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This paper draws together findings from studies of health and identity to develop a model of health identities, based upon Deleuze and Guattari's approach to understanding the relationship between self, body and society. The model is used to inform a methodology for the empirical study of identities in relation to health and the body. Using a sample interview transcript, the methodology of analysis is demonstrated. The application of the model and the methodology for studying health identities are discussed. [ABSTRACT FROM AUTHOR]

Do 'informed' or 'expert' patients challenge dominant traditions in biomedicine or simply adopt these as conventional ways of thinking about body shape and size, illness and health? This paper examines this question in relation to the use of the weight-loss drug Xenical by participants in an Internet forum for obese and overweight people. Ethnographic and interview data from the forum provides evidence that participants share information and support each other as they use Xenical, and in the process emerge as 'expert patients' in relation to their body shape and its treatment. However, it is argued that while an 'expert patient' can be perceived as desirable, enabling the democratisation of healthcare, it can also be constraining. The exchanges between the users in the forum perpetuate a biomedical model of overweight as a condition to be overcome. The discussion critically considers a number of options for the development of the expert patient, including the emergence of an 'informed consumer'. [ABSTRACT FROM AUTHOR]

Risks - and particularly health risks - are predictions about outcomes of human actions. However, actions always have multiple outcomes, and simplistic assertions that a behaviour is 'risky' discounts the multiplicity of ways in which outcomes are differentially valorised.The paper looks at three models of the relationship between risks and hazards, and concludes that hazards are constructs generated from narrow perspectives on the consequences of action. Acknowledging this, the paper goes on to look at people's behaviour as 'experiments in living'. Asking 'what can a body do?' is a way to assess the possibilities for such experiments. Looking at the use of the recreational drug Ecstasy, it is argued that drug users apply a knowledgeability of what a body can do which derives from positive assessments of Ecstasy's effects rather than medical knowledge abilities. What appears to be resistance to research evidence about behaviour is actually pressure against normative limits of what a body can do. [ABSTRACT FROM AUTHOR]

In the modern period, time has been commodified and can be bought, sold and bartered. This paper argues that this means that while time may be a tool of power and control, it is also a site for resistance to power. Four case studies are evaluated from this perspective. A day-case surgery unit is examined to identify the routinization of health care, with time as a tool of control. Decisions over discharge from hospital following surgery demonstrate how time may be 'sold' to 'buy' future time. The disruption of routines during surgery suggest how time may be used as a means of resisting power, while in residential homes, old people find time on their hands as it is transformed into something which must be filled. It is argued that resistance is not achieved by recourse to 'natural' (as opposed to cultural) time, but by rethinking time creatively. [ABSTRACT FROM AUTHOR]

The spaces of the surgical operating theatre (ST) and associated built environment are analysed, to explore what the physical layout means for the interactions which take place. Three 'circuits of hygiene' of surgical staff, surgical instruments, and patients are documented, and analysis of these physical movements through the surgical spaces examined for their contribution to sterility. It is concluded that the built environment of the ST contributes reminders to staff to fulfil the necessary procedures of aseptic technique, to ensure the safe passage of the patient through surgery into a condition where s/he may be designated as 'healed'. [ABSTRACT FROM AUTHOR]

Sociological studies of informal care have documented the contributions of adults, both female and male, however, the contributions of children to care-giving have been relatively under-researched. This paper reports data from a Delphi study of education and welfare professionals with experience of children with caring responsibilities in their family homes. According to these professionals, children are involved in a range of care activities, and often there is a strong emotional component to this care-giving. It is argued that research into informal care needs to recognize the contributions made by children, and that the emotional content of such care-giving is crucial in understanding the character of such care relations. [ABSTRACT FROM AUTHOR]

Behaviour is often the fundamental driver of disease transmission, where behaviours of individuals can be seen to scale up to epidemiological patterns seen at the population level. Here we focus on animal behaviour, and its role in parasite transmission to track its knock-on consequences for parasitism, production and pollution. Livestock face a nutrition versus parasitism trade-off in grazing environments where faeces creates both a nutritional benefit, fertilizing the surrounding sward, but also a parasite risk from infective nematode larvae contaminating the sward. The grazing decisions of ruminants depend on the perceived costs and benefits of the trade-off, which depend on the variations in both environmental (e.g., amounts of faeces) and animal factors (e.g., physiological state). Such grazing decisions determine the intake of both nutrients and parasites, affecting livestock growth rates and production efficiency. This impacts on the greenhouse gas costs of ruminant livestock production via two main mechanisms: (1) slower growth results in longer durations on-farm and (2) parasitised animals produce more methane per unit food intake. However, the sensitivity of behaviour to host parasite state offers opportunities for early detection of parasitism and control. Remote monitoring technology such as accelerometers can detect parasite-induced sickness behaviours soon after exposure, before impacts on growth, and thus may be used for targeting individuals for early treatment. We conclude that livestock host x parasite interactions are at the centre of the global challenges of food security and climate change, and that understanding livestock behaviour can contribute to solving both.

This paper argues that studies of the 'commercial determinants of health' (CDoH) need to acknowledge fully the part the capitalist mode of commodity production and exchange plays in producing negative health outcomes. This proposition is supported by recourse to a recent development in political economy that has established a more-than-human, relational and monist (or 'flat') ontology of capitalism, in place of the more conventional neo-Marxist perspective. This ontology reveals a dynamic to capitalism that operates beyond human intentionality, driven by the supply of, and demand for the capacities of commodities. This dynamic determines the production and consumption of all commodities, some among which (such as tobacco, alcohol and processed foods) contribute to ill-health. A case study of food consumption reveals how these supply and demand affects drive 'unhealthy' food choices by consumers. Ways to undermine this more-than-human dynamic are offered as an innovative approach to addressing the effects of commerce and capitalism upon health., (Copyright © 2024 The Author. Published by Elsevier Ltd.. All rights reserved.)

The critical political economy of health offers different explanations for the social causes of health and the social factors determining the distribution of these causes. However, the relational, post-anthropocentric and monist ontology of the new materialisms overcomes this complexity, while retaining a critical focus. In this perspective, the social, economic and political relations of capitalism act upon bodies and other matter in everyday events, rather than as 'social structures'. Using a conceptual toolkit of 'affect', 'assemblage', 'capacity' and 'micropolitics', the paper asks the question: 'what does capitalism do?' The re-analysis of the social and economic relations of capitalism in terms of a production-assemblage and a market-assemblage reveals not only the workings of capitalist accumulation, but also how previously-unremarked more-than-human affects in these assemblages simultaneously produce uncertainty, waste and inequalities. This micropolitical economy of health is illustrated with examples from recent research, including a critical assessment of health inequalities during the Covid-19 pandemic., Competing Interests: Declaration of conflicting interestsThe author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The substantial literature on interactions between places/spaces and well-being/health often differentiate between physical and social aspects of geographical location. This paper sidesteps this dualism, instead considering places as sociomaterial assemblages of human and non-human materialities. It uses this posthuman and 'new materialist' perspective to explore how place-assemblages affect human capacities, in terms of both health and social dis/advantage. Based on secondary analysis of interview data on human/place interactions, it analyses the physical, sociocultural, psychological and emotional effects of place-assemblages, assessing how these produce opportunities for, and constraints upon human bodies. It than assesses how these emergent capacities affect both social dis/advantage and well-being. This analysis of how place-assemblages contribute positively or negatively to health and dis/advantage offers possibilities for further research and for social and public health policy.

Objectives: The purpose of this study is to identify combinations of workplace conditions that uniquely differentiate high, medium, and low registered nurse (RN) ratings of appropriateness of patient assignment during daytime intensive care unit (ICU) work shifts., Methods: A collective case study design and coincidence analysis were employed to identify combinations of workplace conditions that link directly to high, medium, and low RN perception of appropriateness of patient assignment at a mid-shift time point. RN members of the study team hypothesized a set of 55 workplace conditions as potential difference makers through the application of theoretical and empirical knowledge. Conditions were derived from data exported from electronic systems commonly used in nursing care., Results: Analysis of 64 cases (25 high, 24 medium, and 15 low) produced three models, one for each level of the outcome. Each model contained multiple pathways to the same outcome. The model for "high" appropriateness was the simplest model with two paths to the outcome and a shared condition across pathways. The first path comprised of the absence of overtime and a before-noon patient discharge or transfer, and the second path comprised of the absence of overtime and RN assignment to a single ICU patient., Conclusion: Specific combinations of workplace conditions uniquely distinguish RN perception of appropriateness of patient assignment at a mid-shift time point, and these difference-making conditions provide a foundation for enhanced observability of nurses' work experience during hospital work shifts. This study illuminates the complexity of assessing nursing work system status by revealing that multiple paths, comprised of multiple conditions, can lead to the same outcome. Operational decision support tools may best reflect the complex adaptive nature of the work systems they intend to support by utilizing methods that accommodate both causal complexity and equifinality., Competing Interests: None declared., (Thieme. All rights reserved.)

This paper establishes a relational, post-anthropocentric and materialist approach to the Covid-19 coronavirus pandemic. Analysis of the 'pandemic assemblage' reveals that the virus has subverted the social and economic relations of capitalism, enabling its global spread. This insight establishes a materialist framework for exploring socio-economic disparities in Covid-19 incidence and death rates, via a more-than-human and monist analysis of capitalist production and markets. Disparities derive from the 'thousand tiny dis/advantages' produced by people's daily interactions with human and non-human matter, making sense of the unequal occupational patterning of coronavirus incidence. This more-than-human approach supplies a critical alternative to the mainstream public health and scientific perspectives on the pandemic, with important implications for current and future policy to counter future microbiological outbreaks., (© The Author(s), under exclusive licence to Springer Nature Limited 2022.)

Liver fluke infection (fascioliasis) is a parasitic disease which affects the health and welfare of ruminants. It is a concern for the livestock industry and is considered as a growing threat to the industry because changing climatic conditions are projected to be more favorable to increased frequency and intensity of liver fluke outbreaks. Recent reports highlighted that the incidence and geographic range of liver fluke has increased in the UK over the last decade and estimated to increase the average risk of liver fluke in the UK due to increasing temperature and rainfall. This paper explores financial impacts of the disease with and without climate change effects on Scottish livestock farms using a farm-level economic model. The model is based on farming system analysis and uses linear programming technique to maximize farm net profit within farm resources. Farm level data from a sample of 160 Scottish livestock farms is used under a no disease baseline scenario and two disease scenarios (with and without climate change). These two disease scenarios are compared with the baseline scenario to estimate the financial impact of the disease at farm levels. The results suggest a 12% reduction in net profit on an average dairy farm compared to 6% reduction on an average beef farm under standard disease conditions. The losses increase by 2-fold on a dairy farm and 6-fold on a beef farm when climate change effects are included with disease conditions on farms. There is a large variability within farm groups with profitable farms incurring relatively lesser economic losses than non-profitable farms. There is a substantial increase in number of vulnerable farms both in dairy (+20%) and beef farms (+27%) under the disease alongside climate change conditions., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer JN declared a past co-authorship with one of the authors BV to the handling Editor., (Copyright © 2020 Shrestha, Barratt, Fox, Vosough Ahmadi and Hutchings.)

National and international policy-makers have addressed threats to environmental sustainability from climate change and other environmental degradation for over 30 years. However, it is questionable whether current policies are socially, politically, economically, and scientifically capable of adequately resolving these threats to the planet and living organisms. In this paper we theorize and develop the concept of a "policy assemblage" from within a new materialist ontology, to interrogate critically four policy perspectives on climate change: "liberal environmentalism"; the United Nations policy statements on sustainable development; "green capitalism" (also known as "climate capitalism") and finally "no-growth economics." A materialist analysis of interactions between climate change and policies enables us to establish what each policy can do, what it ignores or omits, and consequently its adequacy to address environmental sustainability in the face of climate change. None, we conclude, is adequate or appropriate to address climate change successfully. We then use this conceptual tool to establish a "posthuman" policy on climate change. Humans, from this perspective, are part of the environment, not separate from or in opposition to it, but possess unique capacities that we suggest are now necessary to address climate change. This ontology supplies the starting point from which to establish sociologically a scientifically, socially, and politically adequate posthuman climate change policy. We offer suggestions for the constituent elements of such a policy., (© 2020 The Authors. The British Journal of Sociology published by John Wiley & Sons Ltd on behalf of London School of Economics and Political Science.)

Culling wildlife to control disease can lead to both decreases and increases in disease levels, with apparently conflicting responses observed, even for the same wildlife-disease system. There is therefore a pressing need to understand how culling design and implementation influence culling's potential to achieve disease control. We address this gap in understanding using a spatial metapopulation model representing wildlife living in distinct groups with density-dependent dispersal and framed on the badger-bovine tuberculosis (bTB) system. We show that if population reduction is too low, or too few groups are targeted, a 'perturbation effect' is observed, whereby culling leads to increased movement and disease spread. We also demonstrate the importance of culling across appropriate time scales, with otherwise successful control strategies leading to increased disease if they are not implemented for long enough. These results potentially explain a number of observations of the dynamics of both successful and unsuccessful attempts to control TB in badgers including the Randomized Badger Culling Trial in the UK, and we highlight their policy implications. Additionally, for parametrizations reflecting a broad range of wildlife-disease systems, we characterize 'Goldilocks zones', where, for a restricted combination of culling intensity, coverage and duration, the disease can be reduced without driving hosts to extinction.

Of anthropogenic methane emissions, 40% can be attributed to agriculture, the majority of which are from enteric fermentation in livestock. With international commitments to tackle drivers of climate change, there is a need to lower global methane emissions from livestock production. Gastrointestinal helminths (parasitic worms) are globally ubiquitous and represent one of the most pervasive challenges to the health and productivity of grazing livestock. These parasites influence a number of factors affecting methane emissions including feed efficiency, nutrient use, and production traits. However, their effects on methane emissions are unknown. This is to our knowledge the first study that empirically demonstrates disease-driven increases in methane (CH 4 ) yield in livestock (grams of CH 4 per kg of dry matter intake). We do this by measuring methane emissions (in respiration chambers), dry matter intake, and production parameters for parasitised and parasite-free lambs. This study shows that parasite infections in lambs can lead to a 33% increase in methane yield (g CH 4 /kg DMI). This knowledge will facilitate more accurate calculations of the true environmental costs of parasitism in livestock, and reveals the potential benefits of mitigating emission through controlling parasite burdens., (Copyright © 2018 Australian Society for Parasitology. Published by Elsevier Ltd. All rights reserved.)

Though mainstream sociological theory has been founded within dualisms such as structure/agency, nature/culture, and mind/matter, a thread within sociology dating back to Spencer and Tarde favoured a monist ontology that cut across such dualistic categories. This thread has been reinvigorated by recent developments in social theory, including the new materialisms, posthumanism and affect theories. Here we assess what a monist or 'flat' ontology means for sociological understanding of key concepts such as structures and systems, power and resistance. We examine two monistic sociologies: Bruno Latour's 'sociology of associations' and DeLanda's ontology of assemblages. Understandings of social processes in terms of structures, systems or mechanisms are replaced with a focus upon the micropolitics of events and interactions. Power is a flux of forces or 'affects' fully immanent within events, while resistance is similarly an affective flow in events producing micropolitical effects contrary to power or control., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Paratuberculosis (Johne's disease) is caused by the bacterium Mycobacterium avium subspecies paratuberculosis ( Map ). Achieving herd-level control of mycobacterial infection is notoriously difficult, despite widespread adoption of test-and-cull-based control strategies. The presence of infection in wildlife populations could be contributing to this difficulty. Rabbits are naturally infected with the same Map strain as cattle, and can excrete high levels in their faeces. The aim of this study is to determine if implementation of paratuberculosis control in cattle leads to a decline in Map infection levels in rabbits. An island-wide, test-and-cull-based paratuberculosis control programme was initiated on a Scottish island in 2008. In this study annual tests were obtained from 15 cattle farms, from 2008 to 2011, totalling 2609 tests. Rabbits (1564) were sampled from the 15 participating farms, from 2008 to 2011, and Map was detected by faecal culture. Map seroprevalence in cattle decreased from 16 to 7.2 per cent, while Map prevalence in rabbits increased from 10.3 to 20.3 per cent. Results indicate that efforts to control paratuberculosis in cattle do not reduce Map levels in sympatric rabbits. This adds to mounting evidence that if Map becomes established in wild rabbit populations, rabbits represent a persistent and widespread source of infection, potentially impeding livestock control strategies., Competing Interests: Competing interests: GLC is the manager of PCHS. None of the other authors of this paper has a financial or personal relationship with other people or organisations that could inappropriately influence or bias the content of the paper., (© British Veterinary Association (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Personal health technologies are near-body devices or applications designed for use by a single individual, principally outside healthcare facilities. They enable users to monitor physiological processes or body activity, are frequently communication-enabled and sometimes also intervene therapeutically. This article explores a range of personal health technologies, from blood pressure or blood glucose monitors purchased in pharmacies and fitness monitors such as Fitbit and Nike+ Fuelband to drug pumps and implantable medical devices. It applies a new materialist analysis, first reverse engineering a range of personal health technologies to explore their micropolitics and then forward engineering personal health technologies to meet, variously, public health, corporate, patient and resisting-citizen agendas. This article concludes with a critical discussion of personal health technologies and the possibilities of designing devices and apps that might foster subversive micropolitics and encourage collective and resisting 'citizen health'.

Objectives: This paper reviews the sociology of environment and health and makes the case for a postanthropocentric approach based on new materialist theory. This perspective fully incorporates humans and their health into 'the environment', and in place of human-centred concerns considers the forces that constrain or enhance environmental capacities., Study Design: This is not an empirical study. The paper uses a hypothetical vignette concerning child health and air pollution to explore the new materialist model advocated in the paper., Methods: This paper used sociological analysis., Results: A new materialist and postanthropocentric sociology of environment and health are possible. This radically reconfigures both sociological theory and its application to research and associated policies on health and the environment. Theoretically, human health is rethought as one among a number of capacities emerging from humans interactions with the social and natural world. Practically, the focus of intervention and policy shifts towards fostering social and natural interactions that enhance environmental (and in the process, human) potentiality., Conclusions: This approach to research and policy development has relevance for public health practice and policy., (Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Climate change has the potential to impair livestock health, with consequences for animal welfare, productivity, greenhouse gas emissions, and human livelihoods and health. Modelling has an important role in assessing the impacts of climate change on livestock systems and the efficacy of potential adaptation strategies, to support decision making for more efficient, resilient and sustainable production. However, a coherent set of challenges and research priorities for modelling livestock health and pathogens under climate change has not previously been available. To identify such challenges and priorities, researchers from across Europe were engaged in a horizon-scanning study, involving workshop and questionnaire based exercises and focussed literature reviews. Eighteen key challenges were identified and grouped into six categories based on subject-specific and capacity building requirements. Across a number of challenges, the need for inventories relating model types to different applications (e.g. the pathogen species, region, scale of focus and purpose to which they can be applied) was identified, in order to identify gaps in capability in relation to the impacts of climate change on animal health. The need for collaboration and learning across disciplines was highlighted in several challenges, e.g. to better understand and model complex ecological interactions between pathogens, vectors, wildlife hosts and livestock in the context of climate change. Collaboration between socio-economic and biophysical disciplines was seen as important for better engagement with stakeholders and for improved modelling of the costs and benefits of poor livestock health. The need for more comprehensive validation of empirical relationships, for harmonising terminology and measurements, and for building capacity for under-researched nations, systems and health problems indicated the importance of joined up approaches across nations. The challenges and priorities identified can help focus the development of modelling capacity and future research structures in this vital field. Well-funded networks capable of managing the long-term development of shared resources are required in order to create a cohesive modelling community equipped to tackle the complex challenges of climate change., (Copyright © 2016 Elsevier Inc. All rights reserved.)

The article reviews the impact of post-structuralism and postmodern social theory upon health sociology during the past 20 years. It then addresses the emergence of new materialist perspectives, which to an extent build upon insights of post-structuralist concerning power, but mark a turn away from a textual or linguistic focus to address the range of materialities that affect health, illness and health care. I conclude by assessing the impact of these movements for health sociology., (© The Author(s) 2015.)

The bacterium Francisella tularensis causes the vector-borne zoonotic disease tularemia, and may infect a wide range of hosts including invertebrates, mammals and birds. Transmission to humans occurs through contact with infected animals or contaminated environments, or through arthropod vectors. Tularemia has a broad geographical distribution, and there is evidence which suggests local emergence or re-emergence of this disease in Europe. This review was developed to provide an update on the geographical distribution of F. tularensis in humans, wildlife, domestic animals and vector species, to identify potential public health hazards, and to characterize the epidemiology of tularemia in Europe. Information was collated on cases in humans, domestic animals and wildlife, and on reports of detection of the bacterium in arthropod vectors, from 38 European countries for the period 1992-2012. Multiple international databases on human and animal health were consulted, as well as published reports in the literature. Tularemia is a disease of complex epidemiology that is challenging to understand and therefore to control. Many aspects of this disease remain poorly understood. Better understanding is needed of the epidemiological role of animal hosts, potential vectors, mechanisms of maintenance in the different ecosystems, and routes of transmission of the disease.

While many aspects of social life possess an emotional component, sociology needs to explore explicitly the part emotions play in producing the social world and human history. This paper turns away from individualistic and anthropocentric emphases upon the experience of feelings and emotions, attending instead to an exploration of flows of 'affect' (meaning simply a capacity to affect or be affected) between bodies, things, social institutions and abstractions. It establishes a materialist sociology of affects that acknowledges emotions as a part, but only a part, of a more generalized affective flow that produces bodies and the social world. From this perspective, emotions are not a peculiarly remarkable outcome of the confluence of biology and culture, but part of a continuum of affectivity that links human bodies to their physical and social environment. This enhances sociological understanding of the part emotions play in shaping actions and capacities in many settings of sociological concern., (© London School of Economics and Political Science 2015.)

Parasitic nematodes represent one of the most pervasive and significant challenges to grazing livestock, and their intensity and distribution are strongly influenced by climate. Parasite levels and species composition have already shifted under climate change, with nematode parasite intensity frequently low in newly colonized areas, but sudden large-scale outbreaks are becoming increasingly common. These outbreaks compromise both food security and animal welfare, yet there is a paucity of predictions on how climate change will influence livestock parasites. This study aims to assess how climate change can affect parasite risk. Using a process-based approach, we determine how changes in temperature-sensitive elements of outbreaks influence parasite dynamics, to explore the potential for climate change to influence livestock helminth infections. We show that changes in temperate-sensitive parameters can result in nonlinear responses in outbreak dynamics, leading to distinct 'tipping-points' in nematode parasite burdens. Through applying two mechanistic models, of varying complexity, our approach demonstrates that these nonlinear responses are robust to the inclusion of a number of realistic processes that are present in livestock systems. Our study demonstrates that small changes in climatic conditions around critical thresholds may result in dramatic changes in parasite burdens.

Parasitic helminths present one of the most pervasive challenges to grazing herbivores. Many macro-parasite transmission models focus on host physiological defence strategies, omitting more complex interactions between hosts and their environments. This work represents the first model that integrates both the behavioural and physiological elements of gastro-intestinal nematode transmission dynamics in a managed grazing system. A spatially explicit, individual-based, stochastic model is developed, that incorporates both the hosts' immunological responses to parasitism, and key grazing behaviours including faecal avoidance. The results demonstrate that grazing behaviour affects both the timing and intensity of parasite outbreaks, through generating spatial heterogeneity in parasite risk and nutritional resources, and changing the timing of exposure to the parasites' free-living stages. The influence of grazing behaviour varies with the host-parasite combination, dependent on the development times of different parasite species and variations in host immune response. Our outputs include the counterintuitive finding that under certain conditions perceived parasite avoidance behaviours (faecal avoidance) can increase parasite risk, for certain host-parasite combinations. Through incorporating the two-way interaction between infection dynamics and grazing behaviour, the potential benefits of parasite-induced anorexia are also demonstrated. Hosts with phenotypic plasticity in grazing behaviour, that make grazing decisions dependent on current parasite burden, can reduce infection with minimal loss of intake over the grazing season. This paper explores how both host behaviours and immunity influence macro-parasite transmission in a spatially and temporally heterogeneous environment. The magnitude and timing of parasite outbreaks is influenced by host immunity and behaviour, and the interactions between them; the incorporation of both regulatory processes is required to fully understand transmission dynamics. Understanding of both physiological and behavioural defence strategies will aid the development of novel approaches for control.

Many studies suggest that health benefits from engaging with the creative arts, but explanations of the association remain tenuous. This article explores both creativity and health from an anti-humanist perspective and develops a Deleuze-inspired analysis to supply the theoretical framework for creativity and health. In this view, creativity is an active, experimenting flow within a network or assemblage of bodies, things, ideas and institutions, while health is understood as the capacity of a body to affect and be affected by this assemblage. It is consequently unsurprising that there is a relationship between creative activity and health. This analysis is used to explore how creative production and reception can affect health, and to assess the implications for sociology and for arts in health-care practice.

Climate change is a driving force for livestock parasite risk. This is especially true for helminths including the nematodes Haemonchus contortus, Teladorsagia circumcincta, Nematodirus battus, and the trematode Fasciola hepatica, since survival and development of free-living stages is chiefly affected by temperature and moisture. The paucity of long term predictions of helminth risk under climate change has driven us to explore optimal modelling approaches and identify current bottlenecks to generating meaningful predictions. We classify approaches as correlative or mechanistic, exploring their strengths and limitations. Climate is one aspect of a complex system and, at the farm level, husbandry has a dominant influence on helminth transmission. Continuing environmental change will necessitate the adoption of mitigation and adaptation strategies in husbandry. Long term predictive models need to have the architecture to incorporate these changes. Ultimately, an optimal modelling approach is likely to combine mechanistic processes and physiological thresholds with correlative bioclimatic modelling, incorporating changes in livestock husbandry and disease control. Irrespective of approach, the principal limitation to parasite predictions is the availability of active surveillance data and empirical data on physiological responses to climate variables. By combining improved empirical data and refined models with a broad view of the livestock system, robust projections of helminth risk can be developed.

Aim: To pilot the delivery of shiatsu in primary care and investigate the non-clinical impact on the general practice, its patients and staff., Design: Ten patients, referred by four GPs, were each offered six shiatsu treatments with a qualified practitioner., Setting: An inner-city general practice in Sheffield, England., Methods: 36 semi-structured interviews, evaluated with Interpretative Phenomenological Analysis and practitioner research including a reflective journal., Findings: GPs welcomed having more options of care, especially for patients with complex, chronic symptoms, and patients appreciated the increased time and holistic, patient-centred approach during shiatsu consultations. Participants claimed the clinic increased equality of access to complementary medicine, improved perceptions of the general practice, reduced consultation and prescription rates, enhanced GP-patient relationships and the working practices of the GPs and shiatsu practitioner., Conclusion: The study successfully integrated a shiatsu clinic into a general practice and offers a model for future research on complementary medicine in primary care., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Fasciola hepatica (liver fluke) is a physically and economically devastating parasitic trematode whose rise in recent years has been attributed to climate change. Climate has an impact on the free-living stages of the parasite and its intermediate host Lymnaea truncatula, with the interactions between rainfall and temperature having the greatest influence on transmission efficacy. There have been a number of short term climate driven forecasts developed to predict the following season's infection risk, with the Ollerenshaw index being the most widely used. Through the synthesis of a modified Ollerenshaw index with the UKCP09 fine scale climate projection data we have developed long term seasonal risk forecasts up to 2070 at a 25 km square resolution. Additionally UKCIP gridded datasets at 5 km square resolution from 1970-2006 were used to highlight the climate-driven increase to date. The maps show unprecedented levels of future fasciolosis risk in parts of the UK, with risk of serious epidemics in Wales by 2050. The seasonal risk maps demonstrate the possible change in the timing of disease outbreaks due to increased risk from overwintering larvae. Despite an overall long term increase in all regions of the UK, spatio-temporal variation in risk levels is expected. Infection risk will reduce in some areas and fluctuate greatly in others with a predicted decrease in summer infection for parts of the UK due to restricted water availability. This forecast is the first approximation of the potential impacts of climate change on fasciolosis risk in the UK. It can be used as a basis for indicating where active disease surveillance should be targeted and where the development of improved mitigation or adaptation measures is likely to bring the greatest benefits.

Governance addresses a wide range of issues including social, economic and political continuity, security and integrity, individual and collective safety and the liberty and rights to self-actualization of citizens. Questions to be answered include how governance can be achieved and sustained within a social context imbued with cultural values and in which power is distributed unevenly and dynamically, and how governance impacts on individuals and institutions. Drawing on Gramscian notions of hegemony and consent, and recent political science literatures on regulation and meta-regulation, this paper develops a sociological model of governance that emphasizes a dynamic and responsive governance in action. Empirical data from a study of pharmaceutical governance is used to show how multiple institutions and actors are involved in sustaining effective governance. The model addresses issues of how governance is sustained in the face of change, why governance of practices varies from setting to setting, and how governance is achieved without legislation.

This paper examines the consequences of a new emphasis on lifestyle in the production, marketing and consumption of pharmaceuticals. Over the past decade, a range of medicines have become available that address aspects of lifestyle, while others have been the subject of lifestyle marketing. We argue, with recourse to a broad literature from the social sciences, economics and health services research and from our study of pharmaceutical consumption, that two processes can be discerned. First, there is a domestication of pharmaceutical consumption, with drugs available via home computers, and marketing of pharmaceuticals that focuses upon private or personal conditions and addresses domestic activities such as sex and cooking. Secondly, there is a pharmaceuticalisation of everyday life as the pharmaceutical industry introduces profitable medicines for a range of daily activities and pharmaceuticals come to be seen by consumers as a 'magic bullet' to resolve problems of daily life. We suggest that the pharmaceuticalisation of daily life links the economics and politics of pharmaceutical production to the private lives of citizens.

Purpose: The combination of cisplatin, etoposide, and paclitaxel was studied in patients with extensive small-cell lung cancer in a phase I component followed by a phase II trial to determine the maximum-tolerated dose (MTD), characterize toxicity, and estimate response and median survival rates., Patients and Methods: Forty-one patients were treated between October 1993 and April 1997. Doses for the initial cohort were cisplatin 75 mg/m(2) on day 1, etoposide 80 mg/m(2)/d on days 1 to 3, and paclitaxel 130 mg/m(2) on day 1 over 3 hours. Cycles were repeated every 3 weeks for up to six cycles. The MTD was reached in the first six patients. In these six patients and in the next 35 patients, who were entered onto the phase II trial, response and survival were estimated., Results: At the initial dose level, one of six patients developed febrile neutropenia, and five of six achieved targeted neutropenia (nadir absolute granulocyte count, 100 to 1,000/microL) without any other dose-limiting toxicity, defining this level as the MTD. Grade 4 neutropenia was observed in 88 (47%) of 188 total courses administered at or less than the MTD. Neutropenia was associated with fever in only 17 (9%) of 188 courses, but two patients experienced neutropenic sepsis that was fatal. Nonhematologic toxicity greater than grade 2 was observed in 10 (5%) of 188 total courses, with fatigue, peripheral neuropathy, and nausea/vomiting most common. The overall objective response rate was 90% of 38 assessable patients: six complete responses (16%) and 28 partial responses(74%). Median progression-free and overall survival durations were 31 and 47 weeks, respectively., Conclusion: The combination of cisplatin, etoposide, and paclitaxel produced response and survival rates similar to those of other combinations and was well tolerated.

Objectives: The WISDOM project applies Internet technologies to create a virtual classroom in health informatics for primary care professionals. Participants use a facilitated E-mail discussion list supported by a web site which provides on-line resources and an archive of teaching materials., Design: The project took an adult-learning model in which participants identify their learning needs, emphasized using informatics skills in practice, and focused on skills likely to enhance evidence-based practice. The paper describes the project and an evaluation of the first programme which ran in 1997 with 28 participants. Pre- and post-intervention questionnaires were used to assess perceived skills in informatics and evidence-based practice., Setting: University of Sheffield., Subjects: Primary care professionals., Results: Participants reported statistically significant increases in eight informatics skills. There were no significant changes in evidence-based practice skills. The web-site, seminar programme and discussion list were highly rated as useful in delivering informatics training., Conclusions: The WISDOM approach is effective for the delivery of informatics training to primary care professionals, and may be used more widely for other subjects and professional groups. There is a need for further research into facilitating virtual classrooms.

Sociological studies of informal care have documented the contributions of adults, both female and male, however, the contributions of children to care-giving has been relatively under-researched. This paper reports data from a Delphi study of eduction and welfare professionals with experience of children with care responsibilities in their family homes. According to these professionals, children are involved in a range of care activities, and often there is a strong emotional component to this care-giving. It is argued that research into informal care needs to recognize the contributions made by children, and that the emotional content of such care-giving is crucial in understanding the character of such care relations.

An impact evaluation was undertaken to ascertain the effects of starting a Master's programme in Primary and Community Care in the University of Sheffield Department of General Practice in terms of workload, use of resources, opportunity costs and general experiences of staff members. Total staff estimates of additional workload amounted to 2758 h during the first year of the course, of which the greater part fell upon the core staff (the course director and the administrative secretary). Staff reported opportunity costs in terms of time devoted to research. Core staff reported additional responsibility, and concomitantly, increased stress. Staff also reported that the introduction of the course had provided opportunities to develop new skills and new knowledge bases, and considered that the presence of postgraduates within the department had given it a 'lift' and raised academic standards.

This paper concerns the information technology course now running in year 1 of the undergraduate curriculum of the medical school of Leeds University. The background and objectives of the course are described, and the course content is outlined in terms of knowledge and practical skills. By the end of the course, 95% of students could successfully accomplish 95% of the skill tasks taught. As regards attitudes to IT, independent studies comparing two randomly selected groups suggested students who had taken the course (a) used IT more frequently, and (b) viewed IT more favourably than their counterparts.

This paper reports association within a curriculum of a theoretical programme in medical sociology for undergraduate medical students with a practical family attachment. These two components constitute the 'sociology' element of a course in behavioural science, and have equal weight for assessment purposes. Recognition of, on one hand, the mutuality of the two elements, and on the other, their similar but distinct theoretical underpinnings, suggests that such an association has the benefit of retaining the individual contributions of each component to student learning, while enabling theoretical and practical components to inform each other. Both are administered from the Department of General Practice of the University of Sheffield, UK. The consequences of such an educational provision are discussed.

The first major intake of medical students who studied the new GCSE occurred in Autumn 1990. These students have experienced a range of student-centred educational approaches to learning, but medical education in the UK remains committed to teacher-centred approaches. This mismatch of expectations is discussed. An innovative course in medical sociology at the University of Sheffield is reported, which illustrates student-centred learning approaches including transferable activity-skills development and self-assessment profiling. An innovative approach to course evaluation is discussed.

A survey conducted among convenors of sociology courses in British medical schools showed a wide variation in course length, with two medical schools having no course, and two schools providing over 60 hours per year. A mean length of 32 hours was found, but there was considerable variation by region. London schools had a mean of 38.5 hours, compared with 40.5 hours in Scotland, and 22.3 hours in English provincial and Welsh schools. The latter group demonstrated a strong correlation between length of time the course had existed and the hours of tuition provided (r = 0.74, P = 0.007). No correlation was found at a significant level for London or Scottish courses. It is concluded that the London University edict making sociology compulsory in the medical curriculum has ensured a reasonable level of provision. Outside London, no such pressure has been available, and sociology has been squeezed as more subjects vie for curriculum time. Attitudes of non-sociology staff are reviewed and found to be predominantly negative. The recent report of the General Medical Council is noted, and it is suggested that the need for such a lobbyist outside London is necessary to ensure sociology attains a more secure and substantial place in the medical curriculum.