How do doctors learn the spoken language of their patients?

Background. In South Africa, many doctors consult across both a language and cultural barrier. If patients are to receive effective care, ways need to be found to bridge this communication barrier.Methods. Qualitative individual interviews were conducted with seven doctors who had successfully learned the language of their patients, to determine their experiences and how they had succeeded.Results. All seven doctors used a combination of methods to learn the language. Listening was found to be very important, as was being prepared to take a risk or appear to be foolish. The doctors found that it was important to try out the newly learned language on patients and additionally stressed that learning the language was also learning a culture. The importance of motivation in language learning, the value of being immersed in the language one is trying to learn, and the role of prior experience in language learning, were commonly mentioned. The doctors deeply valued the improved rapport and deeper relationships with patients that resulted from their language learning efforts

Institutional bridging for SME high-distance internationalisation to China: a contextualised explanation

This article offers a contextualised explanation of the process of institutional bridging by Delta, a British SME, in order to internationalise to China across high institutional distance. The study uncovers three novel mechanisms of ‘Cross-institutional Dissonance Mitigation’, ‘Multi-level Strategic Embedding’, and ‘Cross-institutional Consonance Retuning’ to explain how and why a failing SME with limited resources and networks was able to bridge the institutional distance and internationalise to the challenging Chinese market. This article contributes to the literature on SME internationalisation across high institutional distance by opening the ‘black box’ of SME institutional bridging, hence demonstrating the benefits of contextualised explanations to extend research into internationalisation phenomena that span multiple institutional boundaries

Otitis Media and Mastoiditis in Infancy

The problem of the "diarrhoea and vomiting syndrome" in infancy is one which has interested paediatricians for many years. The striking clinical picture, the definite seasonal incidence and the more or less complete failure to find a satisfactory bacteriological explanation make the problem one of peculiar fascination, while the high mortality rate and the unsatisfactory therapeutic results render it one of the utmost importance in paediatrics. Of recent years, particularly on the continent and in America, the conception has gained ground that a certain proportion of such cases, variously described as "diarrhoea and vomiting syndrome","cholera infantum", or "alimentary intoxication" may be due to a source of infection (parenteral) in the naso-pharynx, nasal accessory sinuses, middle ears or mastoid antra, special stress being laid on the middle ears and mastoid antra. It is suggested in addition that mastoiditis does not manifest itself with the classical picture so well recognised in the older child or adult, but remains "latent", thereby causing difficulty in diagnosis and treatment. The present thesis is an attempt to assess: (1) the part played by otitis media and mastoiditis in the high morbidity and mortality rates of infancy; (2) the value of certain methods of investigation; (3) the value of treatment, operative and non-operative. It is based upon an investigation of fifty infants under the age of one year suffering with an illness character ised by otitis media sometimes with mastoiditis) and varying degrees of diarrhoea and vomiting

Lost that lovin' feeling: The erosion of trust between small, high-distance partners

We investigate the role of high distance in trust erosion between small partners. High distance is known to hinder the formation of trust between potential partners, but its role in trust erosion in established partnerships is less understood by international business scholars. Through a qualitative longitudinal study, we extend current theory of how high distance effects the trust dynamics between cross-border partners. Specifically, we unearth three inter-related mechanisms that together explain how and why trust can erode due to high distance. We show that before a partnership is formed, high distance can lead partners to erroneously attribute cues to a potential partner’s high quality, leading to over-expectations of partner performance. Once the partnership is operational, high distance hinders actors’ ability to understand situational factors associated with disappointing outcomes, and so they are attributed to failings of the partner. At the same time, distance-related challenges of bounded reliability render partners reluctant to discuss partnership outcomes. This can result in a vicious cycle of inertia as partners strive to protect goodwill while abandoning efforts to produce partnership outcome because of doubts of the other’s quality. Thus, our theoretical model illustrates the limitations of trust and explains how, paradoxically, high distance can facilitate both trust formation and trust erosion

The consequences upon patient care of moving Brits Hospital: A case study

Background. In 2001, North West Province took the decision to increase bed capacity at Brits Hospital from 66 beds to 267 beds. After careful consideration of costs and an assessment of available land, it was decided to demolish the existing hospital and rebuild the new hospital on the same site. It was planned that during this time that clinical services would be moved to a temporary makeshift hospital and to primary health care clinics. This case study documents the consequences of this decision to move services to the makeshift hospital and how these challenges were dealt with. Methods. A cross-sectional descriptive study was undertaken. Ten key members of staff at management and service delivery level, in the hospital and the district, were interviewed. Key documents, reports, correspondence, hospital statistics and minutes of meetings related to the move were analysed. Results. The plan had several unforeseen consequences with serious effects on patient care. Maternity services were particularly affected. Maternity beds decreased from 30 beds in the former hospital to 4 beds in the makeshift hospital. As numbers of deliveries did not greatly decrease, this resulted in severe overcrowding, making monitoring and care difficult. Perinatal mortality rates doubled after the move. An increase in maternal deaths was noted. The lack of inpatient ward space resulted in severe overcrowding in Casualty. The lack of X-ray facilities necessitated patients being referred to a facility 72 km away, which often caused a delay of 3 days before management was completed. After-hours X-rays were done in a private facility, adding to unforeseen costs. Although the initial plan was for the makeshift hospital to stabilise and refer most patients, referral routes were not agreed upon or put in writing, and no extra transportation resources were allocated. The pharmacy had insufficient space for storage of medication. In spite of all these issues, relationships and capacity at clinics were strengthened, but not sufficiently to meet the need. Discussion. Hospital revitalisation requires detailed planning so that services are not disrupted. Several case studies have highlighted the planning necessary when services are to be moved temporarily. Makeshift hospitals have been used when renovating or building hospitals. During war or disasters, plans have been made to decant patients from one facility to another. From the Brits case study, it would appear that not enough detailed planning for the move was done initially. This observation includes failure to appreciate the interrelatedness of systems and the practicality of the proposal, and to budget for the move and not just the new structure. Conclusion. The current service offered at the makeshift hospital at Brits is not adequate and has resulted in poor patient care. It is the result of a planning process that did not examine the consequences of the move, both logistic and financial, in adequate detail. Committed hospital staff have tried their best to offer good care in difficult circumstances

Mechanical versus manual chest compressions in the treatment of in-hospital cardiac arrest patients in a non-shockable rhythm : a randomised controlled feasibility trial (COMPRESS-RCT)

Background Mechanical chest compression devices consistently deliver high-quality chest compressions. Small very low-quality studies suggest mechanical devices may be effective as an alternative to manual chest compressions in the treatment of adult in-hospital cardiac arrest patients. The aim of this feasibility trial is to assess the feasibility of conducting an effectiveness trial in this patient population. Methods COMPRESS-RCT is a multi-centre parallel group feasibility randomised controlled trial, designed to assess the feasibility of undertaking an effectiveness to compare the effect of mechanical chest compressions with manual chest compressions on 30-day survival following in-hospital cardiac arrest. Over approximately two years, 330 adult patients who sustain an in-hospital cardiac arrest and are in a non-shockable rhythm will be randomised in a 3:1 ratio to receive ongoing treatment with a mechanical chest compression device (LUCAS 2/3, Jolife AB/Stryker, Lund, Sweden) or continued manual chest compressions. It is intended that recruitment will occur on a 24/7 basis by the clinical cardiac arrest team. The primary study outcome is the proportion of eligible participants randomised in the study during site operational recruitment hours. Participants will be enrolled using a model of deferred consent, with consent for follow-up sought from patients or their consultee in those that survive the cardiac arrest event. The trial will have an embedded qualitative study, in which we will conduct semi-structured interviews with hospital staff to explore facilitators and barriers to study recruitment. Discussion The findings of COMPRESS-RCT will provide important information about the deliverability of an effectiveness trial to evaluate the effect on 30-day mortality of routine use of mechanical chest compression devices in adult in-hospital cardiac arrest patients

Deformation of NaCoF3 perovskite and post-perovskite up to 30 GPa and 1013 K: implications for plastic deformation and transformation mechanism

Texture, plastic deformation, and phase transformation mechanisms in perovskite and post-perovskite are of general interest for our understanding of the Earth's mantle. Here, the perovskite analogue NaCoF3 is deformed in a resistive-heated diamond anvil cell (DAC) up to 30 GPa and 1013 K. The in situ state of the sample, including crystal structure, stress, and texture, is monitored using X-ray diffraction. A phase transformation from a perovskite to a post-perovskite structure is observed between 20.1 and 26.1 GPa. Normalized stress drops by a factor of 3 during transformation as a result of transient weakening during the transformation. The perovskite phase initially develops a texture with a maximum at 100 and a strong 010 minimum in the inverse pole figure of the compression direction. Additionally, a secondary weaker 001 maximum is observed later during compression. Texture simulations indicate that the initial deformation of perovskite requires slip along (100) planes with significant contributions of {110} twins. Following the phase transition to post-perovskite, we observe a 010 maximum, which later evolves with compression. The transformation follows orientation relationships previously suggested where the c axis is preserved between phases and hh0 vectors in reciprocal space of post-perovskite are parallel to [010] in perovskite, which indicates a martensitic-like transition mechanism. A comparison between past experiments on bridgmanite and current results indicates that NaCoF3 is a good analogue to understand the development of microstructures within the Earth's mantle

Multiaxial Kitagawa analysis of A356-T6

Experimental Kitagawa analysis has been performed on A356-T6 containing natural and artificial defects. Results are obtained with a load ratio of R = -1 for three different loadings: tension, torsion and combined tension-torsion. The critical defect size determined is 400 \pm 100 \mum in A356-T6 under multiaxial loading. Below this value, the microstructure governs the endurance limit mainly through Secondary Dendrite Arm Spacing (SDAS). Four theoretical approaches are used to simulate the endurance limit characterized by a Kitagawa relationship are compared: Murakami relationships [Y Murakami, Metal Fatigue: Effects of Small Defects and Nonmetallic Inclusions, Elsevier, 2002.], defect-crack equivalency via Linear Elastic Fracture Mechanics (LEFM), the Critical Distance Method (CDM) proposed by Susmel and Taylor [L. Susmel, D. Taylor. Eng. Fract. Mech. 75 (2008) 15.] and the gradient approach proposed by Nadot [Y. Nadot, T. ~Billaudeau. Eng. Fract. Mech. 73 (2006) 1.]. It is shown that the CDM and gradient methods are accurate; however fatigue data for three loading conditions is necessary to allow accurate identification of an endurance limit.Comment: 27 pages, 11 figure

Weight Gain in Early Life Predicts Risk of Islet Autoimmunity in Children With a First-Degree Relative With Type 1 Diabetes

OBJECTIVE—In a prospective birth cohort study, we followed infants who had a first-degree relative with type 1 diabetes to investigate the relationship between early growth and infant feeding and the risk of islet autoimmunity