Bedside Manners: Play and Workbook

[Excerpt] Our goal in the play was to create a balanced work. In Bedside Manners, the reader will find people who communicate poorly and those who communicate well. Although the play focuses primarily on physicians and nurses and the acute-care hospital setting, we have tried to expand the cast of characters to include others on the health care team and to include other settings. As the safety literature documents, poor communication between members of the health care team is not simply an individual problem—a question of a few bad apples spoiling the barrel—but is rather a system problem that stems from how health care has historically developed. Although it is beyond the scope of this commentary to describe that historical development, suffice it to say that the problems of contemporary health care team relationships have a long history and are shaped not only by economics but also by gender, culture, religion, ethnicity, and many other factors. Although our play is meant to stimulate discussion about health care teamwork and suggest ways that doctors, nurses, and others in health care can develop the skills necessary to create and sustain genuine interprofessional teams, it is primarily a work of theater. Its goal is to help those who work in health care approach a very hot topic in a way that is both interesting and even, dare I say it, fun. To accompany the play and make it more user-friendly, Scott Reeves, Lisa Hayes, and I have also written a workbook, which explains the various ways it can be performed, how to mount a performance, and how to lead a discussion or workshop after the play is over. We also explain how to use the play as part of an interprofessional curriculum. Although some in our audiences have scoffed at such a touchy feely or unconventional way to present a serious issue, our experience has convinced us that theater is a useful tool to enhance teamwork, patient safety, and also to create more satisfying workplace relationships. Theater has been with humankind since almost the beginning of our history precisely because it is such a powerful tool. It can be used by those in health care who spend their days working with sick, frightened, anxious people, people who are, by definition, not at their best. Under the best of circumstances, their work is beyond difficult. Good communication and teamwork not only produces good patient outcomes; it helps health care professionals care for one another

Action languages: Dimensions, effects

Dimensions of action languages are discussed for communication between humans and machines, and the message handling capabilities of object oriented programming systems are examined. Design of action languages is seen to be very contextual. Economical and effective design will depend on features of situations, the tasks intended to be accomplished, and the nature of the devices themselves. Current object oriented systems turn out to have fairly simple and straightforward message handling facilities, which in themselves do little to buffer action or even in some cases to handle competing messages. Even so, it is possible to program a certain amount of discretion about how they react to messages. Such thoughtfulness and perhaps relative autonomy of program modules seems prerequisite to future systems to handle complex interactions in changing situations

Denning ecology of two black bear populations in the Arkansas highlands

The denning ecology of one adult male and 29 adult females in the Arkansas Highlands was studied using radiotelemetry from fall 1988 through spring 1990. Research was conducted on the White Rock and Dry Creek study areas, in the Ozark and Ouachita National Forests. Denning chronology was defined; physical, vegetative, and site parameters were measured at each den. Canonical discriminant analysis was used to determine den habitat utilization and delineate important denning habitat components. Effects of roads on den selection were examined with the aid of a Geographic Information System and repeated measures analysis. Den and ambient temperatures were recorded in week~long intervals using circular thermographs. Den availability was estimated from searches made along random transects. In 1989, pregnant females on both areas denned significantly earlier (p=0.0005) than females with yearlings and barren females. Barren females emerged from dens first, followed by females with yearlings, then females with newborn cubs. Significant differences (p=0.0001) in length of denning period were detected among all reproductive groups. During 1988 on Dry Creek, a year of high food availability, pregnant females denned later (p=0.0183) than in 1989, a year of low food availability. Differences in entrance dates between years were not observed among females with yearlings or barren females. Bears on both areas utilized rock cavity dens (67.3%) most often. Excavation dens (18.4%), clearcuts (6.1%), tree cavities (4.1%), and open nests (4.1%) also were utilized. Rock dens occurred in creek bottoms (rock creek) and along bluffs (rock bluff). Rock creek and excavation dens were prone to flooding during winter dormancy. Bears that occupied dens prone to flooding were significantly younger (p=0.0444) than bears in dens secure from flooding. Roads did not affect den selection because road densities were low and traffic volumes were light during winter. Rock dens maintained a constant temperature that was cooler than day ambient temperatures but warmer than night ambient temperatures (p=0.0230). A gradient of high structural security and inaccessibility existed from rock dens, to excavations, to dens in clearcuts. Security of excavation and clearcut dens was compensated by increased cover and higher understory stem densities. Differences in components of denning habitat did not exist between reproductive classes but were detected between study areas. Twenty-two potential dens were located on White Rock and none on Dry Creek. This discrepancy was related to the sampling technique and the scarcity of rock bluff dens on Dry Creek. Rock dens are available on both areas and utilized at the highest rates. These dens provide the most structural security and persist for many years. Location of improved gravel roads may be related to rock den habitat on Dry Creek. Proximity of roads to rock outcroppings should be given consideration on both areas in future management plans

Development of a simulated round of golf

Purpose The aim of this study was to develop a laboratory-based treadmill simulation of the on-course physiological demands of an 18-hole round of golf and to identify the underlying physiological responses. Methods Eight amateur golfers completed a round of golf during which heart rate (HR), steps taken, and global positioning system (GPS) data were assessed. The GPS data were used to create a simulated discontinuous round on a treadmill. Steps taken and HR were recorded during the simulated round. Results During the on-course round, players covered a mean (±SD) of 8,251 ± 450 m, taking 12,766 ± 1,530 steps. The mean exercise intensity during the on-course round was 31.4 ± 9.3% of age-predicted heart rate reserve (%HRR) or 55.6 ± 4.4% of age-predicted maximum HR (%HRmax). There were no significant differences between the simulated round and the on-course round for %HRR (P = .537) or %HR max (P = .561) over the entire round or for each individual hole. Furthermore, there were no significant differences between the two rounds for steps taken. Typical error values for steps taken, HR, %HRmax, and %HRR were 1,083 steps, ±7.6 b·min?1, ±4.5%, and ±8.1%, respectively. Conclusion Overall, the simulated round of golf successfully recreated the demands of an on-course round. This simulated round could be used as a research tool to assess the extent of fatigue during a round of golf or the impact of various interventions on golfers

Problematising qualitative research in organisations: Three voices, three subjectivities, three struggles

© 2016, © Emerald Group Publishing Limited. Purpose – The purpose of this paper is to illustrate the authors’ multiple subjectivities, in research and in practice which are ever shifting in context with each other. The authors present richness of understanding which can be revealed when researchers eschew consensus, certainty and easy solutions. The authors aim to show that plurality of ontological and epistemological approaches combined with diversity in understanding and subjective experience is necessary in qualitative research in organisations. Design/methodology/approach – The authors take a playful and incomplete narrative approach in their critical reflection on the subjectivities being silenced or ignored in organisations and in academia. The authors present an unsettling and ambiguous read but the aim is to question the formulaic, linear, simplistic solutions and structures evident in organisations and academia that silence uncertainty, emotions, voice and creativity through standardisation and the rhetoric of collaboration for performance enhancement. This process the authors have termed philosophical violence. Findings – The authors identify philosophical violence as a dominant theme in qualitative research, in organisational practice and within academia. In contrast, the authors’ embodied subjectivities preclude the reaching agreement or consensus too quickly, or indeed, at all. The authors’ embodied struggles add to the understanding of ambiguity, difference, critical reflexivity and understanding, providing richness and accommodating diversity and paradox in the inquiries in the organisations. Originality/value – The authors show the struggles as hopeful and the non-collaborative collaboration as a resource from which the authors can individually and jointly develop new understandings of working and thus survive the philosophical violence found in organisations and in research. Honouring subjectivities is essential for rich qualitative research in organisations

Detection and Interpretation Of Long-Lived X-Ray Quasi-Periodic Pulsations in the X-Class Solar Flare On 2013 May 14

Quasi-periodic pulsations (QPP) seen in the time derivative of the GOES soft X-ray light curves are analyzed for the near-limb X3.2 event on 14 May 2013. The pulsations are apparent for a total of at least two hours from the impulsive phase to well into the decay phase, with a total of 163 distinct pulses evident to the naked eye. A wavelet analysis shows that the characteristic time scale of these pulsations increases systematically from $\sim$25 s at 01:10 UT, the time of the GOES peak, to $\sim$100 s at 02:00 UT. A second ridge in the wavelet power spectrum, most likely associated with flaring emission from a different active region, shows an increase from $\sim$40 s at 01:40 UT to $\sim$100 s at 03:10 UT. We assume that the QPP that produced the first ridge result from vertical kink-mode oscillations of the newly formed loops following magnetic reconnection in the coronal current sheet. This allows us to estimate the magnetic field strength as a function of altitude given the density, loop length, and QPP time scale as functions of time determined from the GOES light curves and RHESSI images. The calculated magnetic field strength of the newly formed loops ranges from about $\sim$500 G at an altitude of 24 Mm to a low value of $\sim$10 G at 60 Mm, in general agreement with the expected values at these altitudes. Fast sausage mode oscillations are also discussed and cannot be ruled out as an alternate mechanism for producing the QPP

A Validated Method for the Determination of Firocoxib in Equine Tissues

A new reversed-phase High Performance Liquid Chromatography (HPLC) method was developed and validated for the determination of firocoxib in equine tissue. Firocoxib was detected by ultraviolet detection at 290nm after undergoing a liquid extraction using ethyl acetate: hexane (40:60) and separation on a Sunfire C18 column. The mobile phase consisted of water with 0.025% trifluoroacetic acid and acetonitrile (50:50), with a flow rate 1.1 mL/min. A concentration range of 5-1500ng/gm produced a linear curve with r²\u3e0.99. The lower limit of quantification was 5ng/gm. The intra and inter assay variability was \u3c10% and the average recovery was 97%

Talking about depression during interactions with GPs: a qualitative study exploring older people’s accounts of their depression narratives

Background: Older people can struggle with revealing their depression to GPs and verbalising preferences regarding its management. This contributes to problems for GPs in both detecting and managing depression in primary care. The aim of this study was to explore older people’s accounts of how they talk about depression and possible symptoms to improve communication about depression when seeing GPs. Methods: Adopting a qualitative Interpretivist methodological approach, semi-structured interviews were conducted by IG based on the principles of grounded theory and situational analysis. GPs working in north east England recruited patients aged over 65 with depression. Data analysis was carried out with a process of constant comparison, and categories were developed via open and axial coding and situational maps. There were three levels of analysis; the first developed open codes which informed the second level of analysis where the typology was developed from axial codes. The typology derived from second level analysis only is presented here as older people’s views are rarely reported in isolation. Results: From the sixteen interviews with older people, it was evident that there were differences in how they understood and accepted their depression and that this influenced what they shared or withheld in their narratives. A typology showing three categories of older people was identified: those who appeared to talk about their depression freely yet struggled to accept aspects of it (Superficial Accepter), those who consolidated their ideas about depression aloud (Striving to Understand) and those who shared minimal detail about their depression and viewed it as part of them rather than a treatable condition (Unable to Articulate). The central finding was that older people’s acceptance and understanding of their depression guided their depression narratives. Conclusions: This study identified differences between older people in ways they understand, accept and share their depression. Recognising that their depression narratives can change and listening for patterns in what older people share or withhold may help GPs in facilitating communication to better understand the patient when they need to implement alternative approaches to patient management