“Appropriateness” in foreign language acquisition and use: some theoretical, methodological and ethical considerations

In this contribution, I focus on the concept of “appropriateness” in the usage, the learning and the teaching of foreign languages. Using a participant-based emic perspective, I investigate multilinguals’ perceptions of appropriateness in their foreign languages. Referring to the existing literature, and using previously unpublished material collected through a web questionnaire (Dewaele and Pavlenko 2001–2003), I will show that multilinguals develop their judgements of appropriateness, a crucial aspect of sociopragmatic and sociocultural competence, as part of their socialisation in a new language/culture. However, their ability to judge appropriateness accurately does not imply that they will always act “appropriately”. Indeed, the presence of conflicting norms in their other languages may contribute to conscious or unconscious divergence from the “appropriate” norm in a particular language. Some implications for foreign language teaching will be considered

Rhetoric appropriateness in view of contemporary media communication and journalism

In the article, I present deliberations on the theme of the rhetorical category of appropriateness in the context of its original sources and contemporary media practice. Upon presenting the theory formed in line with the understanding developed in antiquity, I accept as a functional division for the purpose of the discussion the prépon/aptum (decorum) division, i.e. into the historical and literary notion, and appropriateness as a general principle of rhetorical communication to subsequently present a discussion organised on the basis of three theses: 1) The major factor defining the rhetorical model of appropriateness is the mass nature of media communication in the presence of freedom of speech, a democratic system of authority, and economic liberalism; 2) The on-going presence of disputes regarding the appropriateness of public behaviour is a manifestation not as much of its norm-building potential as of the functional approach – of senders, participants of the reported events, and message receivers – towards media communication, which inevitably results in a distinct over-representation of messages the content of which applies to the manifestations of inappropriateness; 3) The appropriateness principle is associated with the difficult task for the receiver to understand her/his role in the world of the media, and its various consequences. I posit that the principle does, in fact, indicate certain criteria which can become a basis for classifying specific messages as those which do or do not meet the requirements of rhetorical tact, yet it does not enable one to define an a priori applicable borderline between appropriateness and inappropriateness in contemporary media. Therefore, it seems that the settlement of any doubts and dilemmas associated with appropriateness ought to be founded on a good upbringing-based social stance and a system of values, i.e. maturity achieved regardless of the influence of the media

Can guidelines improve referral to elective surgical specialties for adults? A systematic review

Aim To assess effectiveness of guidelines for referral for elective surgical assessment. Method Systematic review with descriptive synthesis. Data sources Medline, EMBASE, CINAHL and Cochrane database up to 2008. Hand searches of journals and websites. Selection of studies Studies evaluated guidelines for referral from primary to secondary care, for elective surgical assessment for adults. Outcome measures Appropriateness of referral (usually measured as guideline compliance) including clinical appropriateness, appropriateness of destination and of pre-referral management (eg, diagnostic investigations), general practitioner knowledge of referral appropriateness, referral rates, health outcomes and costs. Results 24 eligible studies (5 randomised control trials, 6 cohort, 13 case series) included guidelines from UK, Europe, Canada and the USA for referral for musculoskeletal, urological, ENT, gynaecology, general surgical and ophthalmological conditions. Interventions varied from complex (“one-stop shops”) to simple guidelines. Four randomized control trials reported increases in appropriateness of pre-referral care (diagnostic investigations and treatment). No evidence was found for effects on practitioner knowledge. Mixed evidence was reported on rates of referral and costs (rates and costs increased, decreased or stayed the same). Two studies reported on health outcomes finding no change. Conclusions Guidelines for elective surgical referral can improve appropriateness of care by improving prereferral investigation and treatment, but there is no strong evidence in favour of other beneficial effects

Nurse-friendly nutritional screening for patient benefit

Screening for undernutrition is highly important and may reduce morbidity and mortality. The Minimal Eating Observation and Nutrition Form – Version II (MEONF-II) is a nutritional screening tool specifically developed for use by nurses. Here, we describe the translation, performance and appropriateness of the MEONF-II for the UK. Following translation from Swedish to British English, the user-friendliness and appropriateness of the British MEONF-II was tested by 29 registered nurses and final year student nurses on 266 hospital inpatients. The new British MEONF-II was perceived as highly user-friendly and appropriate. They found the MEONF-II to compare favourably to other similar tools in terms of preference, usefulness and helpfulness in providing good nutritional care. Dependency in activities and poorer subjective health were associated with a higher undernutrition risk. These findings support the appropriateness of the British MEONF-II version and suggest it may act as a user-friendly facilitator towards good nutritional nursing care

Appropriateness of referrals for single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) in a developing community: A comparison between 2005 and 2009 versions of ACCF/ASNC appropriateness criteria

Appropriateness of referrals for myocardial perfusion imaging (MPI) in developing countries has not been extensively studied. Our study was conducted to describe the ordering practices of physicians and appropriateness of MPI referrals in Iran. We prospectively applied 2005 and 2009 versions of the Appropriateness Use Criteria published by the American College of Cardiology Foundation (ACCF) and the American Society of Nuclear Cardiology (ASNC) to 291 consecutive patients (age 55.3 ± 10.3 years) who underwent SPECT-MPI. For this purpose, we convened a panel, consisting of two academic cardiologists, one academic clinician in internal medicine, and one academic clinician in nuclear medicine. The panelists were invited for a face-to-face meeting to judge appropriateness of SPECT-MPI and independently assign a specific indication (scenario), whenever possible, for each case in accordance with ACCF/ASNC appropriateness scenarios. Based on the 2005 ACCF/ASNC criteria, SPECT-MPI studies were judged appropriate for 211 (72.5%), uncertain for 36 (12.4%), inappropriate for 32 (11.0%), and unclassifiable for 12 (4.1%) referrals. The same figures based on the 2009 version were 219 (75.3%), 15 (5.2%), 49 (16.8%), and 8 (2.7%) patients, respectively. Overall agreement between the 2005 and 2009 versions was good (κ 0.63). Lack of chest pain and age below 60 years were significant indicators increasing the likelihood of inappropriate referrals by 2.9-3.4 fold. Absence of diabetes mellitus and hypertension, a normal lipid profile, lack of a past history of myocardial infarction or cardiovascular interventions (CABGs or PCI), as well as lack of application and exercise ECG stress test as the gate keeper (keeping abnormal ETT or inability of the patient to perform exercise as the appropriate indication for SPECT-MPI referral) were significant indicators, decreasing the odds of appropriate referrals. Generally a higher percentage of referrals with inappropriate indications had normal MPI. Our study provides an evidence for the fact that SPECT-MPI ordering practices in our developing community largely parallel the ACCF/ASNC recommendations. The implementation of appropriateness criteria is feasible in clinical settings and might provide an alternative to utilization management. © 2011 American Society of Nuclear Cardiology

Private Accreditation as a Substitute for Direct Government Regulation in Public Health Insurance Programs: When Is It Appropriate?

The appropriateness of the use of private accreditation in regulating and defining the quality of health care providers under government health insurance programs is examined. The characteristics of health care institutions and the patients they serve are important considerations

Underuse of coronary revascularization procedures in patients considered appropriate candidates for revascularization.

Background: Ratings by an expert panel of the appropriateness of treatments may offer better guidance for clinical practice than the variable decisions of individual clinicians, yet there have been no prospective studies of clinical outcomes. We compared the clinical outcomes of patients treated medically after angiography with those of patients who underwent revascularization, within groups defined by ratings of the degree of appropriateness of revascularization in varying clinical circumstances.Methods: This was a prospective study of consecutive patients undergoing coronary angiography at three London hospitals. Before patients were recruited, a nine-member expert panel rated the appropriateness of percutaneous transluminal coronary angioplasty (PTCA) and coronary-artery bypass grafting (CABG) on a nine-point scale (with 1 denoting highly inappropriate and 9 denoting highly appropriate) for specific clinical indications. These ratings were then applied to a population of patients with coronary artery disease. However, the patients were treated without regard to the ratings. A total of 2552 patients were followed for a median of 30 months after angiography.Results: Of 908 patients with indications for which PTCA was rated appropriate (score, 7 to 9), 34 percent were treated medically; these patients were more likely to have angina at follow-up than those who underwent PTCA (odds ratio, 1.97; 95 percent confidence interval, 1.29 to 3.00). Of 1353 patients with indications for which CABG was considered appropriate, 26 percent were treated medically; they were more likely than those who underwent CABG to die or have a nonfatal myocardial infarction - the composite primary outcome (hazard ratio, 4.08; 95 percent confidence interval, 2.82 to 5.93) - and to have angina (odds ratio, 3.03; 95 percent confidence interval, 2.08 to 4.42). Furthermore, there was a graded relation between rating and outcome over the entire scale of appropriateness (P for linear trend = 0.002).Conclusions: On the basis of the ratings of the expert panel, we identified substantial underuse of coronary revascularization among patients who were considered appropriate candidates for these procedures. Underuse was associated with adverse clinical outcomes. (N Engl J Med 2001;344:645-54.) Copyright (C) 2001 Massachusetts Medical Society

The importance of task appropriateness in computer‐supported collaborative learning

Collaborative learning activities can be beneficial for exchanging ideas, sharing experiences, and developing shared understanding. It is our view that the task given to the student is central to the success or otherwise of the learning experience. In this paper, we discuss the need for the adaptation of traditional face‐to‐face tasks when these are incorporated in computer‐supported collaborative learning (CSCL) environments. We focus on critical issues in relation to the implementation of CSCL tasks including: the appropriateness of the medium for the task, the role of individuals, the volume of work involved, the time allocated for tasks or sub‐tasks, and, the assessment procedures