232 research outputs found
Rickettsiales and rickettsial diseases in Australia
No full textCurrently, there are 12 known Rickettsiales species in Australia. However research into the diversity and range of these agents in Australia is still far from complete.
A sero-epidemiological study was undertaken around the city of Launceston in Tasmania, Australia to determine the level of exposure to spotted fever group (SFG) rickettsia among the local cat and dog population. The study showed that over 50% of the dogs and cats tested were positive for SFG rickettsiae antibodies. However, no correlation was observed between the animals’ health and seropositivity at the time of testing.
Ixodes tasmani ticks collected from Tasmanian devils in Tasmania were tested for the presence of SFG and typhus group (TG) rickettsiae using a specific real time PCR (qPCR), and 55% were found to be positive. The gltA, rompA, rompB and sca4 genes were then sequenced. Using the current criteria this new rickettsia qualified as a Candidatus species, and was named Candidatus Rickettsia tasmanensis, after the location from which it was first detected.
Soft ticks of the species Argas dewae were collected from bat roosting boxes north of Melbourne. Of the ten ticks collected, seven (70%) were positive for SFG rickettsiae using the qPCR mentioned above. An isolate was obtained using cell culture isolation methods and the rrs, gltA, rompA, rompB and sca4 genes were sequenced. Using the current criteria this new rickettsia qualified as a novel species, and was tentatively named Rickettsia argasii sp. nov. after the tick genus from which it was isolated.
Four family members and their neighbour living in metropolitan Victoria became ill after exposure to a flea-infested kitten. Initial serological analysis indicated a typhus group (TG) rickettsial infection. However, testing of fleas from the group of cats in Lara, Victoria, where the kitten originated, revealed the presence of R. felis, the agent of cat flea typhus. This was the first case of human infection with R. felis in Australia and the first detection of R. felis in fleas in Victoria.
A tourist returning to Australia from the United Arab Emirates was diagnosed with a scrub typhus group (STG) rickettsial infection and the agent was isolated from their blood. Analysis of the rrs and 47kDa genes showed significant divergence compared to all available strains of Orientia tsutsugamushi. Due to the degree of genetic divergence and the geographically unique origin of this isolate it was considered to be a new species, which has been tentatively named Orientia chuto, with ‘chuto’ being Japanese for ‘Middle East’.
Dogs in central and northern Australia were tested for Anaplasma platys using a specifically designed real-time PCR (qPCR) assay. Of the 68 dogs tested, 27 (40%) were positive for A. platys DNA, including six dogs from Western Australia. This was the first report of A. platys in Western Australia.
These studies offer an insight into the range and diversity of Rickettsiales and rickettsial diseases previously unrecognised in Australia
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Fenwick on civil liberties and human rights /
No full text"More than merely describing the evolution of human rights and civil liberties law, this...textbook provides students with...coverage of the most crucial developments in the field, clearly explaining the law in context and practice. Updated throughout for this new edition, [the author] considers a number of recent major changes in the law, in particular proposals to replace the Human Rights Act with a British Bill of Rights, and the Counter-Terrorism and Security Act 2015, whilst also contextualising the impact of reforms on hate speech and contempt due to advances in new media."-
Epidemiology of the highly pathogenic avian influenza H5N1 in Northern Vietnam: Applications for surveillance and control
No full textThe epidemiology and the sanitary situation of avian influenza changed dramatically with the emergence of the highly pathogenic H5N1 virus (HPAI) in 1996. As a consequence, knowledge previously accumulated on the epidemiology and the ecology of the avian influenza viruses was questioned and was required to be updated to understand the current pandemic caused by the virus (Webster, 2007; Sturm-Ramirez, 2005).
This PhD combined a number of different epidemiological studies aimed at understanding the epidemiology of the H5N1 virus in the natural and human context of the Red River Delta area in Northern Vietnam.
Firstly, retrospectives studies were conducted to identify the determinants of occurrence of HPAI outbreaks at 2 different scales: provincial and regional. Those 2 approaches allowed us to study the influence of the poultry production systems (provincial scale) and the influence of environmental determinants (regional scale).
In addition, substantial field work was undertaken to monitor the serological and virological prevalence of HPAI in domestic poultry in our study area. After evaluation of the serological diagnostic tools being used, the data analysis contributed to a better understanding of the epidemiology of the H5N1 virus within a mass vaccination context. Furthermore, an evaluation of the vaccination strategy and implementation was also possible. In addition, to support our findings, a specific protocol to monitor the antibody kinetics of vaccinated poultry under field conditions was also conducted.
Finally, a study was undertaken, in collaboration with a sociologist, to better capture the way sanitary information was circulating within our community of poultry farmers and through the formal surveillance system.
Together with the results of our epidemiological work, this sociological study enabled us to propose measures to improve the surveillance and control of HPAI at the community level, to assist the people whose livelihoods were most affected
Falcated Teal:
No full text1994Purchased for the Camosun College Art Collection by the Camosun College Cultural Enhancement Committee from the Art Gallery of Greater Victoria (Art Rental and Sales Gallery).James Fenwick Lansdowne (Order of Canada, Order of BC, Royal Canadian Academy of the Arts), was an internationally renowned wildlife artist and author. Born to British parent in Hong Kong in 1937, Lansdowne grew up in Victoria, BC and was taught to paint by his mother, an accomplished artist trained in Chinese watercolour painting. He began his artistic career at a young age presenting his first exhibition at the Royal Ontario Museum at the age of nineteen. His work has been closely compared to the paintings of John James Audubon, as it often portrayed a specific bird species over a neutral coloured background. Lansdowne’s work however has been lauded for its life-like realism and ability to present birds in naturalistic poses. He studies his subjects in their natural habitat and paints them in gouache. In 1977, Lansdowne was made an Officer of the Order of Canada, and in 1979, received an honourary Doctor of Laws from the University of Victoria. Lansdowne’s works have exhibited internationally at museums and galleries including Audubon House in New York, London’s Truon Galleries, and the Smithsonian Institute in Washington DC.
ARTIST INFO: Times Colonist Obituary: http://www.legacy.com/obituaries/timescolonist/obituary.aspx?n=james-fenwick-lansdowne&pid=114495190 (Accessed January 9, 2017); CBC Obituary: http://www.cbc.ca/news/entertainment/renowned-b-c-bird-artist-and-author-james-fenwick-lansdowne-dies-at-71-1.694563 (Accessed January 9, 2017); University of Victoria Collection Search Results: http://collection.legacy.uvic.ca/index.php?artist_id=2123&artist_action=get_art_w_bio (Accessed February 26, 2017)Robbyn LanningGouache is an watermedia which possesses qualities of both watercolour and acrylic/oil paints. Similar to watercolour paint, gouache has a matte finish, can be rewet, and can permeate its paper support. Like acrylic or oil paints, gouache is opaque and can also be used to form a superficial layer on top of its support.
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Detection and characterization of rickettsiae in Western Australia
No full textThe aim of this study was to address the shortfall in current, in-depth knowledge of Western Australian rickettsiae investigating in particular, the role of native and feral animals as reservoir hosts. Two novel species of rickettsiae were detected in ticks collected from native and feral animals and humans, these were characterised using molecular methods. A preliminary investigation into the pathogenic potential of one of the isolates was also undertaken.
To facilitate investigation, ectoparasites (principally ticks) were opportunistically collected from across the State, with an emphasis on native and feral animals and people. All ectoparasites were screened for rickettsial infection using a polymerase chain reaction incorporating Rickettsia-specific citrate synthase gene (gltA) primers. Preliminary sequencing was performed on representative PCR-positive samples from each geographical location, vertebrate host and ectoparasite in order to identify and characterize the infecting rickettsia. Isolation in cell culture and further genotypic characterization was then performed. Finally, a serosurvey and questionnaire were implemented in one of the study areas to determine whether people were being infected with a Rickettsia spp. and whether infection was associated with clinical signs.
Ectoparasite collection produced three genera of ticks (Ixodes, Amblyomma and Haemaphysalis) from native animals, feral pigs and people, primarily from the southwest of Western Australia and Barrow Island in the Pilbara region. Ticks from a number of sources were shown to be infected with rickettsiae by the PCR, including feral pigs, people, bobtail lizards, kangaroos, bandicoots, burrowing bettongs, common brushtail possums and yellow-footed antechinus. Genotypic characterization of positive amplicons from ticks revealed the presence of two novel spotted fever group rickettsiae. Rickettsia gravesii sp. nov., named in honour of Dr Stephen Graves, was identified extensively throughout the southwest of the State and on Barrow Island in Ixodes, Amblyomma and Haemaphysalis spp. ticks from multiple hosts. Candidatus Rickettsia antechini was detected in Ixodes spp. only from yellow-footed antechinus in Dwellingup. In addition, a novel Bartonella spp. (Bartonella sp. strain Mu1) was also detected from Acanthopsylla jordani fleas collected from yellow-footed antechinus in Dwellingup.
Rickettsia gravesii sp. nov. is most closely related to the Rickettsia massiliae subgroup of the spotted fever group and to R. rhipicephali in particular. Sequence similarities between this novel species and the subgroup were 99.7%, 98.4%, 95.8% and 97.4% based on its 16S rRNA, gltA, ompA and ompB genes respectively.
Candidatus Rickettsia antechini also demonstrated a close relationship to the R. massiliae subgroup (99.4%, 94.8% and 97.1% sequence similarity based on its gltA, ompA and ompB genes respectively). The two novel Western Australian species demonstrated 98.4%, 96.3% and 96.7% sequence similarity to each other based on gltA, ompA and ompB genes respectively indicating separate species. The novel Bartonella spp. (Bartonella sp. strain Mu1) detected in fleas collected from yellow-footed antechinus in Dwellingup demonstrated greatest gltA gene sequence similarity to Bartonella strain 40 at 86.1%.
Results from the serosurvey and questionnaire-based investigation into the zoonotic importance of R. gravesii sp. nov. on Barrow Island supported the results of the tick study and suggested that a tick-borne rickettsia(e) was infecting people on the island. However, a significant association between seroconversion and a history of symptoms consistent with a rickettsiosis was not found, and it is possible therefore, that R. gravesii sp. nov. produces only asymptomatic infections.
Future work on rickettsiae in Western Australia will involve phenotypic characterization of the novel species, further investigation of their epidemiology and pathogenicity and an ongoing search for additional undiscovered species
Internet daemons: digital communications possessed
No full textWe’re used to talking about how tech giants like Google, Facebook, and Amazon rule the internet, but what about daemons? Ubiquitous programs that have colonized the Net’s infrastructure—as well as the devices we use to access it—daemons are little known. Fenwick McKelvey weaves together history, theory, and policy to give a full account of where daemons come from and how they influence our lives—including their role in hot-button issues like network neutrality.
Going back to Victorian times and the popular thought experiment Maxwell’s Demon, McKelvey charts how daemons evolved from concept to reality, eventually blossoming into the pandaemonium of code-based creatures that today orchestrates our internet. Digging into real-life examples like sluggish connection speeds, Comcast’s efforts to control peer-to-peer networking, and Pirate Bay’s attempts to elude daemonic control (and skirt copyright), McKelvey shows how daemons have been central to the internet, greatly influencing everyday users.
Internet Daemons asks important questions about how much control is being handed over to these automated, autonomous programs, and the consequences for transparency and oversight.
Table of Contents
Abbreviations and Technical Terms
Introduction
1. The Devil We Know: Maxwell’s Demon, Cyborg Sciences, and Flow Control
2. Possessing Infrastructure: Nonsynchronous Communication, IMPs, and Optimization
3. IMPs, OLIVERs, and Gateways: Internetworking before the Internet
4. Pandaemonium: The Internet as Daemons
5. Suffering from Buffering? Affects of Flow Control
6. The Disoptimized: The Ambiguous Tactics of the Pirate Bay
7. A Crescendo of Online Interactive Debugging? Gamers, Publics and Daemons
Conclusion
Acknowledgments
Appendix: Internet Measurement and Mediators
Notes
Bibliography
Index
Reviews
Beneath social media, beneath search, Internet Daemons reveals another layer of algorithms: deeper, burrowed into information networks. Fenwick McKelvey is the best kind of intellectual spelunker, taking us deep into the infrastructure and shining his light on these obscure but vital mechanisms. What he has delivered is a precise and provocative rethinking of how to conceive of power in and among networks.
—Tarleton Gillespie, author of Custodians of the Internet
Internet Daemons is an original and important contribution to the field of digital media studies. Fenwick McKelvey extensively maps and analyzes how daemons influence data exchanges across Internet infrastructures. This study insightfully demonstrates how daemons are transformative entities that enable particular ways of transferring information and connecting up communication, with significant social and political consequences.
—Jennifer Gabrys, author of Program Eart
Development and evaluation of DNA vaccines in chickens against a wild bird H6N2 avian influenza virus from Western Australia
No full textGenetic immunization, also known as DNA or polynucleotide immunisation, is well documented to induce broad-based immunity in various animal models of infectious and non-infectious diseases. However, the low potency of DNA vaccines has to date precluded the development of commercial vaccines. The aim of this study was to systematically investigate a number of parameters to improve the potency of DNA vaccines for use in chickens, using a low pathogenic avian influenza (LPAI) virus as a proof-of-concept for their ability to produce a humoral immune response.
The index virus used in the study was avian influenza virus A/coot/WA/2727/79 (H6N2), isolated from an apparently healthy Eurasian coot in 1979. Prior to any DNA experiments the virus was rigorously characterized. The virus strain was shown to be an H6 subtype by haemaglutination inhibition (HI) testing and as an N2 subtype by gene sequence analysis. The isolate was shown to be able to grow on MDCK cells in the absence of exogenous trypsin. It was further biologically characterized as LPAI with an intravenous pathogenicity index (IVPI) of 0.15 and a motif of 321PQAETRG328 at the cleavage site of the haemagglutinin (HA) protein. It was capable of infecting domestic chickens under experimental conditions with a low level of virus excretion via the cloaca and oropharynx following intravenous or oral and oculonasal inoculation.
The full-length HA and nucleoprotein (NP) genes of this H6N2 virus were subsequently cloned into the eukaryotic expression vector VR1012 to generate VR-HA and VR-NP constructs. Six-week-old Hy-Line chickens were intramuscularly injected with either the VR-HA or VR-NP vaccine at different dose rates, with or without lipofectin as adjuvant. Minimal or no detectable antibody was produced, as measured by HI, ELISA and Western blotting-based assay, but high titres of H6-specific HI antibodies appeared 10 days after homologous virus challenge. In contrast to the empty vector controls, there was a significant difference in HI antibody titre between pre- and post-challenge in vaccinated birds, indicating some evidence for the priming effect of the DNA vaccines. Using the frequency of virus shedding as an indicator of protection, lower doses (50 or 100 ¦Ìg per chicken) of either adjuvanted VR-HA or VR-NP vaccine significantly reduced virus shedding in oropharyngeal and cloacal swabs compared to higher doses (300 or 500 ¦Ìg per chicken ) or empty vector control chickens. Although two vaccinations with naked VR-HA alone were not sufficient to induce an effective immune response against a homologous virus challenge, further repeat vaccinations and incorporation of adjuvant did lead to the generation of low to moderate HI antibody titres in some chickens and resulted in no or reduced virus shedding after challenge.
Next, to examine the effect of expression vector, three different DNA vectors, pCI, pCI-neo and pVAX1 were used to clone the same HA gene and generate three DNA vaccine constructs. Once again, direct intramuscular injection of the three DNA constructs did not elicit measurable H6-specific HA antibody response in Hy-Line chickens but the 100 µg pCI-HA lipofectin adjuvanted vaccine group showed a significant increase in post-challenge HI titres from the naive control group, indicating that an anamnestic antibody response had been induced by the pCI-HA DNA vaccination. Compared with the controls, the three DNA constructs showed significantly reduced virus shedding in cloacal swabs post virus challenge, suggesting that the three DNA vaccines induced some level of immune response in vaccinated chickens. As with the VR-HA construct, the lower dose groups for each vaccine (50 or 100 g) were more effective at reducing virus shedding from the cloaca than the higher dose group (300 g).
To further investigate why the DNA vaccines did not elicit a measurable antibody response, the HA gene incorporating a Kozak enhancer sequence was cloned into an alternative expression vector, pCAGGS, to produce the pCAG-HAk construct. Three-week-old SPF chickens were immunized with this construct either by the intramuscular route (IM) or electroporation (EP). H6 HI antibodies were present in some chickens by 3 weeks after the first IM vaccination and 75% of the chickens vaccinated with 10, 100 or 300 µg pCAG-HAk were antibody positive by 2 weeks after the second IM vaccination. For EP immunization, 87.5% of vaccinated birds seroconverted after the first vaccination and 100% seroconverted after the second vaccination and the H6 HI antibody titres were significantly higher than for chickens vaccinated by IM inoculation. Another group was given a single dose IM vaccination with 100 µg of the pCAG-HAk construct and showed a maximum sero-conversion rate of 53.3% with a peak H6 HI titre of 27 at 5 weeks post-vaccination. This demonstrated that optimization of the expression vector and insertion of a Kozak sequence could synergistically enhance expression of the H6 HA gene and result in a measurable H6 antibody response in SPF chickens. EP was also compared with IM inoculation with the 100 g pCI-HA construct in SPF chickens, resulting in a 50% sero-conversion rate and mean HI titre of 21.3 at 2 weeks after the second vaccination by EP. By comparison, only 25% chickens had trace HI titres by IM inoculation. This indicated that EP was more efficient than IM delivery for both constructs.
A codon-optimized complete HA gene from A/coot/WA/2727/79 (H6N2) was then chemically synthesized and cloned into a pCAGGS vector to generate the pCAG-optiHAk construct. SPF chickens immunized twice with either 10 µg or 100 µg of pCAG-optHA showed 37.5% and 87.5% sero-conversion rates respectively, with a mean H6 HI tire of 21.4 and 22.6 at 3 weeks after the second immunization, but the differences were not statistically significant. There were also no significant differences in either the sero-conversion rate or the H6 HI titre between the pCAG-HAk and pCAG-optiHAk groups, suggesting that a codon-optimized HA DNA vaccine did not achieve significantly better immunogenicity than the pCAG-HAk vaccine.
In vitro expression of the developed DNA constructs in chicken-, hamster-, monkey- and human-origin cells, as measured by Western blotting and immunofluorescence testing (IFT), showed the strength of H6 HA expression in the following descending order - pCAG-optiHAk/pCAG-HAk, pCI-HAk, VR-HA, pCI-HA, pCIneo-HA and pVAX-HA. The in vivo chicken vaccinations also showed that the pCI-HA construct was more effective than the pCI-neo-HA, and that the pCAG-optiHA or pCAG-HAk constructs were better than pCI-HAk in term of reduction in virus shedding after H6N2 virus challenge. Thus, in vitro HA gene expression directly correlated with the generation of immune responses in vivo, indicating that in vitro studies can be used for pre-selection of expression plasmids prior to development of avian influenza DNA vaccines.
Lipofectin as a chemical adjuvant was shown to enhance the DNA-induced immune response but is prohibitively expensive for routine use in poultry vaccines. Thus, an experimental adjuvant for poultry DNA vaccines (Essai) and a new nanoparticle (Phema) adjuvant used for the first time in poultry were compared with conventional aluminum salts (alum) adjuvant in the present study. No HI antibody was detected in any adjuvant-vaccinated Hy-Line chickens following two immunizations. However, in comparison with the naive control group, the alum- and Phema adjuvanted pCAG-HAk groups significantly reduced the frequency of virus shedding in oropharyngeal swabs, but Essai adjuvant was not effective in augmenting the pCAG-HAk vaccine efficacy. This pilot study also emphasised that the traditional aluminum hydroxide adjuvant, either DNA binding or non-binding, may be useful as an adjuvant for enhancing DNA-induced immune responses in chickens owing to its low price and safety record.
Overall, DNA immunization with various HA-expressing constructs was shown to be variably effective in inducing immune responses in chickens. The efficacy of DNA vaccines could be synergistically improved by taking appropriate approaches. With continuing research DNA vaccines have the potential to become an important tool for disease prevention and control
An epidemiological and serological study of Rickettsia in Western Australia
No full textThe study was aimed at investigating Western Australian rickettsiae, delving deeper into the epidemiology of a recently described rickettsia, Rickettsia gravesii, and any other rickettsiae lurking in the Western Australian bush. Prior to the discovery of R. gravesii, only Rickettsia typhi was known to be endemic to Western Australia. With the addition of R. gravesii and another novel rickettsia named candidatus “Rickettsia antechini”, understanding and investigation of the potential effects these organisms may have on human and animal health becomes paramount. This research adds to the limited information available in the literature pertaining to Australian rickettsial organisms.
Serotyping of R. gravesii in mice demonstrated distinct specificity differences between R. gravesii, Rickettsia massiliae, Rickettsia australis and Rickettsia honei. R. massiliae was chosen due to R. gravesii’s very close genotypic similarities to the R. massiliae sub-group. R. australis and R. honei were chosen for the possibility of them sharing a similar geographical distribution with R. gravesii.
Collection of ectoparasites, in particular ticks, from humans and larger mammals in south-west Western Australian bush was performed to investigate the prevalence of R. gravesii in tick populations and also to investigate any other rickettsial organisms that may be present. No other rickettsiae were uncovered except for R. gravesii among ixodid ticks collected. Four tick species collected during the course of the study harboured R. gravesii with prevalences of up to 15% in Amblyomma albolimbatum (n=45), 75% in Amblyomma triguttatum (n=187), 51% in Ixodes australiensis (n=63) and 25% in Ixodes fecialis (n=8). No rickettsial DNA was detected in Haemaphysalis
longicornis, though only a single specimen was found. Transovarial transmission of R. gravesii in A. triguttatum ticks from infected females to viable larvae was observed by PCR. Detection of R. gravesii in the salivary glands, ovaries and gut suggests the potential of horizontal, transovarial and transtadial transmission.
Feral pigs (n=148) trapped within the water-catchment areas for Perth were tested for SFG rickettsiae and a prevalence of 49% was observed by microimmunofluorescence at titres of 1:128 and higher. A baseline control group made up of domestic farmed pigs (n=67) was used to determine the cut-off titre (1:128) where no non-specific antigen-antibody detectable by microscopy was observed.
Sero-prevalence in humans was also investigated. Volunteers that are exposed to ticks as a result of occupational and recreational activities were recruited over a 3 year period. Sera were collected and a questionnaire asking about participants’ bush activities was filled out. Two occupational groups were involved in the study, workers from Barrow Island (n=67) and Whiteman Park (n=12). The recreational group was made up of members of the Western Australian Rogaining Association (n=104). The control group used in the study was made up of volunteers among the staff and students of Murdoch University (n=60). Rickettsial prevalence was observed at higher levels in the occupational groups than recreational group participants; 44.8% in Barrow Island workers, 50% in Whiteman Park staff, 23.4% in rogainers and 1.7% in the control group.
Analysis of the questionnaires filled out by participants from the human sero-prevalence study demonstrated a significant association between bush activity and exposure to rickettsial organisms and their vectors. A follow-up of volunteers 10-14 months after the first serum collection from Whiteman Park staff (n=8) and among the rogainers (n=62) showed no significant rates of seroconversion or seroreversion.
Odds ratio analysis (adjusted for age and gender) based on questionnaire results and sero-prevalence of rickettsial antibodies in the different interest groups and control cohort showed that the recreational group had an odds ratio of 13.70 (95% CI=1.73-108.49). Odds ratio for the occupational group is 38.81 (95% CI=5.02-300.34). This shows a significant risk for people performing activities in the bush for extended periods of time, with occupational activities posing the highest risk, potentially due to the longer hours compared to recreational activities in general.
The presence of R. gravesii in Western Australia and the data reported in this study underscores the lack of information available to public health authorities with regards to rickettsial organisms and their hosts. Even though no official reports of debilitating spotted fever infections have been reported in WA in the literature thus far, the potential of it happening cannot be disregarded. Increased awareness of rickettsial organisms and infection need to be instilled among public health officials, doctors and veterinarians. Other animal populations and parts of Western Australia not covered in this study need to be further investigated
Sub-National Governance in England
No full textThis discussion is concerned with sub-national governance in England. It will suggest that the most striking characteristic of English sub-national governance is its fragmentary and incoherent nature, embracing regions (if they can still be said to exist), city-regions (which are subject to a number of different definitions) and local government (which itself is sub-divided from place to place into metropolitan, non-metropolitan, unitary and two-tier systems, with a range of differing political management arrangements). This pattern of sub-national provision has grown ever-more varied, subject to ad hoc initiatives, and with no overall rationale. It will be argued that - in contrast to other parts of the United Kingdom - there is currently no political incentive to address the nature of
English sub-national governance. Hence there is little likelihood that the pattern of governance depicted here will change, unless new factors are brought into play. Some of these are suggested at the end of this paper
Social media and medical professionalism: rethinking the debate and the way forward
No full textThis Perspective addresses the growing literature about online medical professionalism. Whereas some studies point to the positive potential of social media to enhance and extend medical practice, the dominant emphasis is on the risks and abuses of social media. Overall evidence regarding online medical professionalism is (as with any new area of practice) limited; however, simply accumulating more evidence, without critically checking the assumptions that frame the debate, risks reinforcing negativity toward social media. In this Perspective, the author argues that the medical community should step back and reconsider its assumptions regarding both professionalism and the digital world of social media. Toward this aim, she outlines three areas for critical rethinking by educators and students, administrators, professional associations, and researchers. First she raises some cautions regarding the current literature on using social media in medical practice, which sometimes leaps too quickly from description to prescription. Second, she discusses professionalism. Current debates about the changing nature and contexts of professionalism generally might be helpful in reconsidering notions of online medical professionalism specifically. Third, the author argues that the virtual world itself and its built-in codes deserve more critical scrutiny. She briefly summarizes new research from digital studies both to situate the wider trends more critically and to appreciate the evolving implications for medical practice. Next, the author revisits the potential benefits of social media, including their possibilities to signal new forms of professionalism. Finally, the Perspective ends with specific suggestions for further research that may help move the debate forward
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