Reducing inappropriate antibiotics prescribing: The role of online commentary on physical examination findings

Objective: This study investigates the relationship of ‘online commentary’(contemporaneous physician comments about physical examination [PE] findings) with (i) parent questioning of the treatment recommendation and (ii) inappropriate antibiotic prescribing. Methods: A nested cross-sectional study of 522 encounters motivated by upper respiratory symptoms in 27 California pediatric practices (38 pediatricians). Physicians completed a post-visit survey regarding physical examination findings, diagnosis, treatment, and whether they perceived the parent as expecting an antibiotic. Taped encounters were coded for ‘problem’ online commentary (PE findings discussed as significant or clearly abnormal) and ‘no problem’ online commentary (PE findings discussed reassuringly as normal or insignificant). Results: Online commentary during the PE occurred in 73% of visits with viral diagnoses (n = 261). Compared to similar cases with ‘no problem’ online commentary, ‘problem’ comments were associated with a 13% greater probability of parents uestioning a non-antibiotic treatment plan (95% CI 0-26%, p = .05,) and a 27% (95% CI: 2-52%, p < .05) greater probability of an inappropriate antibiotic prescription. Conclusion: With viral illnesses, problematic online comments are associated with more pediatrician-parent conflict over non-antibiotic treatment recommendations. This may increase inappropriate antibiotic prescribing. Practice implications: In viral cases, physicians should consider avoiding the use of problematic online commentary

Displays and claims of understanding in conversation by people with aphasia

Background: There is scope for additional research into the specific linguistic and sequential structures used in speech and language therapist (SLT)-led therapeutic conversations with people with aphasia (PWA). Whilst there is some evidence that SLTs use different conversational strategies than the partners of PWA, research to date has focussed mainly on measuring the effects of conversation-based therapies—not on analysing therapeutic conversations taking place between SLTs and PWA. Aims: This paper presents an analysis of the use of oh-prefacing by some PWA during therapeutic supported conversations with SLTs. Methods & Procedures: Normally occurring therapeutic conversations between SLTs and PWA after stroke were qualitatively analysed using Conversation Analysis. Interactions with five PWA were video-recorded, involving three different specialist stroke SLTs. Outcomes & Results: The analysis revealed a difference in the way some PWA use turns that display understanding (e.g., oh right) versus those that continue the conversation, merely claiming understanding (e.g., right). This use of oh-prefacing is similar to that described in the literature on typical conversations. In our data, SLTs are shown to treat oh-prefaced turns differently from non-oh-prefaced turns, by pursuing the topic in the latter, and progressing on to a new topic in the former. Conclusions: At least some PWA use oh-prefacing in the same way as non-language-impaired adults to display understanding of information versus merely claiming to understand. The SLTs in our data are shown to treat non-oh-prefaced turns as mere claims of understanding by providing the PWA with additional information, using supported conversation techniques, and pursuing additional same-topic talk, whereas oh-prefaced turns are treated as displays of understanding by being confirmed, and leading to changes of topic. This study is a first step in providing SLTs with a clearer understanding of the ways in which they are assessing the understanding of PWA, which may in turn help them better support non-therapy staff

Memory in Interaction: An Analysis of Repeat Calls to a Home Birth Helpline

Drawing on a corpus of 80 calls to a Home Birth helpline, we use conversation analysis to analyze how callers and call takers display to one another that they are talking for a second or subsequent time. We focus in particular on the role of memory in these interactions. We show how caller and call taker are oriented to remembering at the beginning of calls as displayed in what we call the recognition-solicit pre-sequence, how participants are oriented to issues of forgetting and remembering during the course of repeat calls, and how remembering and forgetting are made manifest in interaction. Our analysis shows how the human capacity to remember and propensity to forget have reverberating implications in calling for help

Corrigendum: Initiating Change of People With Criminal Justice Involvement Through Participation in a Drama Project: An Exploratory Study

Author proofs are not yet ready for revisio

Paraphrases and summaries: A means of clarification or a vehicle for articulating a preferred version of student accounts?

The use of group discussions as a means to facilitate learning from experiences is well documented in adventure education literature. Priest and Naismith (1993) assert that the use of the circular discussion method, where the leader poses questions to the participants, is the most common form of facilitation in adventure education. This paper draws on transcripts of facilitation sessions to argue that the widely advocated practice of leader summaries or paraphrases of student responses in these sessions functions as a potential mechanism to control and sponsor particular knowledge(s). Using transcripts from recorded facilitation sessions the analysis focuses on how the leader paraphrases the students’ responses and how these paraphrases or ‘formulations’ function to modify or exclude particular aspects of the students’ responses. I assert that paraphrasing is not simply a neutral activity that merely functions to clarify a student response, it is a subtle means by which the leader of the session can, often inadvertently or unknowingly, alter the student’s reply with the consequence of favouring particular knowledge(s). Revealing the subtle work that leader paraphrases perform is of importance for educators who claim to provide genuine opportunities for students to learn from their experience

Negotiation of entitlement in proposal sequences

Meetings are complex institutional events at which participants recurrently negotiate institutional roles, which are oriented to, renegotiated, and sometimes challenged. With a view to gaining further understanding of the ongoing negotiation of roles at meetings, this article examines one specific recurring feature of meetings: the act of proposing future action. Based on microanalysis of video recordings of two-party strategy meetings, the study shows that participants orient to at least two aspects when making proposals: 1) the acceptance or rejection of the proposal; and 2) questions of entitlement: who is entitled to launch a proposal, and who is entitled to accept or reject it? The study argues that there is a close interrelation between questions of entitlement, aligning and affiliating moves, and the negotiation of institutional roles. The multimodal analysis also reveals the use of various embodied practices by participants for the local negotiation of entitlement and institutional roles

What explains the uneven take-up of ISO 14001 at the global level?: a panel-data analysis

Since its release in the mid-1990s, close to 37 000 facilities have been certified to ISO 14001, the international voluntary standard for environmental management systems. Yet, despite claims that the standard can be readily adapted to very different corporate and geographic settings, its take-up has been highly geographically variable. This paper contributes to a growing body of work concerned with explaining the uneven diffusion of ISO 14001 at the global level. Drawing from the existing theoretical and empirical literature we develop a series of hypotheses about how various economic, market, and regulatory factors influence the national count of ISO 14001 certifications. These hypotheses are then tested using econometric estimation techniques with data for a panel of 142 developed and developing countries. We find that per capita ISO 14001 counts are positively correlated with income per capita, stock of foreign direct investment, exports of goods and services to Europe and Japan, and pressure from civil society. Conversely, productivity and levels of state intervention are negatively correlated. The paper finishes by offering a number of recommendations to policymakers concerned with accelerating the diffusion of voluntary environmental standards

Exploring Pompeii: discovering hospitality through research synergy

Hospitality research continues to broaden through an ever-increasing dialogue and alignment with a greater number of academic disciplines. This paper demonstrates how an enhanced understanding of hospitality can be achieved through synergy between archaeology, the classics and sociology. It focuses on classical Roman life, in particular Pompeii, to illustrate the potential for research synergy and collaboration, to advance the debate on hospitality research and to encourage divergence in research approaches. It demonstrates evidence of commercial hospitality activities through the excavation hotels, bars and taverns, restaurants and fast food sites. The paper also provides an example of the benefits to be gained from multidisciplinary analysis of hospitality and tourism

Vorticity alignment results for the three-dimensional Euler and Navier-Stokes equations

We address the problem in Navier-Stokes isotropic turbulence of why the vorticity accumulates on thin sets such as quasi-one-dimensional tubes and quasi-two-dimensional sheets. Taking our motivation from the work of Ashurst, Kerstein, Kerr and Gibson, who observed that the vorticity vector {\boldmath\omega} aligns with the intermediate eigenvector of the strain matrix $S$, we study this problem in the context of both the three-dimensional Euler and Navier-Stokes equations using the variables \alpha = \hat{{\boldmath\xi}}\cdot S\hat{{\boldmath\xi}} and {\boldmath\chi} = \hat{{\boldmath\xi}}\times S\hat{{\boldmath\xi}} where \hat{{\boldmath\xi}} = {\boldmath\omega}/\omega. This introduces the dynamic angle $\phi (x,t) = \arctan(\frac{\chi}{\alpha})$, which lies between {\boldmath\omega} and S{\boldmath\omega}. For the Euler equations a closed set of differential equations for $\alpha$ and {\boldmath\chi} is derived in terms of the Hessian matrix of the pressure $P = \{p_{,ij}\}$. For the Navier-Stokes equations, the Burgers vortex and shear layer solutions turn out to be the Lagrangian fixed point solutions of the equivalent (\alpha,{\boldmath\chi}) equations with a corresponding angle $\phi = 0$. Under certain assumptions for more general flows it is shown that there is an attracting fixed point of the (\alpha,\bchi) equations which corresponds to positive vortex stretching and for which the cosine of the corresponding angle is close to unity. This indicates that near alignment is an attracting state of the system and is consistent with the formation of Burgers-like structures.Comment: To appear in Nonlinearity Nov. 199