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"Morris, Carolyn"
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Indigenous communalism : belonging, healthy communities, and decolonizing the collective
\"From the tactile descriptions of a grandmother's inter-generational care, to the strategic and slow consensus work of elected tribal leaders, native community builders perform the daily work of constructing culture and nurturing community. Indigenous Communalism describes a critical ethnography of community-building and community builders in the Akimel O'odham of Southern Arizona, and considers what we can learn about culture, and about strong, healthy communities from Indigenous peoples. This ethnography is deeply descriptive of the moral value of communalism, something that is present in all human communities. But Indigenous peoples express and practice it in distinctive ways. As a contrast to the hyper-individualism in most contemporary economic, legal, and scientific discourse, this book promotes critical awareness of individualist assumptions\"-- Provided by publisher.
Book
Not-Talking/Not-Knowing: Autoethnography and Settler Family Histories in Aotearoa New Zealand
Critical family history analyses have generated powerful insights into the history and ongoing workings of colonization by bringing to light forgotten family histories and reframing them as stories of colonialism. Such work unsettles the descendants of early colonizers by compelling them to acknowledge the ways in which they continue to benefit from the colonizing actions of their ancestors. My family were colonizers, and some not-very-distant ancestors were part of the first wave of “settlers” who dispossessed Māori of their land in coastal Taranaki. Where my family differs from the families of many writers in the critical family history field is that they remain almost to this day on the land first taken by our direct ancestors. The question I address is how these settler farmers deal with the fact that the land that is now theirs is only recently so, and only became so through acts of violent dispossession, and that the descendants of the original possessors of that land continue to live on the Coast. I argue that one way that settler-colonizers deal with this uncomfortable history is to erase it. The erasure of this history is accomplished through the simple but effective strategy of not-talking about it, which leads to not-knowing about it. This practice, I suggest is critical for the subjective security of settlers, and it remains a crucial strategy in ongoing practices of quotidian colonization. My analysis emanates from a critically reflexive exploration of my memories, of what I know and what I do not know about the history of the farm I grew up on, and demonstrates that autoethnography as a methodology is particularly useful for interrogating and breaking the silences about colonization that contribute to its perpetuation.
Journal Article
Obesity exacerbates influenza-induced respiratory disease via the arachidonic acid-p38 MAPK pathway
Obesity is a risk factor for severe influenza, and asthma exacerbations caused by respiratory viral infections. We investigated mechanisms that increase the severity of airway disease related to influenza in obesity using cells derived from obese and lean individuals, and in vitro and in vivo models. Primary human nasal epithelial cells (pHNECs) derived from obese compared with lean individuals developed increased inflammation and injury in response to influenza A virus (IAV). Obese mice infected with influenza developed increased airway inflammation, lung injury and elastance, but had a decreased interferon response, compared with lean mice. Lung arachidonic acid (AA) levels increased in obese mice infected with IAV; arachidonic acid increased inflammatory cytokines and injury markers in response to IAV in human bronchial epithelial (HBE) cells. Obesity in mice, and AA in HBE cells, increased activation of p38 MAPK signaling following IAV infection; inhibiting this pathway attenuated inflammation, injury and tissue elastance responses, and improved survival. In summary, obesity increases disease severity in response to influenza infection through activation of the p38 MAPK pathway in response to altered arachidonic acid signaling.
Journal Article
Smoking-associated risks of conventional adenomas and serrated polyps in the colorectum
Purpose: Prior studies suggest cigarette smoking is associated with 1.5- to twofold increased risk of colorectal adenomas and possibly a higher risk of serrated polyps. Further clarification of risk differences between adenomas and serrated polyps is needed with regard to co-occurrence and polyp location. Methods: We conducted a combined analysis of conventional adenoma and serrated polyp occurrence using individual-level data from 2,915 patients participating in three colonoscopy-based clinical trials. All participants had ≥1 adenomas removed at baseline and were followed for up to 4 years. Smoking habits and other lifestyle factors were collected at baseline using questionnaires. We used generalized linear regression to estimate risk ratios and 95 % confidence intervals. Results: Smokers were at slightly increased risk of adenomas compared to never smokers [current: RR 1.29 (95 % CI 1.11–1.49) and former: RR 1.18 (1.05–1.32)]. Smoking was associated with greater risk of serrated polyps [current: RR 2.01 (1.66–2.44); former: RR 1.42 (1.20–1.68)], particularly in the left colorectum. Associations between current smoking and occurrence of serrated polyps only [RR 2.33 (1.76–3.07)] and both adenomas and serrated polyps [RR 2.27 (1.68–3.06)] were more pronounced than for adenomas only [RR 1.31 (1.08–1.58)]. Results were similar for other smoking variables and did not differ by gender or for advanced adenomas. Conclusions: Cigarette smoking has only a weak association with adenomas, but is associated with a significantly increased risk of serrated polyps, particularly in the left colorectum. Since a minority of left-sided serrated polyps is thought to have malignant potential, the role of smoking in initiation phases of carcinogenesis is uncertain.
Journal Article
Electronic patient self-Reporting of Adverse-events: Patient Information and aDvice (eRAPID): a randomised controlled trial in systemic cancer treatment
Background
eRAPID (electronic patient self-Reporting of Adverse-events: Patient Information and aDvice) is an internet based system for patients to self-report symptoms and side effects (adverse events or AE) of cancer treatments. eRAPID allows AE reporting from home and patient reported data is accessible via Electronic Patient Records (EPR) for use in routine care. The system can generate alerts to clinical teams for severe AE and provides patient advice on managing mild AEs. The overall aims of eRAPID are to improve the safe delivery of cancer treatments, enhance patient care and standardise AE documentation.
Methods
The trial is a prospective randomised two-arm parallel group design study with repeated measures and mixed methods. Participants (adult patients with breast cancer on neo-adjuvant or adjuvant chemotherapy, colorectal and gynaecological cancer receiving chemotherapy) are randomised to receive the eRAPID intervention or usual care over 18 weeks of treatment. Participants in the intervention arm receive training in using the eRAPID system to provide routine weekly adverse event reports from home. Hospital staff can access eRAPID reports via the EPR and use the information during consultations or phone calls with patients.
Prior to commencing the full trial an internal pilot phase was conducted (
N
= 87 participants) to assess recruitment procedures, consent and attrition rates, the integrity of the intervention information technology and establish procedures for collecting outcome data. The overall target sample for the trial is
N
= 504.
The primary outcome of the trial is quality of life (FACT-G) with secondary outcomes including health economics (costs to patients and the NHS), process of care (e.g. contacts with the hospital, number of admissions, clinic appointments and changes to treatment/medications) and patient self-efficacy. Outcome data is collected at baseline, 6, 12, 18 weeks and 12 months. The intervention is also being evaluated via end of study interviews with patient participants and clinical staff.
Discussion
The pilot phase was completed in February 2016 and recruitment and attrition rates met criteria for continuing to the full trial. Recruitment recommenced in May 2016 and is planned to continue until December 2017. Overall findings will determine the value of the eRAPID intervention for supporting the care of patients receiving systemic cancer treatment.
Trial registration
Current Controlled Trials
ISRCTN88520246
. Registered 11 September 2014.
Journal Article
The Digital Rectal Examination: A Multicenter Survey of Physicians' and Students' Perceptions and Practice Patterns
The digital rectal examination (DRE) may be underutilized. We assessed the frequency of DREs among a variety of providers and explored factors affecting its performance and utilization.
A total of 652 faculty, fellows, medical residents, and final-year medical students completed a questionnaire about their use of DREs.
On average, 41 DREs per year were performed. The yearly number of examinations was associated with years of experience and specialty type. Patient refusal rates were lowest among gastroenterology (GI) faculty and highest among primary-care doctors. Refusal rates were negatively correlated with comfort level of the physician in performing a DRE. More gastroenterologists used sophisticated methods to detect anorectal conditions, and gastroenterologists were more confident in diagnosing them. Confidence in making a diagnosis with a DRE was strongly associated with the number of DREs performed annually.
The higher frequencies of performing a DRE, lower refusal rate, degree of comfort, diagnostic confidence, and training adequacy were directly related to level of experience with the examination. Training in DRE technique has diminished and may be lost. The DRE's role in medical school and advanced training curricula needs to be re-established.
Journal Article
Small stories, small acts in sites of struggle: the establishment of Māori wards in Taranaki
Between 2001 and 2021, the eight iwi of Taranaki entered into Deeds of Settlement with the Crown. These settlements, which saw the Crown acknowledge and apologise for its historical breaches of Te Tiriti o Waitangi, also served to extinguish the rights of Taranaki Māori to seek further redress from the Crown. The Treaty Settlement process over, Taranaki Māori and the many non-Māori that have settled in the rohe (tribal territory) are left to themselves to deal with any lingering tensions, ongoing enmity and forms of structural injustice stemming from the settler-colonial process. This paper is not about the formal processes of colonisation or Crown-initiated attempts to atone for the past through the Treaty Settlement process. Rather, this paper concerns the painstaking work of change undertaken on the ground by local people, Māori and non-Māori alike. It concerns the 'small stories' of colonisation, the myriad endeavours of local people working for change in local contexts. In particular, the article concerns the fight for Māori wards on Councils in New Plymouth and South Taranaki, and the extraordinary work done by ordinary people in attempting to forge some kind of future of togetherness in a region riven by the violence of colonisation.
Journal Article
Macrophage-intrinsic DUOX1 contributes to type 2 inflammation and mucus metaplasia during allergic airway disease
The NADPH oxidase DUOX1 contributes to epithelial production of alarmins, including interleukin (IL)-33, in response to injurious triggers such as airborne protease allergens, and mediates development of mucus metaplasia and airway remodeling in chronic allergic airways diseases. DUOX1 is also expressed in non-epithelial lung cell types, including macrophages that play an important role in airway remodeling during chronic lung disease. We therefore conditionally deleted DUOX1 in either lung epithelial or monocyte/macrophage lineages to address its cell-specific actions in innate airway responses to acute airway challenge with house dust mite (HDM) allergen, and in chronic HDM-driven allergic airway inflammation. As expected, acute responses to airway challenge with HDM, as well as type 2 inflammation and related features of airway remodeling during chronic HDM-induced allergic inflammation, were largely driven by DUOX1 with the respiratory epithelium. However, in the context of chronic HDM-driven inflammation, DUOX1 deletion in macrophages also significantly impaired type 2 cytokine production and indices of mucus metaplasia. Further studies revealed a contribution of macrophage-intrinsic DUOX1 in macrophage recruitment upon chronic HDM challenge, as well as features of macrophage activation that impact on type 2 inflammation and remodeling.
Journal Article
Assessing Indigenous Community Radio as Two-Way Communications Infrastructure: Communal Engagement and Political Mobilization in Ecuador
Because Indigenous peoples face unique challenges to their autonomy and lifeways from dominant media influences, Indigenous radio has been used to facilitate intra-community engagement among these groups. A small but long-standing literature reveals both strengths and vulnerabilities of Indigenous radio, though the rapidly changing communications landscape suggests new possibilities for these media sources. Our research was a community–academic collaboration that employed exploratory and mixed (survey, interview, and observational) methods across two Indigenous communities in the Central and Southern Amazon of Ecuador. The Indigenous radio station, La Voz de la CONFENIAE (Confederación de las Nacionalidades Indígenas de la Amazonía Ecuatoriana), sought to perform an impact assessment that would measure both the character and extent of the impact of radio programming with sensitivity to the priorities of listeners as to the purpose, function, and appropriate impact metrics for an Indigenous radio station. A total of 92 surveys and 30 interviews across two communities were conducted in July and August of 2022. Our findings reveal (a) the informational function of this radio for the Indigenous communities in its listening reach; (b) that radio programming conveys family, community, and cultural knowledge bi-directionally both from and to its listening audience; and (c) that members of the audience were, in turn, prompted to action and engagement. In our discussion, we identify opportunities to improve the assessment of community-owned radio as a bidirectional resource for communities. Our work also advances a model of self-determined and stakeholder-driven evaluation for Indigenous community radio, with particular attention to the material (e.g., behavioral) impacts of radio messages and potential for radio to support communal and collective engagements desired by the communities it serves.
Journal Article