No abstract

As professionals belong to occupational systems but also increasingly work inside organizations, new linkages between occupational and organizational domains are required, but they are difficult to develop. Occupational principles and professional standards are usually considered to be at odds with managerial and organizational control principles. This generates academic and practical dualisms. Either a return to professionalism is advocated in order to protect occupational spaces and 'rescue' professional work, or there is a move beyond professionalism in order to restrict autonomies and discipline professional work. This article argues that both stances are unsatisfactory and that new forms of organized professionalism are called for. Changing circumstances force professional services to respond to external changes that call for organizational capacities, also inside professional domains: (a) professionals develop new work preferences and seek organized work conditions; (b) professionals face new cases, which are difficult to categorize and call for well-organized multi-professional acts; (c) due to critical attention for case treatment and incidents, professionals face new risks that have to be managed. The article shows how these realities are incorporated in professional practices -albeit slowly -and it draws normative conclusions. Professionals must take organizing and managing more seriously and will have to develop organizational capacities. In addition, connective organizational standards must be established in order to strengthen the viability and legitimacy of professional services in demanding times.

Professionals in healthcare are increasingly encouraged to work together. This has acted as a catalyst for research on interprofessional collaboration. Authors suggest developing interprofessional collaboration is not just the job of managers and policy makers; it also requires active contributions of professionals. Empirical understanding of whether professionals make such contributions and if so, how and why, remains fragmented. This systematic review of 64 studies from the past 20 years shows there is considerable evidence for professionals actively contributing to interprofessional collaboration. Although the evidence is limited, we can show they do so in three distinct ways: by bridging professional, social, physical and task-related gaps, by negotiating overlaps in roles and tasks, and by creating spaces to be able to do so. Professionals from different professions seem to make different contributions. Moreover, differences exist between collaborative settings and healthcare subsectors. We conclude by proposing a research agenda to advance our understanding of these contributions in theoretical, methodological and empirical ways.

Public sectors struggle with professionalism. Classic professions are weakened, welfare state occupations professionalize, and public managers try to become professionals. This raises questions. What is professionalism? What is professional control in ambiguous occupational domains? What happens when different types of occupational control get mixed up? The first question is answered by portraying classic professionalism as "controlled content." The second question is answered by tracing a transition from "pure" to "hybrid" professionalism in domains such as health care and social work. The third question is answered by portraying present-day professionalism as "content of control" instead of controlled content.

Objective. We previously demonstrated that CD4؉,CD25؉ regulatory T (Treg) cells are present in increased numbers in the synovial fluid (SF) of rheumatoid arthritis (RA) patients and display enhanced suppressive activity as compared with their peripheral blood (PB) counterparts. Despite the presence of these immunoregulatory cells in RA, chronic inflammation persists. The purpose of the present study was to investigate whether particular proinflammatory mediators that are associated with RA could abrogate CD4؉,CD25؉ Treg-mediated suppression.Methods.

Dendritic cells (DC) play a pivotal role in the control of T cell immunity due to their ability to stimulate naive T cells and direct effector function. Murine and human DC are composed of a number of phenotypically, and probably developmentally, distinct subsets, which may play unique roles in the initiation and regulation of T cell responses. The skin is populated by at least two subsets of DC: Langerhans cells (LC), which form a contiguous network throughout the epidermis, and dermal DC. LC have classically been thought vital to initiate T cell responses to cutaneous Ags. However, recent data have highlighted the importance of dermal DC in cutaneous immunity, and the requirement for LC has become unclear. To define the relative roles of LC and dermal DC, we and others generated mouse models in which LC were specifically depleted in vivo. Unexpectedly, these studies yielded conflicting data as to the role of LC in cutaneous contact hypersensitivity (CHS). Extending our initial finding, we demonstrate that topical Ag is inefficiently transported to draining lymph nodes in the absence of LC, resulting in suboptimal priming of T cells and reduced CHS. However, dermal DC may also prime cutaneous T cell responses, suggesting redundancy between the two different skin DC subsets in this model.

Langerhans cells suppress the immune response to low-dose Leishmania major infection in part by inducing regulatory T cells.

Traditionally, professionals such as medical doctors, lawyers, and academics are protected. They work within well-defined jurisdictions, belong to specialized segments, have been granted autonomy, and have discretionary spaces. In this way, they can be socialized, trained, and supervised, case-related considerations and decisions can be substantive (instead of commercial), and decisions can be taken independently. Ideally, these decisions are authoritative and accepted, both by clients as well as society (stakeholders) who trust professional services. This ideal-typical but also ‘ideal’ imagery always had its flaws; nowadays, shortcomings are increasingly clear. ‘Protective professionalism’ is becoming outdated. Due to heterogeneity and fragmentation within professional fields, the interweaving of professional fields, and dependencies of professional actions on outside worlds, professionals can no longer isolate themselves from others and outsiders. At first sight, this leads to a ‘decline’, ‘withering away’, or ‘hollowing out’ of professionalism. Or it leads to attempts to ‘reinstall’, ‘reinvent’, or ‘return to’ professional values and spaces. In this article, we avoid such ‘all or nothing’ perspectives on changing professionalism and explore the ‘reconfiguration’ of professionalism. Professional identities and actions can be adapted and might become ‘hybrid’, ‘organized’, and ‘connected’. Professional and organizational logics might be interrelated; professionals might see organizational (or organizing) duties as belonging to their work; and professional fields might open up to outside worlds. We particularly explore connective professionalism, arguing that we need more fundamental reflections and redefinitions of what professionalism means and what professionals are. We focus on the question of how professional action can be related to others and outsiders and remain ‘knowledgeable’, ‘autonomous’, and ‘authoritative’ at the same time. This can no longer be a matter of expertise, autonomy, and authority as fixed and closed entities. These crucial dimensions of professional action become relational and processual. They have to be enacted on a continuous basis, backed by mechanisms that make professionalism knowledgeable, independent, and authoritative in the eyes of others.