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Chaucer's first winter
A curious young bear, who does not want to miss the delights of winter, skips his first hibernation to play in the snow, glide on the ice, and admire the glittering rows of icicles and snow-covered pine trees.
Book
Chondrocytes Transdifferentiate into Osteoblasts in Endochondral Bone during Development, Postnatal Growth and Fracture Healing in Mice
One of the crucial steps in endochondral bone formation is the replacement of a cartilage matrix produced by chondrocytes with bone trabeculae made by osteoblasts. However, the precise sources of osteoblasts responsible for trabecular bone formation have not been fully defined. To investigate whether cells derived from hypertrophic chondrocytes contribute to the osteoblast pool in trabecular bones, we genetically labeled either hypertrophic chondrocytes by Col10a1-Cre or chondrocytes by tamoxifen-induced Agc1-CreERT2 using EGFP, LacZ or Tomato expression. Both Cre drivers were specifically active in chondrocytic cells and not in perichondrium, in periosteum or in any of the osteoblast lineage cells. These in vivo experiments allowed us to follow the fate of cells labeled in Col10a1-Cre or Agc1-CreERT2 -expressing chondrocytes. After the labeling of chondrocytes, both during prenatal development and after birth, abundant labeled non-chondrocytic cells were present in the primary spongiosa. These cells were distributed throughout trabeculae surfaces and later were present in the endosteum, and embedded within the bone matrix. Co-expression studies using osteoblast markers indicated that a proportion of the non-chondrocytic cells derived from chondrocytes labeled by Col10a1-Cre or by Agc1-CreERT2 were functional osteoblasts. Hence, our results show that both chondrocytes prior to initial ossification and growth plate chondrocytes before or after birth have the capacity to undergo transdifferentiation to become osteoblasts. The osteoblasts derived from Col10a1-expressing hypertrophic chondrocytes represent about sixty percent of all mature osteoblasts in endochondral bones of one month old mice. A similar process of chondrocyte to osteoblast transdifferentiation was involved during bone fracture healing in adult mice. Thus, in addition to cells in the periosteum chondrocytes represent a major source of osteoblasts contributing to endochondral bone formation in vivo.
Journal Article
Historians on Chaucer : the 'general prologue' to the Canterbury tales
\"As literary scholars have long insisted, an interdisciplinary approach is vital if modern readers are to make sense of works of medieval literature. In particular, rather than reading the works of medieval authors as addressing us across the centuries about some timeless or ahistorical 'human condition', critics from a wide range of theoretical approaches have in recent years shown how the work of poets such as Chaucer constituted engagements with the power relations and social inequalities of their time. Yet, perhaps surprisingly, medieval historians have played little part in this 'historical turn' in the study of medieval literature. The aim of this volume is to allow historians who are experts in the fields of economic, social, political, religious, and intellectual history the chance to interpret one of the most famous works of Middle English literature, Geoffrey Chaucer's 'General Prologue' to the Canterbury Tales, in its contemporary context. Rather than resorting to traditional historical attempts to see Chaucer's descriptions of the Canterbury pilgrims as immediate reflections of historical reality or as portraits of real-life people whom Chaucer knew, the contributors to this volume have sought to show what interpretive frameworks were available to Chaucer in order to make sense of reality and how he adapted his literary and ideological inheritance so as to engage with the controversies and conflicts of his own day. Beginning with a survey of recent debates about the social meaning of Chaucer's work, the volume then discusses each of the Canterbury pilgrims in turn. Historians on Chaucer should be of interest to all scholars and students of medieval culture whether they are specialists in literature or history\"-- Back cover.
BOOK
The sinking of the Titanic and great sea disasters : thrilling stories of survivors with photographs and sketches
\"The Sinking of the Titanic and Great Sea Disasters is an exciting collection of firsthand stories describing the catastrophe of Titanic's maiden voyage as told by its survivors shortly after the ship sank. Originally written and published in 1912, Logan Marshall's book was the very first attempt to solve the mystery of the accident and relieve the heartache it stirred internationally. Marshall narrates the personal stories of Titanic's passengers before, during, and after the sinking of the ill-fated ship. This book takes us back in time and forces us to understand the trauma of our ancestors from a not-so-comfortable distance. Listen to the voices of real passengers tell their own touching stories of tragedy and see the photographs and sketches that accompany their stories. Also included are records of previous great disasters of the sea, descriptions of the development of safety and life-saving appliances, and a plain statement of causes of such catastrophes and how to avoid them\"--Page 4 of cover.
Book
Patient-Clinician Communication About Pain: A Conceptual Model and Narrative Review
Abstract
Objective
Productive patient-clinician communication is an important component of effective pain management, but we know little about how patients and clinicians actually talk about pain in clinical settings and how it might be improved to produce better patient outcomes. The objective of this review was to create a conceptual model of patient-clinician communication about noncancer pain, review and synthesize empirical research in this area, and identify priorities for future research.
Methods
A conceptual model was developed that drew on existing pain and health communication research. CINAHL, EMBASE, and PubMed were searched to find studies reporting empirical data on patient-clinician communication about noncancer pain; results were supplemented with manual searches. Studies were categorized and analyzed to identify crosscutting themes and inform model development.
Results
The conceptual model comprised the following components: contextual factors, clinical interaction, attitudes and beliefs, and outcomes. Thirty-nine studies met inclusion criteria and were analyzed based on model components. Studies varied widely in quality, methodology, and sample size. Two provisional conclusions were identified: contrary to what is often reported in the literature, discussions about analgesics are most frequently characterized by patient-clinician agreement, and self-presentation during patient-clinician interactions plays an important role in communication about pain and opioids.
Conclusions
Published studies on patient-clinician communication about noncancer pain are few and diverse. The conceptual model presented here can help to identify knowledge gaps and guide future research on communication about pain. Investigating the links between communication and pain-related outcomes is an important priority for future research.
Journal Article
Let’s talk about pain and opioids: Low pitch and creak in medical consultations
In recent years, the opioid crisis in the United States has sparked significant discussion on doctor–patient interactions concerning chronic pain treatments, but little to no attention has been given to investigating the vocal aspects of patient talk. This exploratory sociolinguistic study intends to fill this knowledge gap by employing prosodic discourse analysis to examine context-specific linguistic features used by the interlocutors of two distinct medical interactions. We found that patients employed both low pitch and creak as linguistic resources when describing chronic pain, narrating symptoms and requesting opioids. The situational use of both features informs us about the linguistic ways in which patients frame fraught issues like chronic pain in light of the current opioid crisis. This study expands the breadth of phonetic analysis within the domain of discourse analysis, serving to illuminate discussions surrounding the illocutionary role of the lower vocal tract in expressing emotions.
Journal Article
Visit Linearity in Primary Care Visits for Patients with Chronic Pain on Long-term Opioid Therapy
BackgroundPhysicians and patients report frustration after primary care visits for chronic pain. The need to shift between multiple clinical topics to address competing demands during visits may contribute to this frustration.ObjectiveThis study creates a novel measure, “visit linearity,” to assess visit organization and examines whether visits that require less shifting back and forth between topics are associated with better patient and physician visit experiences. It also explores whether visit linearity differs depending on the following: (1) whether or not pain is a major topic of the visit and (2) whether or not pain is the first topic raised.DesignThis study analyzed 41 video-recorded visits using inductive, qualitative analysis informed by conversation analysis. We used linear regression to evaluate associations between visit organization and post-visit measures of participant experience.ParticipantsPatients were established adult patients planning to discuss pain management during routine primary care. Physicians were internal or family medicine residents.Main MeasuresVisit linearity, total topics, return topics, topic shifts, time per topic, visit duration, pain main topic, pain first topic, patient experience, and physician difficulty.Key ResultsVisits had a mean of 8.1 total topics (standard deviation (SD)=3.46), 14.5 topic shifts (SD=6.28), and 1.9 topic shifts per topic (SD=0.62). Less linear visits (higher topic shifts to topic ratio) were associated with greater physician visit difficulty (β=7.28, p<0.001) and worse patient experience (β= −0.62, p=0.03). Visit linearity was not significantly impacted by pain as a major or first topic raised.ConclusionsIn primary care visits for patients with chronic pain taking opioids, more linear visits were associated with better physician and patient experience. Frequent topic shifts may be disruptive. If confirmed in future research, this finding implies that reducing shifts between topics could help decrease mutual frustration related to discussions about pain.
Journal Article