Organizational aspects of tissue engineering clinical translation: insights from a qualitative case study.

Background: Tissue engineering is a multidisciplinary field that combines principles from cell biology, bioengineering, material sciences, medicine and surgery to create functional and viable bioproducts that can be used to repair or replace damaged or diseased tissues in the human body. The complexity of tissue engineering can affect the prospects of efficiently translating scientific discoveries in the field into scalable clinical approaches that could benefit patients. Organizational challenges may play a key role in the clinical translation of tissue engineering for the benefit of patients. Methods: To gain insight into the organizational aspects of tissue engineering that may create impediments to efficient clinical translation, we conducted a retrospective qualitative case study of one tissue engineering multi-site translational project on knee cartilage engineered tissue grafts. We collected qualitative data using a set of different methods: semi-structured interviews, documentary research and audio-visual content analysis. Results: Our study identified various challenges associated to first-in-human trials in tissue engineering particularly related to: logistics and communication; research participant recruitment; clinician and medical student participation; study management; and regulation. Conclusions: While not directly generalizable to other types of advanced therapies or to regenerative medicine in general, our results offer valuable insights into organizational barriers that may prevent efficient clinical translation in the field of tissue engineering.

Long Covid requires a global response centred on equity and dialogue.

Long Covid, or Post-Covid Conditions, is a global health problem. Yet we know strikingly little about the different experiences of Long Covid patients cross-nationally. To address this shortcoming, we conducted an online survey of Long Covid patients active on social media in the U.S. (n = 334, October to December 2021) and Brazil (n = 144, January to April 2022). Our analysis of short answer responses indicates patient dissatisfaction with medical care provided for Long Covid in both the U.S. and Brazil. For Long Covid patients in Brazil, there were additional concerns raised about the lack of local expertise about their condition. Based on these results, we urge policymakers to expand the education of medical professionals in order to raise awareness of Long Covid. Experts in the Global North should also be encouraged to engage in dialogue with patient groups and experts in the Global South, in order to better understand how local contexts shape the experience of Long Covid.

Long covid and medical gaslighting: Dismissal, delayed diagnosis, and deferred treatment.

While we know a lot more about Long Covid today, patients who were infected with Covid-19 early on in the pandemic and developed Long Covid had to contend with medical professionals who lacked awareness of the potential for extended complications from Covid-19. Long Covid patients have responded by labeling their contentious interactions with medical professionals, organizations, and the broader medical system as "gaslighting." We argue that the charge of medical gaslighting can be understood as a form of ontological politics. Not only do patients demand that their version of reality be recognized, but they also blame the experts who hold gatekeeping power over their medical care for producing a distorted version of said reality. By analyzing results from an online survey of Long Covid patients active on social media in the United States (n â€‹= â€‹334), we find that experiences of contention and their reframing as "gaslighting" were common amongst our respondents. In short answer responses about their experience obtaining medical care for Long Covid, our respondents described encountering medical professionals who dismissed their experience, leading to lengthy diagnostic odysseys and lack of treatment options for Long Covid. Even though we are limited by characteristics of our sample, there is good reason to believe that these experiences and their contentious reframing as medical gaslighting are exacerbated by gender, class, and racial inequalities.

"It's (Not) Like the Flu": Expert Narratives and the COVID-19 Pandemic in Mainland China, Hong Kong, and the United States.

We trace the crafting of expert narratives during the initial months of the COVID-19 pandemic in Mainland China, Hong Kong, and the United States. By expert narratives, we refer to how experts drew different lessons from past disease experiences to guide policymakers and the public amidst uncertainty. These expert narratives were mobilized in different sociopolitical contexts, resulting in varying configurations of expertise networks and allies that helped contain and mitigate COVID-19. In Mainland China, experts carefully advanced a managed narrative, emphasizing the new pandemic akin to the 2003 SARS outbreak can be managed while destressing the similar mistakes the government made during the two crises. In Hong Kong, experts invoked a distrust narrative, pointing to a potential coverup of COVID-19 similar to SARS, activating allies in civil society to pressure policymakers to act. In the United States, experts were mired in a contested narrative and COVID-19 was compared to different diseases; varying interpretations of COVID-19's consequences was exacerbated by political polarization. In expert narratives, the resonance of the past is emergent: the past becomes a site of struggle and a cultural object that is presented as potentially useful in solving problems of the present.

Whose Advice is Credible? Claiming Lay Expertise in a Covid-19 Online Community.

During the initial months of the Covid-19 pandemic, credentialed experts-scientists, doctors, public health experts, and policymakers-as well as members of the public and patients faced radical uncertainty. Knowledge about how Covid-19 was spread, how best to diagnose the disease, and how to treat infected patients was scant and contested. Despite this radical uncertainty, however, certain users of Covid-19 Together, a large online community for those who have contracted Covid-19, were able to dispense advice to one another that was seen as credible and trustworthy. Relying on Goffman's dramaturgical theory of social interaction, we highlight the performative dimension of claims to lay expertise to show how credibility is accrued under conditions of radical uncertainty. Drawing on four months of data from the forum, we show how credible performances of lay expertise necessitated the entangling of expert discourse with illness experience, creating a hybrid interlanguage. A credible performance of lay expertise in this setting was characterized by users' ability to switch freely between personal and scientific registers, finding and creating resonances between the two. To become a credible lay expert on this online community, users had to learn to ask questions and demonstrate a willingness to engage with biomedical knowledge while carefully generalizing their personal experience.

Testing the talented child: Direct-to-consumer genetic talent tests in China.

One controversial area of direct-to-consumer genetic testing in China is "genetic talent testing" for children. In this study, I show that while experts criticize genetic talent testing as unscientific, the persistence of genetic talent testing is not merely a product of parents' scientific illiteracy. Instead, genetic talent testing reflects parents' pragmatic use of technology in response to the parenting pressures in contemporary China. Parents see the results of genetic talent testing as offering an advantage for their children when combined with the intensive parenting strategy of precision education. Drawing on the sociology of testing, I argue how genetic talent testing in China is a product of broader concerns about population quality and can potentially reshape how parents imagine quality children through the theory of multiple intelligences. My study of this "off label" use of direct-to-consumer genetic testing also suggests that scientists need to broaden their imagination of potential misuses of their technologies.

Recent scientific/intellectual movements in biomedicine.

This study compares the trajectories of recent scientific/intellectual movements (SIMs) in biomedicine: evidence-based medicine, translational medicine, precision medicine, personalized medicine, stratified medicine, and genomic medicine. Drawing on bibliometric analysis of these six SIMs, this study identifies three patterns: field integration, niche creation, and disruptive insurgence. Field integration SIMs such as evidence-based medicine and translational medicine are characterized by centrality of key concept papers of the SIM in co-citation networks and dense institutional and country collaboration networks, signaling the resonance of the SIM to the broader biomedical community. In contrast, niche creation SIMs such as stratified medicine and genomic medicine are characterized by lower levels of annual scientific production, the lack centrality or connectivity of key concept papers in co-citation networks, and less density in collaboration networks. Disruptive insurgence SIMs such as precision medicine and personalized medicine are characterized by a high level of annual scientific production, driven by a smaller core of institutions and countries. This is likely a transitional stage as field disrupting SIMs can either become integrated with the broader field or become influential in niches. Proponents of the current push for precision medicine should ensure that a wide range of institutions and specialties be included while being mindful of the dominance of cancer and genomic approaches to health and medicine.