Stakeholder perspectives on contributors to delayed and inaccurate diagnosis of cardiovascular disease and their implications for digital health technologies: a UK-based qualitative study

Objective: The aim of this study is to understand stakeholder experiences of diagnosis of cardiovascular disease (CVD) to support the development of technological solutions that meet current needs. Specifically, we aimed to identify challenges in the process of diagnosing CVD; to identify discrepancies between patient and clinician experiences of CVD diagnosis, and to identify the requirements of future health technology solutions intended to improve CVD diagnosis. Design: Semi-structured focus groups and 1-1 interviews to generate qualitative data that was subjected to thematic analysis 2 Participants: UK-based individuals (N = 32) with lived experience of diagnosis of CVD (n = 23) and clinicians with experience in diagnosing CVD (n = 9). Results: We identified four key themes related to delayed or inaccurate diagnosis of CVD: Symptom Interpretation, Patient Characteristics, Patient-Clinician Interactions, and Systemic Challenges. Sub-themes from each are discussed in depth. Challenges related to time and communication were greatest for both stakeholder groups, however, there were differences in other areas, for example, patient experiences highlighted difficulties with the psychological aspects of diagnosis and interpreting ambiguous symptoms, while clinicians emphasised the role of individual patient differences and the lack of rapport in contributing to delays or inaccurate diagnosis. Conclusions: Our findings highlight key considerations when developing digital technologies that seek to improve the efficiency and accuracy of diagnosis of CVD. </p

Turkey and the EU after the first year of negotiations: Reconciling internal and external policy challenges

The EU's commencement of accession negotiations with Turkey in October 2005 represents a watershed in Turkish-EU relations. However, even in the area of straightforward technicalities, the negotiations are linked to a wider set of unresolved and highly sensitive political issues, of which the Cyprus question is the most significant. Unresolved Aegean disputes with Greece and the Armenian issue form another set of wider external issues that affect the day-to-day framework of the negotiations. Internal issues that can have repercussions on the negotiations include Kurdish minority rights and the decision of the European Court of Human Rights calling for a retrial of PKK leader Abdullah Ocalan. The EU accession process has left Turkey with the dilemma of how to reconcile its internal and external policy challenges. Traditionally, Turkey has separated its internal security challenges, such as Kurdish separatism and Islamic fundamentalism, from its external security relations, which are based on state-centric security relationships. This situation is being superseded by an emergent discourse on Turkish foreign policy, as Euro-sceptics who frame Turkey's national security within a traditionalist military-dominant perspective are challenged by pro-EU actors who view economic instability as more significant than traditional military threats. While Turkey's uniqueness - such as the special place of its military within the state and society - is difficult for the EU to grasp, the very speciality of the Turkish case does not in itself warrant an alternative to full membership, such as privileged partnership. All previous accession negotiations have ended in full membership. If Turkey were to become an exception after it has made headway in implementing EU criteria, this would have wider repercussions for Turkey's relations with the West and the EU's image in the Islamic world at large. Thus, the Turkish case probably constitutes the greatest challenge the EU has had to face in dealing with an accession country

Constructing identity as a second-generation Cypriot Turkish in Australia: the multi-hyphenated other

This article explores how Cypriot Turkish people in Australia construct their multi-hyphenated identity and the implications this has for their sense of belonging. Ethnic identity is conceptualized as a set of social and cultural understandings, shaped by historical processes, positions of power and patterns of privilege, which people draw on to understand and experience themselves. Ten Cypriot Turkish people’s identities were explored through semi-structured interviews. Discourse analysis was used to identify the discursive constructions of identity and belongingness. Discourses that constructed the Cypriot Turkish Australian identity were: modern Muslim, language, phenotype and ancestry and generation discourse. These discourses give rise to the multi-hyphenation of this identity, positioning them as either Cypriot Turkish Australians or Cypriot Turkish in Australia. The discourses have highlighted not only the current socio-political context as shaping subjectivities, but also the historical and political collective memory that continues in the construction of ethnic identities