'Managing scarcity'- a qualitative study on volunteer-based healthcare for chronically ill, uninsured migrants in Berlin, Germany

OBJECTIVES: In Germany, healthcare for people lacking legal residency status and European Union citizens without health insurance is often provided by non-governmental organisations. Scientific studies assessing the situation of the patients with chronic diseases in this context are scarce. We aimed to characterise medical care for chronically ill migrants without health insurance and outline its possibilities and limitations from the treating physicians' perspective. DESIGN: Qualitative semi-structured interviews; qualitative content analysis. SETTING: Organisations and facilities providing healthcare for uninsured migrants: free clinics, medical practices and public health services. PARTICIPANTS: 14 physicians working regularly in healthcare for uninsured migrants. RESULTS: Delayed contact to the healthcare system was frequently addressed in the interviews. Care was described as constrained by a scarcity of resources that often impedes adequate treatment for many conditions, most pronounced in the case of oncological diseases or chronic viral infections (HIV, hepatitis). For other chronic conditions such as cardiovascular diseases or diabetes, some diagnostics and basic medications were described as partially available, while management of complications or rehabilitative measures are frequently unfeasible. For the patients with mental health problems, attainability of psychotherapeutic treatment is reported as severely limited. Care is predominantly described as fragmented with limitations to information flow and continuity. Which level of care a patient receives appears to depend markedly on the respective non-governmental organisation and the individual commitment, subjective decisions and personal connections of the treating physician. CONCLUSIONS: Restrictions in medical care for uninsured migrants have even more impact on chronically ill patients. Volunteer-based care often constitutes an inadequate compensation for regular access to the healthcare system, as it is strongly influenced by the limitation of its resources and its arbitrariness

Trauma-centred identity and autobiographical memory in posttraumatic stress disorder (PTSD)

Posttraumatic stress disorder is a prevalent and disabling disorder that can occur following experience of trauma. Contemporary clinical models of PTSD assert that memories for trauma are poorly elaborated and inadequately integrated into autobiographical memory (AM). Recent work of cognitive psychologists suggests, however, that trauma memories remain highly accessible and form a cognitive reference point for the organisation of autobiographical knowledge, leading to the development of trauma-centred identity. The current study sought to explore further the relationships between PTSD symptoms, the phenomenological properties of AM for trauma, and trauma-centred identity. A community sample of 82 participants (male, n = 24; mean age = 36.10 years, SD = 10.82) was recruited. A within-subjects, correlational design was employed. Participants completed online questionnaires relating to PTSD symptoms, the phenomenological properties of a trauma memory and negative memory, and centrality of event to identity. Participants also provided written narratives of both a trauma and negative event. Differences between traumatic and negative memories, and relationships between trauma memory features and both PTSD and centrality were assessed using computerised textual analysis and self-report measures. Results indicated that trauma memories were significantly less coherent, less detailed, and contained fewer spatial references but more cognitive process terms than negative memories. PTSD symptoms correlated significantly with fragmentation of trauma memories and with use of the present tense in trauma narratives. A sense of reliving when remembering trauma and use of present tense were both significantly associated with centrality of event. Results were thus primarily consistent with contemporary clinical theories of PTSD with certain 3 elements of the centrality position also demonstrated. Findings were discussed in relation to the study’s methodological limitations, including difficulties encountered through LIWC’s lack of consideration of context when counting lexical items. Theoretical implications regarding the measurement of constructs such as fragmentation were outlined. Findings supported current treatment guidelines

Digital Preservation, Archival Science and Methodological Foundations for Digital Libraries

Digital libraries, whether commercial, public or personal, lie at the heart of the information society. Yet, research into their long‐term viability and the meaningful accessibility of their contents remains in its infancy. In general, as we have pointed out elsewhere, ‘after more than twenty years of research in digital curation and preservation the actual theories, methods and technologies that can either foster or ensure digital longevity remain startlingly limited.’ Research led by DigitalPreservationEurope (DPE) and the Digital Preservation Cluster of DELOS has allowed us to refine the key research challenges – theoretical, methodological and technological – that need attention by researchers in digital libraries during the coming five to ten years, if we are to ensure that the materials held in our emerging digital libraries are to remain sustainable, authentic, accessible and understandable over time. Building on this work and taking the theoretical framework of archival science as bedrock, this paper investigates digital preservation and its foundational role if digital libraries are to have long‐term viability at the centre of the global information society.

Dismembering organisation: The coordination of algorithmic work in healthcare

Algorithms are increasingly being adopted in healthcare settings, promising increased safety, productivity and efficiency. The growing sociological literature on algorithms in healthcare shares an assumption that algorithms are introduced to ‘support’ decisions within an interactive order that is predominantly human-oriented. We present a different argument, calling attention to the manner in which organisations can end up introducing a non-negotiable disjuncture between human initiated care work and work that supports algorithms, which we call algorithmic work. Drawing on an ethnographic study, we describe how two hospitals in England implemented an Acute Kidney Injury (AKI) algorithm and we analyse ‘interruptions’ to the algorithm’s expected performance. When the coordination of algorithmic work occludes care work, we find a ‘dismembered’ organisation that is algorithmically-oriented rather than human-oriented. In our discussion, we examine the consequences of coordinating human and non-human work in each hospital and conclude by urging sociologists of organisation to attend to the importance of the formal in algorithmic work. As the use of algorithms becomes widespread, our analysis provides insight into how organisations outside of healthcare can also end up severing tasks from human experience when algorithmic automation is introduced

Hidden in full sight: kinship, science and the law in the aftermath of the Srebrenica genocide

Terms such as “relationship testing,” “familial searching” and “kinship analysis” figure prominently in professional practices of disaster victim identification (DVI). However, despite the dependence of those identification technologies on DNA samples from people who might be related to the dead and despite also the prominence of the notion of “relatedness” as a device for identifying the dead, the concepts of “relatedness” and “kinship” remain elusive both in practice and in analyses of the social and ethical aspects of DVI by DNA; they are hidden in full sight. In this article, we wish to bring kinship more to the fore. We achieve this through a case study of a setting where bio-legal framings dominate, that is, in the trial at the International Criminal Tribunal for the former Yugoslavia (ICTY) of Radovan Karadžić for the Srebrenica genocide in 1995. DNA samples from the families of those massacred in Srebrenica were vital for the identification of individual victims but are now also utilized as “evidence” by both the prosecution and the defense. By viewing practices of science (“evidence” and “identification”) and legal practices (“justice,” “prosecution” and “defence”) through the lens of kinship studies, we will present some alternative and complementary framings for the social accomplishment of ‘relatedness’

Phenomenology of Intrusive Trauma Memory in Psychosis and its Relationship with Hallucinations and Persecutory Beliefs

This thesis is presented in three parts, and is focused on developing the theoretical understanding of the role of trauma memory in psychosis. The systematic literature review investigates the relationship between psychosis symptom severity and re-experiencing of traumatic memories. 13 studies published since 1980 were identified as meeting the review criteria. Overall, findings suggest that people with more severe hallucinations and paranoia experiences report more re-experiencing of traumatic memories. However, this relationship was not seen when looking at more global symptoms of psychosis. The role of trauma memory in the development and maintenance of psychosis therefore warrants further investigation. The empirical paper (a joint project with Carr (2016), “Developing a brief trauma screening tool for use in psychosis”) explores the phenomenology of intrusive trauma memory in psychosis and investigates its relationship to hallucinations and persecutory beliefs. In line with theoretical accounts (Steel et al, 2005), it was hypothesised that increased memory fragmentation would be associated with more severe hallucinations. Twenty participants described an intrusive trauma memory and its phenomenological characteristics. Findings indicated that subjective fragmentation of intrusive memories was associated with more severe hallucinations but not persecutory beliefs, although the relationship between the two ratings of objective memory fragmentation and hallucinations were equivocal, with a negative correlation for one rating and no relationship for the other. Participants with psychosis also reported more frequent and vivid intrusions, with an increased sense of reliving, compared to non-clinical sample. The study suggests a potential role for memory fragmentation in hallucinatory experience, although the complexities of assessing memory characteristics are highlighted. The critical appraisal focuses on the experience of the research process, which includes reflections on methodological issues in memory assessment, challenges to recruitment in psychosis services and the role of the research process in the author’s professional development

Implementing a knowledge management system within an NHS hospital:a case study exploring the roll-out of an Electronic Patient Record (EPR)

This research aims to contribute to understanding the implementation of knowledge management systems (KMS) in the field of health through a case study, leading to theory building and theory extension. We use the concept of the business process approach to knowledge management as a theoretical lens to analyse and explore how a large teaching hospital developed, executed and practically implemented a KMS. A qualitative study was conducted over a 2.5 year period with data collected from semi-structured interviews with eight members of the strategic management team, 12 clinical users and 20 patients in addition to non-participant observation of meetings and documents. The theoretical propositions strategy was used as the overarching approach for data analysis. Our case study provides evidence that true patient centred approaches to supporting care delivery with a KMS benefit from process thinking at both the planning and implementation stages, and an emphasis on the knowledge demands resulting from: the activities along the care pathways; where cross-overs in care occur; and knowledge sharing for the integration of care. The findings also suggest that despite the theoretical awareness of KMS implementation methodologies, the actual execution of such systems requires practice and learning. Flexible, fluid approaches through rehearsal are important and communications strategies should focus heavily on transparency incorporating both structured and unstructured communication methods

Big data analytics:Computational intelligence techniques and application areas

Big Data has significant impact in developing functional smart cities and supporting modern societies. In this paper, we investigate the importance of Big Data in modern life and economy, and discuss challenges arising from Big Data utilization. Different computational intelligence techniques have been considered as tools for Big Data analytics. We also explore the powerful combination of Big Data and Computational Intelligence (CI) and identify a number of areas, where novel applications in real world smart city problems can be developed by utilizing these powerful tools and techniques. We present a case study for intelligent transportation in the context of a smart city, and a novel data modelling methodology based on a biologically inspired universal generative modelling approach called Hierarchical Spatial-Temporal State Machine (HSTSM). We further discuss various implications of policy, protection, valuation and commercialization related to Big Data, its applications and deployment

Palaeodemography and palaeopathology in early mediaeval Säben-Sabiona, South Tyrol, Italy

The early mediaeval period was characterised by continuous variations of frontiers, leadership, and consequently also socio-economic instabilities. Located in the central Alps, along one of the most important passageways between Germany and Italy, the episcopal see of Säben-Sabiona played a central role and was particularly affected by these fluctuations. The site is located on a mount in the Eisack-Isarco valley, which, starting from the 7th century A.D. was occupied by Germanic groups, such as Bavarians and Longobards. Three archaeological excavations uncovered a palaeochristian church, dated to the 5th-8th centuries A.D., featuring between 366 and 370 graves. Due to the quantity of burials and wealth of some of these, Säben-Sabiona is regarded as the largest early mediaeval burial site in South Tyrol and the only one evidencing an admixture of autochthonous, i.e., local Romans, and allochthonous groups, i.e., Bavarians and/or Longobards. Up to date, only detailed historical and archaeological investigations concerning the palaeochristian church were accomplished, yet the anthropological analysis of these remains was still outstanding. As the first anthropological study ever performed on this site, the present thesis focused on establishing the palaeodemographic composition as well as the living and health conditions of the individuals buried within and surrounding the palaeochristian church. Due to the unavailability of skeletal remains from earlier archaeological investigations and the limited archaeological and historical contextualisation of these, the present anthropological analysis focused on the subpopulation addressed in the publication by Bierbrauer and Nothdurfter (2015). A traditional osteological approach to endeavour this aim was predefined, after consulting with my supervisors. A full anthropological analysis, i.e., consisting of the biological and pathological profile of the human skeletal remains, recovered during the last excavation, i.e., 185 graves, was performed. The biological profile included the estimation of the minimum number of individuals, sex, age at death, stature, body weight and robusticity. These data were used to perform further palaeodemographic analyses, such as estimation of the masculinity index, the probability of dying at a certain age, the average life expectancy at different ages and population size. Additionally, an extensive palaeopathological examination was conducted, concentrating on dental alterations yielding information about diet, dental and skeletal conditions linked to the exposure to chronic stress as well as skeletal lesions used to infer information about activity and lifestyle. Due to the nature of the site and in consideration of the archaeological and historical evidence, identifying Säben-Sabiona as a burial ground of the ruling classes, which appears to have been stratified by rank as suggested by the variations of burial context and location, the sample was subdivided into an elite (n=107), i.e., graves within the church, inside a crypt and/or featuring wealthy material culture, and a non-elite group (n=78), i.e., burials outside the church with poor or no funerary goods. The examined graves featured a minimum number of 226 individuals, which consisted of 94 males, 39 females, 54 subadults and 39 adults of not determinable sex. Based on the previously mentioned classification, 133 individuals were assigned to the elite group and 93 individuals to the non-elite group. In both subsamples, males were overrepresented. The lack of female burials for both subgroups further enforced the notion of a selective burial ground, whereby females appeared to have been interred elsewhere. Both subsamples displayed adaptations to the alpine environment, i.e., high levels of bone robusticity, and palaeopathological profiles consistent with a macronutrient rich diet, fairly frequent exposure to chronic stress and extremely physically demanding lifestyles. Even though osteological disorders were found in similar frequencies in both subgroups, thus, suggesting that social stratification was low, for almost all conditions the non-elite sample was more commonly and/or more severely affected. This thesis provided novel insights into the demographic structure, diet and health of populations associated with early mediaeval Säben-Sabiona. Unique information about the composition of the Säben-Sabiona cemetery, which elucidates socio-cultural values and practices of populations residing in early mediaeval South Tyrol, was generated. The detailed palaeopathological analysis informs about health and living conditions of the people buried at this important site, in consideration of their social stratification. The combination of a thorough palaeodemographic and palaeopathological investigation in conjunction with an evaluation of funerary customs and materials provides a holistic interpretation, not only of the individual life history, but also the population as a whole. Thus, improves the contextualisation of the palaeochristian church at Säben-Sabiona and aids the understanding of early mediaeval social stratification. As for South Tyrol, standardised anthropological research concerning osteological samples is still in its very early stages, the present thesis provides a first step in supplying data, which can be used to establish normal osteological parameters, thus provides a solid foundation for future research

Approaching ancient disease from a One Health perspective: Interdisciplinary review for the investigation of zoonotic brucellosis

Today, brucellosis is the most common global bacterial zoonosis, bringing with it a range of significant health and economic consequences, yet it is rarely identified from the archaeological record. Detection and understanding of past zoonoses could be improved by triangulating evidence and proxies generated through different approaches. The complex socio‐ecological systems that support zoonoses involve humans, animals, and pathogens interacting within specific environmental and cultural contexts, and as such there is a diversity of potential datasets that can be targeted. To capture this, in this paper we consider how to approach the study of zoonotic brucellosis in the past from a One Health perspective, one which explicitly acknowledges the health link between people, animals and environments (both physical and cultural). One Health research is explicitly interdisciplinary and conceptually moves away from an anthropocentric approach, allowing the component parts to be considered in holistic and integrated ways to deliver more comprehensive understanding. To this end, in this paper we review the methods, selected evidence and potential for past brucellosis identification and understanding, focussing on osteological markers in humans and animals, historical, biomolecular and epidemiological approaches. We also present an agenda and potential for future research