Speech, Sound, Technology

Johannes Mulder and Theo van Leeuwen investigate how the microphone, the amplifier, and the loudspeaker have changed the semiotic potential of the sound of the voice. Based on a social semiotic understanding, the authors discuss the voice from three perspectives: physical, focusing on how bodily experience from speaking and singing informs the understanding of the sound of the voice (covering implications such as pitch, loudness, and alterations of various kinds); social, based on the way human social and cultural experiences, such as accents and different vocal styles, inform the understanding of sound; and, finally, the technologically enhanced voice, showing that, even though the appreciation of this voice rests on prior understanding of biological and social voices, this voice introduces extraexperiential dimensions that slowly assimilate into the culture as a form of disembodied, nonhuman voice

Diffusion of a collaborative care model in primary care: a longitudinal qualitative study

<p>Background</p> <p>Although collaborative team models (CTM) improve care processes and health outcomes, their diffusion poses challenges related to difficulties in securing their adoption by primary care clinicians (PCPs). The objectives of this study are to understand: (1) how the perceived characteristics of a CTM influenced clinicians' decision to adopt -or not- the model; and (2) the model's diffusion process.</p> <p>Methods</p> <p>We conducted a longitudinal case study based on the Diffusion of Innovations Theory. First, diffusion curves were developed for all 175 PCPs and 59 nurses practicing in one borough of Paris. Second, semi-structured interviews were conducted with a representative sample of 40 PCPs and 15 nurses to better understand the implementation dynamics.</p> <p>Results</p> <p>Diffusion curves showed that 3.5 years after the start of the implementation, 100% of nurses and over 80% of PCPs had adopted the CTM. The dynamics of the CTM's diffusion were different between the PCPs and the nurses. The slopes of the two curves are also distinctly different. Among the nurses, the <it>critical mass</it> of adopters was attained faster, since they adopted the CTM earlier and more quickly than the PCPs. Results of the semi-structured interviews showed that these differences in diffusion dynamics were mostly founded in differences between the PCPs' and the nurses' perceptions of the CTM's <it>compatibility</it> with norms, values and practices and its <it>relative advantage</it> (impact on patient management and work practices). Opinion leaders played a key role in the diffusion of the CTM among PCPs.</p> <p>Conclusion</p> <p>CTM diffusion is a social phenomenon that requires a major commitment by clinicians and a willingness to take risks; the role of opinion leaders is key. Paying attention to the notion of a <it>critical mass</it> of adopters is essential to developing implementation strategies that will accelerate the adoption process by clinicians.</p