Reviver Voce: The Voice, Technology, and Death

This is Reviver Voce. A deliberate verbal play on viva voce, the Latin term meaning, ‘By word of mouth; in speech; orally’ (OED 2020) Given the oral nature of this submission, it is understandably a pun that works better when spoken aloud, but this title has not simply been selected for wordplay or the direct reference to the oral defence of a doctoral thesis. Mladen Dolar, in his discussion of the political role of the voice, observes that the ‘viva voce, or just viva . . . has to be made “in the living voice”’ (2006: 110). It is this conception of “the living voice”—and its implied other, “the dead voice”—that sits at the core of this research: the work confronts the revivification of voices in recorded media, reassessing the relationship between technology, the voice, and death, and considering the ideological implications inherent within this emergent realm: the voice’s position within this act of revivification. This research represents a study of the voice and its relationship to technological developments and death: what our voices mean to us, to others, and to death in this ever-changing space. For over a century the dead have “lived on” through audio, but with each advancement in sound recording and media storage we see new uses for the deceased and the bereaved. The voice, as a unique identifier of a person and their life, is entering new territory in a world of hypothetical digital immortality where it is possible to digitise an individual’s vocal characteristics. As the spoken voice is central to this research, this thesis comprises of a collection of 33⅓ rpm, long-play records, primarily—but not entirely—voiced by the author. The introduction and subsequent chapters are presented on separate pressings, each side roughly 30 minutes in length. Practice, too, is submitted on this physical, audio-only medium. Through this research, it is suggested that developments in technology, a shift to everyday and pedestrian practices of recording, and our changing interactions with new media, leave the voice and death, and our relationship with the two, in fundamentally altered spaces

The measurement of response shift in patients with advanced prostate cancer and their partners

BACKGROUND: There is increasing evidence to support the phenomenon of response shift (RS) in quality of life (QoL) studies, with many current QoL measures failing to allow for this. If significant response shift occurs amongst prostate cancer patients, it will be necessary to allow for this in the design of future clinical research and to reassess the conclusions of previous studies that have not allowed for this source of bias. This study therefore aimed to assess the presence of RS and psychosocial morbidity in patients with advanced prostate cancer and their partners. METHODS: 55 consecutive advanced prostate cancer patients and their partners completed the Prostate Cancer Patient & Partner questionnaire (PPP), shortly after diagnosis and again at 3 months and 6 months. At the follow-up visits, both patients and partners also completed a then-test in order to assess RS. RESULTS: Partners consistently showed greater psychological morbidity than patients in relation to the prostate cancer. This was most marked on the General Cancer Distress (GCD) subscale (p < 0.001, paired t-test), and regarding worries about treatment (p = 0.01). Significant RS was identified in partners and patients by the use of the then-test technique, particularly on the GCD subscale, the concerns about treatment and the concerns about urinary symptoms items. CONCLUSION: These results suggest the presence of RS in patients with advanced prostate cancer and their partners, with higher levels of psychosocial morbidity noted amongst partners. This is the first study to identify RS in partners and calls into question the interpretation of all studies assessing changes in QoL that fail to allow for this phenomenon

Non-technical skills assessments in undergraduate medical education: A focused BEME systematic review: BEME Guide no. 54

Consensus on how to assess non-technical skills is lacking. This systematic review aimed to evaluate the evidence regarding non-technical skills assessments in undergraduate medical education, to describe the tools used, learning outcomes and the validity, reliability and psychometrics of the instruments. A standardized search of online databases was conducted and consensus reached on included studies. Data extraction, quality assessment, and content analysis were conducted per Best Evidence in Medical Education guidelines. Nine papers met the inclusion criteria. Assessment methods broadly fell into three categories: simulated clinical scenarios, objective structured clinical examinations, and questionnaires or written assessments. Tools to assess non-technical skills were often developed locally, without reference to conceptual frameworks. Consequently, the tools were rarely validated, limiting dissemination and replication. There were clear themes in content and broad categories in methods of assessments employed. The quality of this evidence was poor due to lack of theoretical underpinning, with most assessments not part of normal process, but rather produced as a specific outcome measure for a teaching-based study. While the current literature forms a good starting position for educators developing materials, there is a need for future work to address these weaknesses as such tools are required across health education

Teaching handover in undergraduate education: an evidence-based multi-disciplinary approach

Poor standards of handover threaten patient safety and continuity of care, contributing significantly to morbidity and mortality. Handover practices has risen to the forefront of the patient safety agenda, with a call to develop and implement undergraduate handover modules into undergraduate healthcare education. Recent systematic reviews demonstrate a common failure of educational interventions to demonstrate a theoretical and pedagogical framework underpinning the delivery of education and method of assessment. The authors developed and piloted a multi-disciplinary evidence-based undergraduate handover training program to health care students studying at a UK university. The intervention was designed based on underpinning educational theories. It has been developed in a manner that supports dissemination and replication, with a model that is cost effective. The intervention was designed to assess learner reaction, attitudes and confidence, and knowledge and skills. This was achieved through a pre- and post-intervention attitude questionnaire, and an externally validated pre- and postintervention knowledge assessment. 46 undergraduate students participated, with a statistically significant increase in self-reported attitudes (p < 0.001) and knowledge (p < 0.001) following the handover intervention. Students participated from the disciplines of medicine, adult nursing, pharmacy, mental health nursing, paramedic practice and operating department practioners. This intervention serves as a significant resource for those looking to develop local interventions and stands as a truly multi-disciplinary approach to handover education, mirroring the clinical reality. The introduction of this handover intervention immediately improves the attitudes, knowledge and skills of undergraduate healthcare students. Future work should sample beyond the selected 6 professions, investigating the transference of outcomes to the workplace, as well as the impact on patient safety

Cochrane vs Non-Cochrane Review in IBD: A Systematic Review

In meta-analyses with the same set of interventions and outcomes, what are the differences in terms of methodological and statistical quality, and effect size

Antibiotics for the induction and maintenance of remission in ulcerative colitis

Objectives This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To determine whether antibiotic therapy is safe and effective for the induction and maintenance of remission in ulcerative colitis (UC)

Medical Students’ Experience: Community Engagement and Advocacy through Photovoice

N

Digitizing UK analogue magnetogram records from large geomagnetic storms of the past two centuries

Continuous geomagnetic records of the strength and direction of the Earth's field at the surface extend back to the 1840s. Over the past two centuries, eight observatories have existed in the United Kingdom, which measured the daily field variations using light-sensitive photographic paper to produce analogue magnetograms. Around 350,000 magnetograms have been digitally photographed at high resolution. However, converting the traces to digital values is difficult and time consuming as the magnetograms can have over-lapping lines, low quality recordings and obscure metadata for conversion to SI units. We discuss our approach to digitizing the traces from large geomagnetic storms and highlight some of the issues to be aware of when capturing magnetic information from analogue measurements. These include cross-checking the final digitized values with the recorded hourly mean values from observatory year books and comparing several observatory records for the same storm to catch errors such as sign inversions or incorrect ‘wrap-around’ of data on the paper records

Fostering intrinsic motivation in remote undergraduate histopathology education

Aims The levels of abstraction, vast vocabulary and high cognitive load present significant challenges in undergraduate histopathology education. Self-determination theory describes three psychological needs which promote intrinsic motivation. This paper describes, evaluates and justifies a remotely conducted, post-COVID-19 histopathology placement designed to foster intrinsic motivation. Methods 90 fourth-year medical students took part in combined synchronous and asynchronous remote placements integrating virtual microscopy into complete patient narratives through Google Classroom, culminating in remote, simulated multidisciplinary team meeting sessions allowing participants to vote on ‘red flag’ signs and symptoms, investigations, histological diagnoses, staging and management of simulated virtual patients. The placement was designed to foster autonomy, competence and relatedness, generating authenticity, transdisciplinary integration and clinical relevance. A postpositivistic evaluation was undertaken with a validated preplacement and postplacement questionnaire capturing quantitative and qualitative data. Results There was a significant (p<0.001) improvement in interest, confidence and competence in histopathology. Clinical integration and relevance, access to interactive resources and collaborative learning promoted engagement and sustainability post-COVID-19. Barriers to online engagement included participant lack of confidence and self-awareness in front of peers. Conclusions Fostering autonomy, competence and relatedness in post-COVID-19, remote educational designs can promote intrinsic motivation and authentic educational experiences. Ensuring transdisciplinary clinical integration, the appropriate use of novel technology and a focus on patient narratives can underpin the relevance of undergraduate histopathology education. The presentation of normal and diseased tissue in this way can serve as an important mode for the acquisition and application of clinically relevant knowledge expected of graduates