Infection systems biology:from reactive to proactive (P4) medicine

This short review establishes the conceptual bases and discusses the principal aspects of P4-shorthand for predictive, preventive, personalized and participatory medicine-medicine, in the framework of infectious diseases. P4 medicine is a new way to approach medical care; instead of acting when the patient is sick, physicians will be able to detect early warnings of disease to take early action. Furthermore, people might even be able to adjust their lifestyles to prevent disease. P4 medicine is fuelled by systems approaches to disease, including methods for personalized genome sequencing and new computational techniques for building dynamic disease predictive networks from massive amounts of data from a variety of OMICs. An excellent example of the effectiveness of the P4 medicine approach is the change in cancer treatments. Emphasis is placed on early detection, followed by genotyping of the patient to use the most adequate treatment according to the genetic background. Cardiovascular diseases and perhaps even neurodegenerative disorders will be the next targets for P4 medicine. The application of P4 medicine to infectious diseases is still in its infancy, but is a promising field that will provide much benefit to both the patients and the health-care system.

A cross-national cross-sectional survey of the attitudes and perceived competence of final-year medicine, nursing and pharmacy students in relation to end-of-life care in dementia

Background:Little is known about the attitudes of healthcare professional students' perceived competence and confidence in treating those with dementia who are at the end of life.Aim:To explore the attitudes of final year medical, nursing and pharmacy students towards people with dementia and to evaluate their perceived competence and confidence dealing with biomedical and psychosocial issues within the context of palliative care provision to patients with dementia.Design:Cross-sectional survey using a questionnaire.Setting/participants:Final-year students in each profession from Queen's University Belfast (Northern Ireland) and the University of Iowa (USA) were recruited.Method:Three versions of an online questionnaire (containing the Attitudes to Dementia Questionnaire and a series of questions on end-of-life care in dementia) were distributed.Results:A total of 368 responses were received (response rate 42.3%). All respondents reported positive attitudes towards people with dementia. US nursing students reported significantly more positive attitudes than the medical students of United States and Northern Ireland. Medical students were more likely to report low confidence in discussing non-medical aspects of dying, whereas nursing students were most likely to feel prepared and confident to do this. Medical and nursing students reported low confidence with aspects of medication-related care; however, data from the pharmacy samples of Northern Ireland and United States suggested that these students felt confident in advising other healthcare professionals on medication-related issues.Conclusions:While healthcare students hold positive attitudes towards people with dementia, some clinical tasks remain challenging and further basic training may be of benefit.

Military Service Pensions for Veterans of the Irish Revolution, 1916–1923

In 1924 the Irish Free State government passed legislation to award pensions to veterans of the Irish revolution and Civil War. This article argues that the motivation for the pensions was the need to placate the national army after a failed mutiny in 1924 and that this explains their unusual nature in being based on service alone rather than disability. It will also explore the problems this created for defining service, examine the extension of eligibility to former republican enemies of the state and women revolutionaries in 1934, and describe the application and assessment procedure.

Immunohistochemistry in the era of personalised medicine

Immunohistochemistry (IHC) plays a central role in the histopathological classification of diseases, including cancer. More recently, the importance of immunohistochemical staining is increasing. IHC usage in diagnostics is invaluable; however, the genetic and therapeutic significance of biomarker immunostaining has become equally relevant.

The use of topical anaesthesia during repair of minor lacerations in Departments of Emergency Medicine:a literature review

There are currently a number of different methods available to obtain anaesthesia in minor dermatological procedures. Although intradermal infiltration of 1% lidocaine is the favoured method for anaesthesia induction in laceration repair, it can cause significant pain in itself. Topical anaesthesia has been investigated as an alternative to infiltration anaesthesia, with the majority of studies looking at preparations of either TAC (tetracaine, adrenaline and cocaine) or LAT (lidocaine, adrenaline and tetracaine).

Crime, justice and the legitimacy of military power in the international sphere

This article examines how a discourse of crime and justice is beginning to play a significant role in justifying international military operations. It suggests that although the coupling of war with crime and justice is not a new phenomenon, its present manifestations invite careful consideration of the connection between crime and political theory. It starts by reviewing the notion of sovereignty to look then at the history of the criminalisation of war and the emergence of new norms to constrain sovereign states. In this context, it examines the three ways in which military force has recently been authorised: in Iraq, in Libya and through drones in Yemen, Pakistan and Somalia. It argues the contemporary coupling of military technology with notions of crime and justice allows the reiteration of the perpetration of crimes by the powerful and the representation of violence as pertaining to specific dangerous populations in the space of the international. It further suggests that this authorises new architectures of authority, fundamentally based on military power as a source of social power.

Appealing to the Republic of Letters: An Autopsy of Anti-venereal Trials in Eighteenth-century Mexico

This study analyses the narrative elements of a little-known report into anti-venereal trials written by an Irish military physician-surgeon, Daniel O'Sullivan (1760–c.1797). It explores the way in which O'Sullivan as the narrator of the Historico-critical report creates medical heroes and anti-heroes as a means to criticise procedures initiated by staff in the Hospital General de San Andrés, Mexico City. The resulting work depicts a much less positive picture of medical trials and hospital authorities in this period than has been recorded to date, and provides a critical and complicated assessment of one of Spain's leading physicians of the nineteenth century, Francisco Javier Balmis (1753–1819).

International differences in sport medicine access and clinical management

I undertook the 2012 ECOSEP travelling fellowship, sponsored by Bauerfeind, between May and August 2012, which involved visiting 5 European sport medicine centres and spending approximately one week in each centre. The 5 centres included: National Track and Field Centre, SEGAS, Thessaloniki, Greece; Professional School in Sport & Exercise Medicine, University of Barcelona, Spain; Sport Medicine Frankfurt Institute, Germany; Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy, and Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, England. Throughout the fellowship, the clinical cases which were routinely encountered were documented. The following sections detail my experiences throughout the fellowship, the sports of the athletes and the injuries which were treated at each of the sport medicine centres during the fellowship visit and the different forms of management employed. © 2012, CIC Edizioni Internazionali

The making of a void sovereignty: political implications of the military checkpoints in the West Bank

Research on the Israeli checkpoints in the West Bank has emphasized not only that these checkpoints have dire implications for the Palestinians living there, at the personal, familial, and communal levels, and devastating eff ects on the Palestinian economy, but also that they have far-reaching consequences for the ability of the Palestinians to establish an independent political entity. At the same time, analysis of the Israeli forms of domination over the Palestinians has also stressed the role of a Palestinian governing authority in sustaining the Israeli rule, since the former relieves the latter of its responsibility to care for the occupied Palestinian population. This paper aims to address this apparent contradiction claiming that a comprehensive analysis of Israeli forms of domination requires a spatial examination of the operation of sovereignty with an assessment of governmentalizing arrays. This combined analysis suggests that a Palestinian sovereignty, but one which is emptied of its actual ruling power, is construed at the checkpoints as an epiphenomenon of Israeli apparatuses of control. © 2013 Pion and its Licensors.

Between Imaginary Lines: Violence and its Justifications at the Military Checkpoints in Occupied Palestine

Looking at one site, the Israeli checkpoints in the occupied Palestinian territory, this article seeks to understand the mechanisms by which violence can present itself as justifiable (or justified), even when it materializes within frames presumably set to annul it. We look at the checkpoints as a condensed microcosmos operating within two such frames. One is the prolonged IsraeliPalestinian ‘peace process’ (the checkpoints became a primary technology of control in the period following the beginning of the peace process), and the other is regulatory power (disciplinary and biopower), which in the Foucauldian framework presumably sidelines the violent form which sovereign power takes. We argue that the checkpoints, which dissect the Palestinian occupied territories into dozens of enclaves and which are one of the most effective and destructive means of control within the current stage of occupation, can be seen as more than obstacles in the way of Palestinian movement; we suggest that they also function as corrective technologies that are meant to fail. It is with this failure that violence can appear as justified. In order to show the operation of this embedded failure, we examine one mechanism operating within the checkpoints: ‘the imaginary line’. The imaginary line is both a component within, and an emblem of a mode of control that constantly undoes itself in order to summon violence. Since it is never visibly marked in the physical space, the imaginary line is bound to be unintentionally crossed, thereby randomly rendering Palestinians as ‘transgressors’ of the rule and thus facilitating eruptions of violence by the soldiers stationed at the checkpoints. This article proposes an analysis of this hidden demarcation of space in order to question the different relations between subjects and power which it both assumes and constitutes.

The impact of personalised therapies on respiratory medicine

Stratified approaches to treating disease are very attractive, as efficacy is maximised by identifying responders using a companion diagnostic or by careful phenotyping. This approach will spare non-responders form potential side-effects. This has been pioneered in oncology where single genes or gene signatures indicate tumours that will respond to specific chemotherapies. Stratified approaches to the treatment of asthma with biological therapies are currently being extensively studied. In cystic fibrosis (CF), therapies have been developed that are targeted at specific functional classes of mutations. Ivacaftor, the first of such therapies, potentiates dysfunctional cystic fibrosis transmembrane conductance regulator (CFTR) protein Class III mutations and is now available in the USA and some European countries. Pivotal studies in patients with a G551D mutation, the most common Class III mutation, have demonstrated significant improvements in clinically important outcomes such as spirometry and exacerbations. Sweat chloride was significantly reduced demonstrating a functional effect on the dysfunctional CFTR protein produced by the G551D mutation. Symptom scores are also greatly improved to a level that indicates that this is a transformational treatment for many patients. This stratified approach to the development of therapies based on the functional class of the mutations in CF is likely to lead to new drugs or combinations that will correct the basic defect in many patients with CF. © ERS 2013.