences in disease status between countries and non-standardized approaches to assess freedom from infection pose a risk for countries with CPs for non-regulated diseases as infected animals may influence the progress of the disease control or eradication program. The implementation of output-based standards allows estimation and comparison of the probability of freedom for non-regulated cattle diseases in European countries. The aim of the current study was to assess the existence and quality of data that could be used for estimating freedom from infection in European countries. The online data collection tool was sent to 32 countries participating in the SOUND control COST Action and was completed by 24 countries. Data on cattle demographics and data from CPs of IBR and BVD exist in more than 50% of the response countries. However, data describing risk factors and CP of JD was reported as existing in < 25% of the countries. The overall quality of data in the sections on demographics and CPs of IBR and BVD were evaluated as "good ", but risk factors and JD data were mostly evaluated as "fair. " Data quality was considered less good mainly due to two quality criteria: accessibility and accuracy. The results of this study show that the quantity and quality of data about cattle populations and CPs are relatively similar in many surveyed countries. The outcome of this work provides an overview of the current situation in the European countries regarding data on EU non-regulated ...