Co-constructing desired activities : Small-scale activity decisions in occupational therapy

Social inclusion and exclusion are buzzwords in today’s political discourse. While there are many causes of social exclusion, one of the factors repeatedly shown to lead to social exclusion is mental illness, which may hinder people in developing themselves in accordance with their wishes and abilities. Participation is a key dimension of social inclusion—and one that we particularly seek to increase understanding of in this volume. We focus on participation taking place in face-to-face social encounters, seeking to get to the root of the preconditions and consequences of participation by unraveling the interactional processes that underlie what makes it possible. We presuppose that participation in any social or societal sphere presupposes social interaction, which in turn requires the capacity to coordinate with and make sense of others’ actions. Thus, drawing on joint decision-making as a specific arena of social interaction, where the participants’ collaborative management of the turn-by-turn sequential unfolding of interaction can have tangible consequences for the participants’ social and economic circumstances, we seek to increase understanding of the specific vulnerabilities that individuals with mental illness have in this context.In occupational therapy, a therapist and client engage in shared activities that they perform collaboratively during therapeutic sessions. An important part of this joint performance involves providing the client with the opportunity to make short-term decisions on the activities they wish to perform. Analyzing 15 occupational therapy encounters at psychiatric outpatient clinics, in the chapter I explore the functions of these small-scale decisions. The analysis demonstrates that therapists (1) make room for the client’s proposals by shaping the activity context and (2) make proposals themselves on the ways the performance should be accomplished. To summarize, clients are given decision-making power over the content of the activity, whereas therapists use their decision-making power to assist the client’s performance. The analysis shows how small-scale decisions can be employed to construct the occupational performance as shared endeavors and to position the clients as active subjects rather than objects of the professionals’ performance.Peer reviewe

Engaging terminally ill patients in end of life talk: How experienced palliative medicine doctors navigate the dilemma of promoting discussions about dying

Objective: To examine how palliative medicine doctors engage patients in end-of-life (hereon, EoL) talk. To examine whether the practice of “eliciting and responding to cues”, which has been widely advocated in the EoL care literature, promotes EoL talk. Design: Conversation analysis of video- and audio-recorded consultations. Participants: Unselected terminally ill patients and their companions in consultation with experienced palliative medicine doctors. Setting: Outpatient clinic, day therapy clinic, and inpatient unit of a single English hospice. Results: Doctors most commonly promoted EoL talk through open elaboration solicitations; these created opportunities for patients to introduce Ð then later further articulate Ð EoL considerations in such a way that doctors did not overtly ask about EoL matters. Importantly, the wording of elaboration solicitations avoided assuming that patients had EoL concerns. If a patient responded to open elaboration solicitations without introducing EoL considerations, doctors sometimes pursued EoL talk by switching to a less participatory and more presumptive type of solicitation, which suggested the patient might have EoL concerns. These more overt solicitations were used only later in consultations, which indicates that doctors give precedence to patients volunteering EoL considerations, and offer them opportunities to take the lead in initiating EoL talk. There is evidence that doctors treat elaboration of patients’ talk as a resource for engaging them in EoL conversations. However, there are limitations associated with labelling that talk as “cues” as is common in EoL communication contexts. We examine these limitations and propose “possible EoL considerations” as a descriptively more accurate term. Conclusions: Through communicating Ð via open elaboration solicitations Ð in ways that create opportunities for patients to volunteer EoL considerations, doctors navigate a core dilemma in promoting EoL talk: giving patients opportunities to choose whether to engage in conversations about EoL whilst being sensitive to their communication needs, preferences and state of readiness for such dialogue

Perturbations in plant energy homeostasis prime lateral root initiation via SnRK1-bZIP63-ARF19 signaling

Plant architecture is highly plastic and known to respond sensitively to nutritional changes. Although of great agronomic importance, the underlying molecular mechanisms that sense and transduce these cues into plant development and growth are poorly understood. Applying diverse genetic, biochemical, and microscopic approaches, we disclosed that signaling via the central, evolutionarily conserved fuel-sensor kinase Snf1-RELATED KINASE1 (SnRK1) initiates lateral root (LR) primordia formation in response to transient metabolic perturbations. This is accomplished by SnRK1-mediated activation of a signaling cascade involving the pivotal LR regulator AUXIN RESPONSE FACTOR19 (ARF19). We propose that this developmental priming strategy represents a cost-efficient approach to ensure rapid growth recovery after stress release, providing in competitive ecosystems a clear advantage in terms of Darwinian fitness.Plants adjust their energy metabolism to continuous environmental fluctuations, resulting in a tremendous plasticity in their architecture. The regulatory circuits involved, however, remain largely unresolved. In Arabidopsis, moderate perturbations in photosynthetic activity, administered by short-term low light exposure or unexpected darkness, lead to increased lateral root (LR) initiation. Consistent with expression of low-energy markers, these treatments alter energy homeostasis and reduce sugar availability in roots. Here, we demonstrate that the LR response requires the metabolic stress sensor kinase Snf1-RELATED-KINASE1 (SnRK1), which phosphorylates the transcription factor BASIC LEUCINE ZIPPER63 (bZIP63) that directly binds and activates the promoter of AUXIN RESPONSE FACTOR19 (ARF19), a key regulator of LR initiation. Consistently, starvation-induced ARF19 transcription is impaired in bzip63 mutants. This study highlights a positive developmental function of SnRK1. During energy limitation, LRs are initiated and primed for outgrowth upon recovery. Hence, this study provides mechanistic insights into how energy shapes the agronomically important root system.All study data are included in the article and/or supporting information

Poetic confluence and the public formulation of others’ private matters

This article is an exploratory empirical study of a form of interpersonal relationality that takes the form of a speech event in which one participant produces a spoken turn that exhibits a poetic relationship to a co-participant’s unspoken thoughts or unarticulated mental imagery. The data consist of anecdotal reports, which are analysed in relation to empirical findings from conversation analytic studies of formulations in institutional and naturally occurring talk. The first part of the article establishes its robustness and describes some recurrent properties. The analysis shows how poetic turns formulate modulated versions of others’ sensitive or delicate thoughts or imagery, thereby performing a form of Goffmanesque remedial work. In the discussion, methodological and substantive implications of this phenomenon are discussed, specifically: the use of anecdotes in sociological research, the porousness of personal boundaries, and theoretical accounts of relationality

S1 basic leucine zipper transcription factors shape plant architecture by controlling C/N partitioning to apical and lateral organs

Plants tightly control growth of their lateral organs, which led to the concept of apical dominance. However, outgrowth of the dormant lateral primordia is sensitive to the plant's nutritional status, resulting in an immense plasticity in plant architecture. While the impact of hormonal regulation on apical dominance is well characterized, the prime importance of sugar signaling to unleash lateral organ formation has just recently emerged. Here, we aimed to identify transcriptional regulators, which control the trade-off between growth of apical versus lateral organs. Making use of locally inducible gain-of-function as well as single and higher-order loss-of-function approaches of the sugar-responsive S1-basic-leucine-zipper (S1-bZIP) transcription factors, we disclosed their largely redundant function in establishing apical growth dominance. Consistently, comprehensive phenotypical and analytical studies of S1-bZIP mutants show a clear shift of sugar and organic nitrogen (N) allocation from apical to lateral organs, coinciding with strong lateral organ outgrowth. Tissue-specific transcriptomics reveal specific clade III SWEET sugar transporters, crucial for long-distance sugar transport to apical sinks and the glutaminase GLUTAMINE AMIDO-TRANSFERASE 1_2.1, involved in N homeostasis, as direct S1-bZIP targets, linking the architectural and metabolic mutant phenotypes to downstream gene regulation. Based on these results, we propose that S1-bZIPs control carbohydrate (C) partitioning from source leaves to apical organs and tune systemic N supply to restrict lateral organ formation by C/N depletion. Knowledge of the underlying mechanisms controlling plant C/N partitioning is of pivotal importance for breeding strategies to generate plants with desired architectural and nutritional characteristics