Situating Stigma: An Ethnographic Exploration of How Stigma Arises in Interactions at Different Stages of People's Drug Use Journeys.

The association between stigma and drug use has been widely researched. However, to fully understand the nuances of stigma, as experienced by people who use drugs (PWUD), it is argued that we must look at the situations within which stigma is encountered. To obtain an 'up close' look at situated stigma, data are drawn from two ethnographic studies-one set in a homeless hostel in the South of England and the other at a substance use service in South Wales. This article explores how PWUD experience and negotiate stigma at different stages of their drug use. We identify three notable themes across these settings. Firstly, 'othering' occurs in two distinct ways, by othering the past self or distancing from other PWUDs. Secondly, 'drug exceptionalism' is used to justify an individual's drug use and express frustration at the associations between legality, social harm, and stigma. Finally, in 'negotiating identities', individuals present alternate identity roles to either demonstrate clashes in identity or to promote a conventionally positive sense of self. This article contributes to the existing literature on stigma, firstly, by comparing the stigma management strategies of those in active drug use and recovery and, secondly, by using this to highlight the importance of ethnography and situated stigma within this field.

"Doing What We Can with What We Have": Examining the Role of Local Government in Poverty Management during the COVID-19 Pandemic.

With the dawn of the COVID-19 pandemic and concern regarding the subsequent vulnerabilities of houseless populations, countries have sought to adapt and enhance emergency housing policies with a view of better protecting this population. Drawing on the poverty management perspective, this article focuses on local government and its role in managing houselessness during the COVID-19 pandemic. It achieves this by treating local council meetings as sites of problematization, in which the management of houselessness is rationalized and solutions negotiated. We transcribed local council meetings in Bristol, England and Edmonton, Canada, for an 18-month period from March 2020. Our analysis found that a common set of 'problem spaces' - systems, strategic opportunism and power - were evoked by municipal officials in both cities. Under the umbrella of 'doing what we can', local councils: conceptualized houselessness as complex and systemic; identified what does and does not work; discussed jurisdictional limitations and their impact; and defended new forms of accommodation. Significantly, despite the discursive desire to 'build back better', and a slightly rebalanced poverty management landscape in terms of care and control, local governments alone were unable to end houselessness within the post-COVID city.

The 4-mg intravenous dexamethasone suppression test in the diagnosis of Cushing's syndrome.

OBJECTIVE: Optimal diagnostic criteria for the 4-mg intravenous dexamethasone suppression test (IVDST) in patients with Cushing's syndrome (CS), compared with normal subjects, have not been established. We evaluated the performance of the 4-mg IVDST for differentiating CS from normal subjects and to define the responses in CS of various aetiologies. DESIGN, SUBJECTS, MEASUREMENTS: Thirty-two control subjects [normal and overweight/obese participants with or without type 2 diabetes) were prospectively studied, and data from 66 patients with Cushing's disease (CD), three with ectopic ACTH syndrome (EAS), 14 with adrenal Cushing's (AC)] and 15 with low probability of CS (LPC) from three tertiary hospitals were retrospectively evaluated. Dexamethasone was infused at 1 mg/h for 4 h. Plasma cortisol and ACTH were measured at -60 min (baseline), -5 min, +3 h, +4 h, +5 h and at +23 and +23.5 h on Day 2. RESULTS: Control subjects (including those with type 2 diabetes) exhibited a marked suppression of cortisol which was maintained until Day 2. Two of 15 patients with LPC had Day 2 cortisol results that overlapped with CS. Patients with CD demonstrated partial suppression, with rebound hypercortisolism on Day 2. Patients with AC and EAS did not suppress cortisol levels. Day 2 cortisol level of >130 nmol/l (or >20% of the baseline) diagnosed CS with 100% sensitivity and 96% specificity. CONCLUSION: While the IVDST allowed complete discrimination between control subjects and CS, 13% of LPC overlapped with CS. Given the small number of EAS, no conclusion can be drawn regarding the utility of this test in the differential diagnosis of CS.

Anticoagulant management of pregnancy following heart valve replacement in the United Kingdom, 1986-2002.

BACKGROUND AND AIM OF THE STUDY: Patients with mechanical heart valves require anticoagulation which is associated with significant maternal mortality (1-4%) and fetal complications (31%) in pregnancy. The study aim was to identify anticoagulant protocols and outcomes for pregnant women undergoing heart valve replacement (HVR) in the United Kingdom. METHODS: Women aged between 18 and 45 years and registered with the United Kingdom Heart Valve Registry (UKHVR) each completed a questionnaire, and their obstetric notes were reviewed. The data analyzed included valve type (mechanical, bioprosthetic, homograft), valve site (mitral, aortic, tricuspid, pulmonary), anticoagulation at confirmation of pregnancy, between 6-12 weeks and from 12 weeks to term, delivery, maternal and fetal outcomes, and cause of death. The summary statistics and a descriptive review of the findings are reported. RESULTS: Of 2,532 women eligible for the study, 922 responded. Among these women, 72 became pregnant, with 60 pregnancies in the mechanical valve (MV) group and 45 in the tissue valve (TV) group. Three anticoagulation regimes were used during early pregnancy: unfractionated heparin (UFH), low-molecular-weight heparin (LMWH) or warfarin. All women received warfarin in the second trimester and heparin for delivery. Live births were recorded in 30% of MV pregnancies and in 60% of TV pregnancies. Miscarriage rates differed markedly (37% MV versus 2% TV). Fetal outcome was poorest in the warfarin-only group, with embryopathy occurring at a dose level of 6 mg. The maternal outcomes did not differ significantly among groups. High-dose heparin during the first trimester and for delivery was effective for the majority of mechanical valves. CONCLUSION: The study results illustrate the diverse and uncertain manner in which UKHVR patients are managed during pregnancy. A national notification system would record much-needed prospective information on anticoagulation and pregnancy outcomes, thus aiding evidence-based management.