The impact of using computer decision-support software in primary care nurse-led telephone triage:Interactional dilemmas and conversational consequences

Telephone triage represents one strategy to manage demand for face-to-face GP appointments in primary care. Although computer decision-support software (CDSS) is increasingly used by nurses to triage patients, little is understood about how interaction is organized in this setting. Specifically any interactional dilemmas this computer-mediated setting invokes; and how these may be consequential for communication with patients. Using conversation analytic methods we undertook a multi-modal analysis of 22 audio-recorded telephone triage nurse-caller interactions from one GP practice in England, including 10 video-recordings of nurses' use of CDSS during triage. We draw on Goffman's theoretical notion of participation frameworks to make sense of these interactions, presenting 'telling cases' of interactional dilemmas nurses faced in meeting patient's needs and accurately documenting the patient's condition within the CDSS. Our findings highlight troubles in the 'interactional workability' of telephone triage exposing difficulties faced in aligning the proximal and wider distal context that structures CDSS-mediated interactions. Patients present with diverse symptoms, understanding of triage consultations, and communication skills which nurses need to negotiate turn-by-turn with CDSS requirements. Nurses therefore need to have sophisticated communication, technological and clinical skills to ensure patients' presenting problems are accurately captured within the CDSS to determine safe triage outcomes. Dilemmas around how nurses manage and record information, and the issues of professional accountability that may ensue, raise questions about the impact of CDSS and its use in supporting nurses to deliver safe and effective patient care

Jim Allen : radical drama beyond 'days of hope'

Due to a desire to establish television as a serious medium, television drama has often been seen as a forum for writers, with names such as David Mercer, Dennis Potter and Trevor Griffiths identified by critics as the driving force, or auteur, behind the works that bear their names rather than, as in much writing about film, the director. However, while this has been so, there are also many examples of writers whose contribution to television writing has been much less celebrated, often due to their close collaboration with a high-profile director who in many critics’ view remains the most influential contributor to the final piece of work. One practitioner who arguably has failed to get the critical credit he is due is Jim Allen, a writer still perhaps best known for his work with one such high-profile director, Ken Loach

Hidden violence is a silent rape: prevention of sexual & gender-based violence against refugees & asylum seekers in Europe: a participatory approach report

From the arrival on European territory onwards, young female and male refugees, asylum seekers and undocumented migrants are extremely vulnerable to several types of gender-based violence. This results from the "Hidden Violence is a Silent Rape" Study. This book describes extensively all phases and actions in the project undertaken. We introduce the project, its aims, methods and beneficiaries in Chapter 1 with an overview of the different actions. In Chapter 2 , the results of the Community Based Participatory Research are reported. Chapter 3 and 4 reflect the proceedings and recommendations fo the Hidden Violence is a Silent Rape Seminar

Hearing the Hidden Agenda: The Ethnographic Investigation of Procedure

Laser Doppler flowmetry (LDF) is virtually the only non-invasive technique, except for other laser speckle based techniques, that enables estimation of the microcirculatory blood flow. The technique was introduced into the field of biomedical engineering in the 1970s, and a rapid evolvement followed during the 1980s with fiber based systems and improved signal analysis. The first imaging systems were presented in the beginning of the 1990s. Conventional LDF, although unique in many aspects and elegant as a method, is accompanied by a number of limitations that may have reduced the clinical impact of the technique. The analysis model published by Bonner and Nossal in 1981, which is the basis for conventional LDF, is limited to measurements given in arbitrary and relative units, unknown and non-constant measurement volume, non-linearities at increased blood tissue fractions, and a relative average velocity estimate. In this thesis a new LDF analysis method, quantitative LDF, is presented. The method is based on recent models for light-tissue interaction, comprising the current knowledge of tissue structure and optical properties, making it fundamentally different from the Bonner and Nossal model. Furthermore and most importantly, the method eliminates or highly reduces the limitations mentioned above. Central to quantitative LDF is Monte Carlo (MC) simulations of light transport in tissue models, including multiple Doppler shifts by red blood cells (RBC). MC was used in the first proof-of-concept study where the principles of the quantitative LDF were tested using plastic flow phantoms. An optically and physiologically relevant skin model suitable for MC was then developed. MC simulations of that model as well as of homogeneous tissue relevant models were used to evaluate the measurement depth and volume of conventional LDF systems. Moreover, a variance reduction technique enabling the reduction of simulation times in orders of magnitudes for imaging based MC setups was presented. The principle of the quantitative LDF method is to solve the reverse engineering problem of matching measured and calculated Doppler power spectra at two different source-detector separations. The forward problem of calculating the Doppler power spectra from a model is solved by mixing optical Doppler spectra, based on the scattering phase functions and the velocity distribution of the RBC, from various layers in the model and for various amounts of Doppler shifts. The Doppler shift distribution is calculated based on the scattering coefficient of the RBC:s and the path length distribution of the photons in the model, where the latter is given from a few basal MC simulations. When a proper spectral matching is found, via iterative model parameters updates, the absolute measurement data are given directly from the model. The concentration is given in g RBC/100 g tissue, velocities in mm/s, and perfusion in g RBC/100 g tissue × mm/s. The RBC perfusion is separated into three velocity regions, below 1 mm/s, between 1 and 10 mm/s, and above 10 mm/s. Furthermore, the measures are given for a constant output volume of a 3 mm3 half sphere, i.e. within 1.13 mm from the light emitting fiber of the measurement probe. The quantitative LDF method was used in a study on microcirculatory changes in type 2 diabetes. It was concluded that the perfusion response to a local increase in skin temperature, a response that is reduced in diabetes, is a process involving only intermediate and high flow velocities and thus relatively large vessels in the microcirculation. The increased flow in higher velocities was expected, but could not previously be demonstrated with conventional LDF. The lack of increase in low velocity flow indicates a normal metabolic demand during heating. Furthermore, a correlation between the perfusion at low and intermediate flow velocities and diabetes duration was found. Interestingly, these correlations were opposites (negative for the low velocity region and positive for the mediate velocity region). This finding is well in line with the increased shunt flow and reduced nutritive capillary flow that has previously been observed in diabetes

Analysing Leadership in Global Health Governance

Rhetoric around the need for more and better leadership is everywhere in contemporary global health governance, yet there has been little articulation of what type of leadership is required, who might play leadership roles, and in what fora leadership might be exercised. Global health governance has widely been seen as a policy space characterised by a multiplicity of (often competing) actors with no overall authority. Yet despite this things do ‘get done’, and in some cases there are impressive levels of collective action to address particular health problems. We argue that leadership provides an important lens for understanding how things do (or do not) get done in global health governance. Drawing on the existing literatures on global health governance and leadership and agency in international relations, we set out in this paper a framework for analysing leadership in global health governance. Crucially, we argue, such a framework must be specific enough to be operationalisable in terms of a program of research and at the same time broad enough to capture a wide variety of different sources, sites and forms of leadership – including the roles played by ‘hidden leaders’ who are seldom acknowledged in mainstream analyses of global health politics

The mirage in architecture design studio teaching

The idea introduced in this paper is culled from a wide spectrum of issues the authors have explored in design studio teaching over a period of two decades. One of the affirmations that it is possible to do with regard to the education in the Architecture studio, is the consensus of high expectations in this process. Nevertheless, this aspiration shared by tutors and tutees can end up by being a mirage. In the definition of the mirage the perception of what is seen, is determined by the ambience. This process is inserted in a place and specific time, the environmental conditions of this process of education and learning are, as in reality, determinant for a more real and useful perception. One of the pitfalls that hide a more collective reflection concerning the topic of learning in studio is the permanent urgency of the theoretical and/or professional agendas in architecture. This environmental condition determines the vision, reflection and the practice of the architecture. Nevertheless, this energy and attention tends to alienate the most permanent need of a reflection with regard to the daily action of learning in studio. The studio Culture is an extraordinary way of learning that has survived 275 years, and has been in discourse since then. This culture is created in a field of tension between reason, emotion and intuition, on both sides ‘Tutor/Student and Student/Tutor’. Schon (1981,83) has long identified three reasons why studio teaching could go wrong as the Stance adopted towards communication, the qualities of the `behavioural world they created for each other, and thirdly the theory in use. The importance of this statement, shift the attention from declared intentions (Learning outcomes) written in programmes and the expected standard, to the student’s and tutor own experiences. Concomitantly, studio teaching/learning process can go wrong today for a number of reasons and expectations, the syndrome of viewing architecture as art and only art, the syndrome of embedding an envisioned ambiguous sustainable agenda, and the syndrome of emphasizing the development of skills at the expense of knowledge. Clear guideline in objectives and standards are developed in the form of learning contract (Learning outcome, teaching methodology, assessment criteria, etc.). Special consideration has been given to the semantic of it. However, design process is a not a solving - programme mental method that operates as a recipe, neither a completely random exercise for the sake of the imaginary. Individuals make a difference with theirs own contributions. Tutors in the way they created the safe environment for risk taking and students which committed themselves for their own agendas. But it is by no doubt the tutor’s responsibility to stick to the learning outcomes, and develop it based on his/her own experience. Developing the outcome is therefore, a complete different story then operating his/her own hidden agenda that does not fulfil the requirements of the contract the tutor is eligible to fulfil for the student. However, a text and discourse analysis studied revealed that an objective defined as outcome in a particular learning contract, vary in its meaning and interpretation and within the relationship; Students-Students. / Students –Tutor / Tutor-Tutor / Tutor- External. Hidden values, circumstantial agendas are sometimes legitimised by the power the tutor have on his/her own studio.. The outcome of this procedure could have a negative effect on tutors and tutees. This in turn has a mal effect on motivation and self confidence, which are both crucial components of an optimal experience in learning. “It is about learning! and, it is about time”. A needed switch: it is not about performance, but Learning process, it is about accomplishing and improvement, but mainly about a deep review of our studio practice. In essence, this paper identifies illusions present in architecture studio teaching. It sheds the lights on hidden agendas within the studio and the effect these agendas have on the long term architects (architectural students) that such environments develop. The results of investigating this multilayered studio teaching approach offers important lessons to be learnt in our design studio teaching for both Tutors and Tutees

Meetings and Meeting Modeling in Smart Environments

In this paper we survey our research on smart meeting rooms and its relevance for augmented reality meeting support and virtual reality generation of meetings in real time or off-line. The research reported here forms part of the European 5th and 6th framework programme projects multi-modal meeting manager (M4) and augmented multi-party interaction (AMI). Both projects aim at building a smart meeting environment that is able to collect multimodal captures of the activities and discussions in a meeting room, with the aim to use this information as input to tools that allow real-time support, browsing, retrieval and summarization of meetings. Our aim is to research (semantic) representations of what takes place during meetings in order to allow generation, e.g. in virtual reality, of meeting activities (discussions, presentations, voting, etc.). Being able to do so also allows us to look at tools that provide support during a meeting and at tools that allow those not able to be physically present during a meeting to take part in a virtual way. This may lead to situations where the differences between real meeting participants, human-controlled virtual participants and (semi-) autonomous virtual participants disappear