‘Good’ patient/‘bad’ patient: clinical learning and the entrenching of inequality

This article develops sociological understanding of the reproduction of inequality in medicine. The material is drawn from a longitudinal study of student experiences of clinical learning that entailed 72 qualitative in‐depth interviews with 27 medical students from five medical schools in the USA. To highlight the subtle, yet powerful, ways in which inequality gets entrenched, this article analyses ideas of the ‘good’ and the ‘bad’ patient. Bad patients question not only biomedical knowledge but also medical students’ commitment to helping people. Good patients engage with medical students in a manner that upholds biomedical knowledge and enables students to assume the role of the healer and the expert. At the same time, good patients possess cultural skills that align with those of medical practitioners. This alignment is, furthermore, central to definitions of the good patient. Distinctions drawn between good and bad patients thus both embody as well as enforce social inequality. The subtle reproduction of inequality is, however, difficult to discern because judgements about patients entwine with emotion.     

A 10-Minute “Mix and Read” Antibody Assay for SARS-CoV-2

Accurate and rapid diagnostic tools are needed for management of the ongoing coronavirus disease 2019 (COVID-19) pandemic. Antibody tests enable detection of individuals past the initial phase of infection and help examine vaccine responses. The major targets of human antibody response in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are the spike glycoprotein (SP) and nucleocapsid protein (NP). We have developed a rapid homogenous approach for antibody detection termed LFRET (protein L-based time-resolved Förster resonance energy transfer immunoassay). In LFRET, fluorophore-labeled protein L and antigen are brought to close proximity by antigen-specific patient immunoglobulins of any isotype, resulting in TR-FRET signal. We set up LFRET assays for antibodies against SP and NP and evaluated their diagnostic performance using a panel of 77 serum/plasma samples from 44 individuals with COVID-19 and 52 negative controls. Moreover, using a previously described SP and a novel NP construct, we set up enzyme linked immunosorbent assays (ELISAs) for antibodies against SARS-CoV-2 SP and NP. We then compared the LFRET assays with these ELISAs and with a SARS-CoV-2 microneutralization test (MNT). We found the LFRET assays to parallel ELISAs in sensitivity (90–95% vs. 90–100%) and specificity (100% vs. 94–100%). In identifying individuals with or without a detectable neutralizing antibody response, LFRET outperformed ELISA in specificity (91–96% vs. 82–87%), while demonstrating an equal sensitivity (98%). In conclusion, this study demonstrates the applicability of LFRET, a 10-min “mix and read” assay, to detection of SARS-CoV-2 antibodies.     

Increased Risk for ESBL-Producing Bacteria from Co-administration of Loperamide and Antimicrobial Drugs for Travelers’ Diarrhea

Antimicrobial drug treatment of travelers’ diarrhea is known to increase the risk for colonization with extended-spectrum β-lactamase-producing Enterobacteriaceae. Among 288 travelers with travelers’ diarrhea, the colonization rate without medications was 21%. For treatment with loperamide only, the rate was 20%; with antimicrobial drugs alone, 40%; and with loperamide and antimicrobial drugs, 71%.     

Pyogenic Spondylitis

During the period 1972-1974 10 patients suffering from pyogenic spondylitis have been treated at the Central Hospital of Middle Finland. Three of the patients had become acutely ill with septic fever and back pain. In the remaining cases the onset of the disease was insidious. Fever, weight loss and fatigue were the general symptoms. Percussion revealed local tenderness at the site of infection in all patients. Two patients showed neurological signs. The ESR was elevated in all cases and alkaline phosphatase was elevated in six patients. Blood culture was positive in those three patients who had become acutely ill. Narrowing of the intervertebral space was observed in all patients. Scanning with Tc⁹⁹ was performed in nine patients, seven of whom were at an early stage of the disease; a significant uptake was recorded in five of these cases. The average interval between the onset of symptoms and the diagnosis was 3 months, range 1 to 5 months. The treatment consisted of bed rest and antibiotics. All the patients recovered and became symptom-free.     

Who is responsible for food risks? The influence of risk type and risk characteristics

The influence of food risk type and risk characteristics on food risk responsibility judgments was studied. A total of 1270 Finnish consumers judged their personal responsibility and the responsibility of three non-personal targets, industry, retail, and society, in relation to six food-related risks. They also evaluated the risks on several psychometric dimensions. The ratings were gathered via internet questionnaire. Industry and society were considered to be most responsible for all risks but the risk of cardiovascular disease, for which personal responsibility was considered to be highest. Judgments of personal controllability predicted personal responsibility judgments, and unnaturalness judgments predicted non-personal targets’ judged responsibility. Personal responsibility judgments were related to different risk dimensions than judgments of non-personal targets’ responsibility.     

The Use of Disaccharides in Inhibiting Enzymatic Activity Loss and Secondary Structure Changes in Freeze-Dried β-Galactosidase during Storage

Purpose  

The purpose of this study is to show how disaccharides differ in their ability to protect lyophilized β-galactosidase from enzymatic activity loss and secondary structure changes during storage.     

Kinetics of Neutralizing Antibodies of COVID-19 Patients Tested Using Clinical D614G,B.1.1.7, and B 1.351 Isolates in Microneutralization Assays

Increasing evidence suggests that some newly emerged SARS-CoV-2 variants of concern (VoCs) resist neutralization by antibodies elicited by the early-pandemic wild-type virus. We applied neutralization tests to paired recoveree sera (n = 38) using clinical isolates representing the first wave (D614G), VoC1, and VoC2 lineages (B.1.1.7 and B 1.351). Neutralizing antibodies inhibited contemporary and VoC1 lineages, whereas inhibition of VoC2 was reduced 8-fold, with 50% of sera failing to show neutralization. These results provide evidence for the increased potential of VoC2 to reinfect previously SARS-CoV-infected individuals. The kinetics of NAbs in different patients showed similar decline against all variants, with generally low initial anti-B.1.351 responses becoming undetectable, but with anti-B.1.1.7 NAbs remaining detectable (>20) for months after acute infection.