A Child\u27s Death: Lessons from Health Care Providers\u27 Texts

This article originates from a research study that explores \u27what happened\u27 to a 10-year-old child with Rett syndrome, who died from severe malnutrition according to a Coroners Service inquest jury. The inquest evidence analyzed, using institutional ethnography, shows that approximately one week prior to this child\u27s death three health care providers (an emergency physician, a hospice volunteer and a home care nurse) conducted individual assessments of the child. Child protection workers were also involved. Textual analysis of the health care providers\u27 records shows how the child was officially and textually constructed as \u27dying from a terminal illness\u27 in contrast to the subsequent Coroners Service finding. The authors argue that although professional and organizational texts are a routinely \u27taken for granted\u27 component of professional practice, they need to be understood as active in the relations of care or service provision. The article supports this argument by demonstrating how the home care nurse\u27s response to the child was textually coordinated with the other two health care providers\u27 actions and how this coordination resulted in the \u27proper\u27 enactment of a Do Not Resuscitate order, leading to courses of action or inaction resulting in the child\u27s death. The lesson offered highlights the problems that can arise when textual realities routinely are given authoritative status and displace other forms of knowing in health care

THE ANALYSIS OF OVER-DISPERSED COUNT DATA FROM A SINGLE FACTOR STUDY

Methods for analyzing over-dispersed count data in a one-way layout were compared using a Monte Carlo study. Several variance stabilizing transformations were examined as alternatives to analyzing the raw data using a general linear model. Additionally, generalized linear models were fit using a log link. For the generalized linear model, three approaches to account for over-dispersion were investigated: (1) a negative binomial distribution with known k, (2) a Poisson distribution with Pearson\u27s X2 as an estimate of the scale parameter, and (3) a Poisson distribution with over-dispersion estimated using the deviance. The analysis of the raw data and log transformed data controlled the size of the tests better than the generalized linear models in the region of the sample space studied

Gendered nationalism : the gender gap in support for the Scottish National Party

Recent major surveys of the Scottish electorate and of Scottish National Party (SNP) members have revealed a distinct gender gap in support for the party. Men are markedly more likely than women to vote for the SNP and they comprise more than two-thirds of its membership. In this article, we use data from those surveys to test various possible explanations for the disproportionately male support for the SNP. While popular accounts have focused on the gendered appeal of recent leaders and on the party’s fluctuating efforts at achieving gender equality in its parliamentary representation, we find much stronger support for a different explanation. Women are less inclined to support and to join the SNP because they are markedly less supportive of its central objective of independence for Scotland. Since men and women barely differ in their reported national identities, the origins of this gender gap in support for independence presents a puzzle for further research

Biological, Social, and Urban Design Factors Affecting Young Street Tree Mortality in New York City

In dense metropolitan areas, there are many factors including traffic congestion, building development and social organizations that may impact the health of street trees. The focus of this study is to better understand how social, biological and urban design factors affect the mortality rates of newly planted street trees. Prior analyses of street trees planted by the New York City Department of Parks & Recreation between 1999 and 2003 (n=45,094) found 91.3% of those trees were alive after two years and 8.7% were either standing dead or missing completely. Using a site assessment tool, a randomly selected sample of 13,405 of these trees was surveyed throughout the City of New York during the summers of 2006 and 2007. Overall, 74.3% of the sample trees were alive when surveyed and the remainder were either standing dead or missing. Results of our initial analyses reveal that highest mortality rates occur within the first few years after planting, and that land use has a significant effect on street tree mortality. Trees planted in one- and two-family residential areas had the highest survival rates (82.7%), while young street trees planted in industrial areas, open space and vacant land had the lowest rates of street tree survival (60.3% -62.9%). Also significant in predicting street tree success and failure are species type, tree pit enhancements, direct tree care/stewardship, and local traffic conditions. These results are intended to inform urban forest managers in making decisions about the best conditions for planting new street trees

A Landscape Cannot Be A Homeland

This is the author accepted manuscript. The final version is available from Taylor & Francis via the DOI in this record.What is the problem for which landscape is the answer? In this paper, I offer a response to this question, first posed at a meeting of landscape researchers in Brussels in 2011. I argue that the problem can be defined as ontopology, or what I call here homeland thinking, and I propose that a landscape cannot be a homeland. The salience of landscape as a critical term instead involves modes of thinking and feeling that chafe against invocations of homeland as a site of existential inhabitation, as a locus of sentiment and attachment, and a wellspring of identity. The paper explores the connections between ideas of landscape and homeland through discussions of the European Landscape Convention, phenomenology and the term homeland itself. I conclude by arguing that a landscape must be understood as a kind of dislocation or distancing from itself. There are, after all, no original inhabitants

Evaluation of a brief pilot nutrition and exercise intervention for the prevention of weight gain in general practice patients

Objective To pilot-test a brief written prescription recommending lifestyle changes delivered by general practitioners (GPs) to their patients.Design The Active Nutrition Script (ANS) included five nutrition messages and personalised exercise advice for a healthy lifestyle and/or the prevention of weight gain. GPs were asked to administer 10 scripts over 4 weeks to 10 adult patients with a body mass index (BMI) of between 23 and 30 kg m&minus; 2. Information recorded on the script consisted of patients\u27 weight, height, waist circumference, gender and date of birth, type and frequency of physical activity prescribed, and the selected nutrition messages. GPs also recorded reasons for administering the script. Interviews recorded GPs views on using the script.Setting General practices located across greater Melbourne.Subjects and results Nineteen GPs (63% female) provided a median of nine scripts over 4 weeks. Scripts were administered to 145 patients (mean age: 54 &plusmn; 13.2 years, mean BMI: 31.7 &plusmn; 6.3 kg m&minus; 2; 57% female), 52% of whom were classified as obese (BMI &gt;30 kg m&minus; 2). GPs cited &lsquo;weight reduction&rsquo; as a reason for writing the script for 78% of patients. All interviewed GPs (90%, n = 17) indicated that the messages were clear and simple to deliver.Conclusions GPs found the ANS provided clear nutrition messages that were simple to deliver. However, GPs administered the script to obese patients for weight loss rather than to prevent weight gain among the target group. This has important implications for future health promotion interventions designed for general practice.<br /

Improving Informed Consent: The Medium Is Not the Message

An important type of research on informed consent involves empirically testing interventions designed to improve the consent process. Here we report on the experience of eight teams that conducted research involving interventions designed primarily to impact one of three categories: decision-making, knowledge, and the therapeutic misconception

LUMINATE: linking agricultural land use, local water quality and Gulf of Mexico hypoxia

In this paper, we discuss the importance of developing integrated assessment models to support the design and implementation of policies to address water quality problems associated with agricultural pollution. We describe a new modelling system, LUMINATE, which links land use decisions made at the field scale in the Upper Mississippi, Ohio and Tennessee Basins through both environmental and hydrological components to downstream water quality effects and hypoxia in the Gulf of Mexico. This modelling system can be used to analyse detailed policy scenarios identifying the costs of the policies and their resulting benefits for improved local and regional water quality. We demonstrate the model\u27s capabilities with a simple scenario where cover crops are incentivised with green payments over a large expanse of the watershed