Reactive oxidant species (superoxide, hydrogen peroxide, hydroxyl radical, hypohalous acid, and nitric oxide) are involved in many of the complex interactions between the invading microorganism and its host. Regardless of the source of these compounds or whether they are produced under normal conditions or those of oxidative stress, these oxidants exhibit a broad range of toxic effects to biomolecules that are essential for cell survival. Production of these oxidants by microorganisms enables them to have a survival advantage in their environment. Host oxidant production, especially by phagocytes, is a counteractive mechanism aimed at microbial killing. However, this mechanism may be contribute to a deleterious consequence of oxidant exposure, i.e., inflammatory tissue injury. Both the host and the microorganism have evolved complex adaptive mechanisms to deflect oxidant-mediated damage, including enzymatic and nonenzymatic oxidant-scavenging systems. This review discusses the formation of reactive oxidant species in vivo and how they mediate many of the processes involved in the complex interplay between microbial invasion and host defense.

https://cmr.asm.org/content/cmr/10/1/1.full.pdf

Role of oxidants in microbial pathophysiology.

The neurodiversity movement challenges the medical model's interest in causation and cure, celebrating autism as an inseparable aspect of identity. Using an online survey, we examined the perceived opposition between the medical model and the neurodiversity movement by assessing conceptions of autism and neurodiversity among people with different relations to autism. Participants (N = 657) included autistic people, relatives and friends of autistic people, and people with no specified relation to autism. Self-identification as autistic and neurodiversity awareness were associated with viewing autism as a positive identity that needs no cure, suggesting core differences between the medical model and the neurodiversity movement. Nevertheless, results suggested substantial overlap between these approaches to autism. Recognition of the negative aspects of autism and endorsement of parenting practices that celebrate and ameliorate but do not eliminate autism did not differ based on relation to autism or awareness of neurodiversity. These findings suggest a deficit-as-difference conception of autism wherein neurological conditions may represent equally valid pathways within human diversity. Potential areas of common ground in research and practice regarding autism are discussed.

Deficit, difference, or both? Autism and neurodiversity

The Structures of the Life-World

We used Framework Analysis to investigate the female autism phenotype and its impact upon the under-recognition of autism spectrum conditions (ASC) in girls and women. Fourteen women with ASC (aged 22-30 years) diagnosed in late adolescence or adulthood gave in-depth accounts of: 'pretending to be normal'; of how their gender led various professionals to miss their ASC; and of conflicts between ASC and a traditional feminine identity. Experiences of sexual abuse were widespread in this sample, partially reflecting specific vulnerabilities from being a female with undiagnosed ASC. Training would improve teachers' and clinicians' recognition of ASC in females, so that timely identification can mitigate risks and promote wellbeing of girls and women on the autism spectrum.

/pdf/the-experiences-of-late-diagnosed-women-with-autism-spectrum-51ynrnissp.pdf

The Experiences of Late-diagnosed Women with Autism Spectrum Conditions: An Investigation of the Female Autism Phenotype

https://jech.bmj.com/content/jech/51/6/733.1.full.pdf

Action Research for Health and Social Care: a guide to practice

In this paper the risks of having a non-obvious disability, Asperger's syndrome [AS], are explored. The key focus is the riskiness associated with being on the margins of normality, where personal experience (and theoretical concepts) of being ‘different’ and ‘normal’ merge. When labelling people in any way other than normal is unpopular, those on such margins remain at risk of being misunderstood and neglected. With AS there continues to be controversy over the diagnostic label, as well as a theoretical tension between the negative versus positive effects of applying such a diagnosis. The basis for this discussion is the findings of a qualitative study exploring the experiences of young adults with AS and those of their parents. Methods used include purposive sampling, unstructured interviews and constant comparative analysis – whereby analysis became organised around the core emergent category of ‘not quite fitting’ – and the kinds of risk associated with the subjectively felt experience, the perception...

Do you know I have Asperger's syndrome? Risks of a non-obvious disability.

Little is known about the prevalence and burden of symptoms in patients managed without dialysis. This study was the result of a larger study exploring the experiences of 30 such patients and their trajectories to death. Data were analysed relating to symptoms once the patients had been referred to a Renal Supportive Care Service based in the East End of London, UK. A high symptom prevalence was found with 30 different symptoms reported at first consultation. Widely reported symptoms impacting on daily living included breathlessness, oedema, pruritus, nausea and vomiting and pain. Findings indicate that as symptoms escalate and death approaches, some symptoms, such as fluid overload and lethargy become difficult to treat indicating that death is close. This new knowledge can help staff as they attempt to determine when the end of life is approaching in order to support and care for patients appropriately. This paper highlights a need for effective identification and management of symptoms as they arise and further exploration of the effects of these symptoms on daily living.

/pdf/exploring-symptoms-in-patients-managed-without-dialysis-a-a2o8qomkg7.pdf

Exploring symptoms in patients managed without dialysis: a qualitative research study

Chronic Granulomatous Disease (CGD) manifests as a predisposition to infection as a result of defective function of the NADPH oxidase of phagocytic cells. Proteins identified as part of this system include two subunits of a cytochrome b (cytochrome b-245) and two cytosolic factors. The affected oxidase component was determined in 63 CGD patients from 57 families, by Western blotting of extracts of their neutrophils with antibodies to those proteins. 38 (67%) of the families were X-linked with a defect of the beta subunit of the cytochrome. 13 (23%) lacked p47-phox, 3 (5%) p67-phox, and 3 (5%) the alpha subunit of the cytochrome.

Identification of the defective NADPH-oxidase component in chronic granulomatous disease: a study of 57 European families.

BACKGROUND As the population ages, sicker patients often with multiple comorbidities are presenting in renal clinics. Some are deciding not to embark on dialysis. The objective of this study was to gain an understanding of the decision that some patients make not to embark on dialysis. METHODS Naturally occurring qualitative interviews were conducted with 30 patients and 17 caregivers managed within a Renal Supportive Care Service in an acute NHS Trust in London. RESULTS Several patients believed they had made an informed and autonomous decision, either on or against the advice of their doctor (n 5 17); some felt that they had no option but to refuse dialysis treatment, as it would not have been of benefit and might ultimately cause their death (n 5 7); some stated they had decided to opt for medication rather than dialysis 3 times a week and seemed to believe that either option would lead to the same outcome (n 5 2), and some felt there had been no decision to be made (n 5 4). CONCLUSIONS Prior to this study, little was known about those who decide not to embark on dialysis and how they make this decision. It cannot be presumed that decisions made by patients are fully understood and free from inappropriate professional or family influence, and the decision needs to be regularly revisited to check patients' and caregivers' understanding and to allow for reversal of the decision if fitting. There is a need to understand how service providers can help to ensure that such decisions are informed and supported by the best available supportive care thereafter.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/dat.20288

Reasons Renal Patients Give for Deciding Not to Dialyze: A Prospective Qualitative Interview Study

This article describes a three-year action research project, aimed to support staff in recognizing and responding to loss of personhood in a continuing care setting. The context of this study was a U.K. National Health Service (NHS) nursing home for the long-term care of older people. Interventions used to support this development included the collection and sharing of residents' life histories, weekly team supervision meetings for staff, an action learning set for managers, and monthly external supervised meetings for both the action researcher and senior manager. This article reports on the processes and outcomes of change achieved and the learning gained from working in a collaborative way with staff. Given that current policy indicates the need for person-centered care, this study provides a possible mechanism for putting it into practice through a systems and psychodynamically informed approach.

Barbara Johnson

Papers

Do you know I have Asperger's syndrome? Risks of a non-obvious disability.

Exploring symptoms in patients managed without dialysis: a qualitative research study

Identification of the defective NADPH-oxidase component in chronic granulomatous disease: a study of 57 European families.

Reasons Renal Patients Give for Deciding Not to Dialyze: A Prospective Qualitative Interview Study

Using Action Research to Address Loss of Personhood in a Continuing Care Setting