The value of choice: A qualitative study

Background Providing choice in health care is part of an ongoing policy initiative Aim To explore how people understand choice in health care provision Setting South East England Design of Study A qualitative study using semi structured interviews Method Twenty two people recruited through advertising were interviewed about choice in general and choice in health care in particular. The data were analysed using template analysis. Results Participants grounded their consideration of choice in the NHS within the GP consultation. Four main themes about choice were identified: positive aspects of choice; the appearance of choice; unwanted choice; and the role of information in choice. In particular, there was strong assent to the value of choice in principle and having choice was seen as positive. The provision of choice options, however, was not always associated with the possibility of meaningful choice and participants felt that the appearance rather than the substance of choice was sometimes in evidence. Making – as opposed to having - choice was often unwanted and considered as indicative of erosion in trust in the GP and to occasion regret. Information was seen as a necessary but not sufficient prerequisite of informed choice Conclusion People value having choices rather than making choices but are concerned about choice provision for its own sake rather than choice that is available in a meaningful way. Health care policy that recommends an increase in choice per se may be met with scepticism which could ultimately undermine rather than promote the doctor / patient relationship

The role of CXCR4/SDF-1 and VLA-4/VCAM-1 in migration of bystander-activated T cells: implications for rheumatoid arthritis

Bystander lymphocytes generated in vitro by cytokine stimulation (IL-2, IL-6, TNFα) have previously been shown to demonstrate significant identity in phenotype and activation of monocyte signalling pathways to T cells isolated from rheumatoid arthritis (RA) synovial tissue. Tck are a therefore relevant surrogate model for studying the RA T cell. The results presented in this thesis extend previous studies of cytokine- activated T cells (Tck) through phenotypic analysis and determination of migratory responsiveness. Cytokine stimulation upregulated expression of chemokine receptors and integrins on Tck, including CXCR4, VLA-4 and LFA-1. Results of in vitro chemotaxis and extravasation studies revealed that increased expression of CXCR4 and VLA-4 integrin resulted in concentration-dependent Tck migration to their ligands, CXCL12 and VCAM-1, which could be blocked through specific inhibitors and neutralizing antibodies. Increased expression of VLA-4 and LFA-1 also resulted in increased Tck extravasation, inhibited through blockade of VLA-1, LFA-1 or their ligands. Moreover, Tck demonstrated an increased chemotactic response to RA fibroblast- like synoviocytes cultured in vitro, which could be decreased using inhibitors against VLA-4 and CXCR4. The RA/ SCID mouse model was established to assess Tck migratory responsiveness in vivo; however the model did not prove sufficiently robust to definitively determine if the in vitro results reflected the situation in vivo. The activated phenotype of Tck results in increased migratory responsiveness to chemokines and proteins found in the RA synovial joint environment. Tcks elicit proinflammatory cytokine production from monocytes, which was further increased in the migrated Tck subset. Tck also exhibit a phenotype similar to RA synovial tissue T cells, indicating that cytokine activation of T cells could contribute to RA pathogenicity by migration and subsequent cell-cell interactions, perpetuating the inflammatory cascade in RA. The CXCR4/ CXCL12 and VLA-4/ VCAM-1 axes could also potentially be exploited for therapeutic gain in treatment of RA

Transforming research on morphology into teacher practice

Research suggests that the explicit teaching of morphological principles will improve children’s spelling. Despite the fact that reference is made to morphology in English policy documents, teachers make limited use of morphology when teaching spelling, relying more heavily on phonic and visual strategies. After attending a course on role of morphemes in spelling, teachers’ own awareness of morphology increased and this was reflected in their practice. This in turn caused their pupils to make significant gains in spelling, compared to a control group. This reinforces the proposition that explicit instruction about morphemes is helpful to children’s learning. It demonstrates the fact that research can be transformed into teacher practice, but it also illustrates the difficulties. Policy documentation alone is insufficient. Professional development can effect change but this may be hard to sustain. Children’s gains are contingent on teacher’s continuing to dedicate class time to focussed intervention

Developing a new empathy-specific admissions test for applicants to medical schools: A discourse-pragmatic approach.

The ability to empathise with patients is an important professional skill for doctors. Medical students practise this skill as part of their medical education and are tested on their use of empathy within their final examination. Evidence shows that appropriate training makes a difference but natural aptitude also plays a role. Most medical schools do, therefore, probe applicants’ basic understanding of empathy at admissions interviews. The purpose of the project presented in this paper was to apply existing understanding of how empathy may be communicated in a clinical context (building on the first author’s previous literature review, 2011) to develop a new empathy-specific medical admissions interview station, probing applicants’ empathic communicative performance (not just theoretical knowledge) and fitting in the widely used Multiple Mini Interview (MMI) interview format. The paper outlines how this tool was developed, trialled and implemented by: 1) Conceptualising empathic communication in discourse-pragmatic terms, that is, as a set of specific but context-dependant empathic speech acts. 2) Formulating and trialling a written and two oral versions of a situational test, capable of probing the applicants’ ability to communicate empathically in everyday conversation and suitable for use at Norwich Medical School and other similar educational institutions

〈Article〉Softening Power : Cuteness as Organizational Communication Strategy in Japan and the West

This paper describes the use of cute communications (visual or verbal, and in various media) as an organizational communication strategy prevalent in Japan and emerging in western countries. Insights are offered for the use of such communications and for the understanding/critique thereof. It is first established that cuteness in Japan–kawaii–is chiefly studied as a sociocultural or psychological phenomenon, with too little analysis of its near-omnipresent institutionalization and conveyance as mass media. The following discussion clarifies one reason for this gap in research–the widespread conflation of \u27organizational communication\u27 with advertising/branding, notwithstanding the variety of other messaging–public relations, employee communications, public service announcements, political campaigns–conveyed through cuteness by Japanese institutions. It is then argued that what few theorizations exist of organizational kawaii communications overemphasize their negative aspects or potentials, attributing to them both too much iniquity and too much influence. Outside of Japan studies, there is even less up-to-date scholarship on organizational cuteness, critical or otherwise. And there are no such studies at all, whether focused on Japan or elsewhere, that integrate intercultural insights. In a preliminary contribution toward such knowledge, we discuss the understudied, longstanding, and increasing use of this strategy by western companies. Points of comparison and contrast with Japanese kawaii are highlighted, in both its organizational and pop-cultural aspects, drawing also on sociological studies of the west\u27s current cuteness craze. Guiding insights are offered and future research directions specified, both for those seeking to advise western organizations in communicating cutely, and for those concerned that such softening power will be abused

Wave Induced Erosion in Artificial Vegetated Beds

Source: ICHE Conference Archive - https://mdi-de.baw.de/icheArchiv

Outcomes and patients’ perspectives of transition from paediatric to adult care in inflammatory bowel disease

This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/ licenses/by-nc/4.0/AIM: To describe the disease and psychosocial outcomes of an inflammatory bowel disease (IBD) transition cohort and their perspectives. METHODS: Patients with IBD, aged > 18 years, who had moved from paediatric to adult care within 10 years were identified through IBD databases at three tertiary hospitals. Participants were surveyed regarding demographic and disease specific data and their perspectives on the transition process. Survey response data were compared to contemporaneously recorded information in paediatric service case notes. Data were compared to a similar age cohort who had never received paediatric IBD care and therefore who had not undergone a transition process. RESULTS: There were 81 returned surveys from 46 transition and 35 non-transition patients. No statistically significant differences were found in disease burden, disease outcomes or adult roles and responsibilities between cohorts. Despite a high prevalence of mood disturbance (35%), there was a very low usage (5%) of psychological services in both cohorts. In the transition cohort, knowledge of their transition plan was reported by only 25/46 patients and the majority (54%) felt they were not strongly prepared. A high rate (78%) of discussion about work/study plans was recorded prior to transition, but a near complete absence of discussion regarding sex (8%), and other adult issues was recorded. Both cohorts agreed that their preferred method of future transition practices (of the options offered) was a shared clinic appointment with all key stakeholders. CONCLUSION: Transition did not appear to adversely affect disease or psychosocial outcomes. Current transition care processes could be optimised, with better psychosocial preparation and agreed transition plans