Situationally-sensitive knowledge translation and relational decision making in hyperacute stroke: a qualitive study

Stroke is a leading cause of disability. Early treatment of acute ischaemic stroke with rtPA reduces the risk of longer term dependency but carries an increased risk of causing immediate bleeding complications. To understand the challenges of knowledge translation and decision making about treatment with rtPA in hyperacute stroke and hence to inform development of appropriate decision support we interviewed patients, their family and health professionals. The emergency setting and the symptomatic effects of hyper-acute stroke shaped the form, content and manner of knowledge translation to support decision making. Decision making about rtPA in hyperacute stroke presented three conundrums for patients, family and clinicians. 1) How to allow time for reflection in a severely time-limited setting. 2) How to facilitate knowledge translation regarding important treatment risks and benefits when patient and family capacity is blunted by the effects and shock of stroke. 3) How to ensure patient and family views are taken into account when the situation produces reliance on the expertise of clinicians. Strategies adopted to meet these conundrums were fourfold: face to face communication; shaping decisions; incremental provision of information; and communication tailored to the individual patient. Relational forms of interaction were understood to engender trust and allay anxiety. Shaping decisions with patients was understood as an expression of confidence by clinicians that helped alleviate anxiety and offered hope and reassurance to patients and their family experiencing the shock of the stroke event. Neutral presentations of information and treatment options promoted uncertainty and contributed to anxiety. ‘Drip feeding’ information created moments for reflection: clinicians literally made time. Tailoring information to the particular patient and family situation allowed clinicians to account for social and emotional contexts. The principal responses to the challenges of decision making about rtPA in hyperacute stroke were relational decision support and situationally-sensitive knowledge translation

Leisure, Popular Culture and Memory: The Invention of Dark Age Britain, Wales, England, and Middle-earth in the songs of Led Zeppelin

In the period of high modernity, and in the process of establishing the imperial nation-state of Great Britain, historians, archaeologists and enthusiastic amateurs searched high and low for material evidence and primary sources from what was called the Dark Ages. There is a gap in knowledge about this past, and all discussion rests on finding meaning in fading inscriptions, or dark earth, or trusting completely the writings of Bede and Gildas. The search for an identity and history for the nation for Great Britain was based on nationalist beliefs about Englishness, Britishness or Welshness. In the twentieth-century, the problem of Englishness, place and myth led Tolkien to write his Middle-earth stories in his leisure time. At the same time, the problem of Welshness or Britishness saw a growth in interest – in film and books - in Arthurian traditions, and a tourist interest in the Celtic fringe of Britain. In this paper, I show how the songs and album covers of Led Zeppelin, and their film The Song Remains the Same, draw upon both the work of Tolkien and the Arthurian traditions to construct ideas of masculine belonging in some mythological medieval time and place. While this constriction is idiosyncratic to the artists, they are drawing on and justifying the wider problem of England, Wales and Britain in leisure and culture

Public health and carrageenan regulation: a review and analysis

The status of carrageenan in the regulatory sphere influences how and where it may be used, with implications for seaweed farmers, carrageenan manufacturers and consumers. Over the period 1935 to the present the status of carrageenan has been effected by changes in the regulatory environment that reflect new understandings about carrageenan, health and health risks as well as broader trade, social and political changes. This paper reviews regulatory progress from the 1930s to the present. It reflects, in particular, the shifting priorities in public health and their effects on the regulatory status of carrageenan. Four case studies of public controversies about carrageenan safety are discussed in relation to regulatory responses and their public health significance. It is concluded that current assessments of risk associated with carrageenan have, in some contexts, failed to take into account the full spectrum of safety assessments that have been carried out and th! e maturing of food additive regulations thereby allowing a myth of risk to continue