Situationally-sensitive knowledge translation and relational decision making in hyperacute stroke: a qualitive study

Stroke is a leading cause of disability. Early treatment of acute ischaemic stroke with rtPA reduces the risk of longer term dependency but carries an increased risk of causing immediate bleeding complications. To understand the challenges of knowledge translation and decision making about treatment with rtPA in hyperacute stroke and hence to inform development of appropriate decision support we interviewed patients, their family and health professionals. The emergency setting and the symptomatic effects of hyper-acute stroke shaped the form, content and manner of knowledge translation to support decision making. Decision making about rtPA in hyperacute stroke presented three conundrums for patients, family and clinicians. 1) How to allow time for reflection in a severely time-limited setting. 2) How to facilitate knowledge translation regarding important treatment risks and benefits when patient and family capacity is blunted by the effects and shock of stroke. 3) How to ensure patient and family views are taken into account when the situation produces reliance on the expertise of clinicians. Strategies adopted to meet these conundrums were fourfold: face to face communication; shaping decisions; incremental provision of information; and communication tailored to the individual patient. Relational forms of interaction were understood to engender trust and allay anxiety. Shaping decisions with patients was understood as an expression of confidence by clinicians that helped alleviate anxiety and offered hope and reassurance to patients and their family experiencing the shock of the stroke event. Neutral presentations of information and treatment options promoted uncertainty and contributed to anxiety. ‘Drip feeding’ information created moments for reflection: clinicians literally made time. Tailoring information to the particular patient and family situation allowed clinicians to account for social and emotional contexts. The principal responses to the challenges of decision making about rtPA in hyperacute stroke were relational decision support and situationally-sensitive knowledge translation

Capability in the digital: institutional media management and its dis/contents

This paper explores how social media spaces are occupied, utilized and negotiated by the British Military in relation to the Ministry of Defence’s concerns and conceptualizations of risk. It draws on data from the DUN Project to investigate the content and form of social media about defence through the lens of ‘capability’, a term that captures and describes the meaning behind multiple representations of the military institution. But ‘capability’ is also a term that we hijack and extend here, not only in relation to the dominant presence of ‘capability’ as a representational trope and the extent to which it is revealing of a particular management of social media spaces, but also in relation to what our research reveals for the wider digital media landscape and ‘capable’ digital methods. What emerges from our analysis is the existence of powerful, successful and critically long-standing media and reputation management strategies occurring within the techno-economic online structures where the exercising of ‘control’ over the individual – as opposed to the technology – is highly effective. These findings raise critical questions regarding the extent to which ‘control’ and management of social media – both within and beyond the defence sector – may be determined as much by cultural, social, institutional and political influence and infrastructure as the technological economies. At a key moment in social media analysis, then, when attention is turning to the affordances, criticisms and possibilities of data, our research is a pertinent reminder that we should not forget the active management of content that is being similarly, if not equally, effective

Intra-annual patterns of tracheid size in the Mediterranean tree Juniperus thurifera as an indicator of seasonal water stress

Because climate can affect xylem cell anatomy, series of intra-annual cell anatomical features have the potential to retrospectively supply seasonal climatic information. In this study, we explored the ability to extract information about water stress conditions from tracheid features of the Mediterranean conifer Juniperus thurifera L. Tracheidograms of four climatic years from two drought-sensitive sites in Spain were compared to evaluate whether it is possible to link intra-annual cell size patterns to seasonal climatic conditions. Results indicated site-specific anatomical adjustment such as smaller and thicker tracheids at the dryer site but also showed a strong climatic imprint on the intra-annual pattern of tracheid size. Site differences in cell size reflected expected structural adjustments against cavitation failures. Differences between intra-annual patterns, however, indicated a response to seasonal changes in water availability whereby cells formed under drought conditions were smaller and thicker, and vice versa. This relationship was more manifest and stable at the dryer sit

Understanding and explaining the marginalization of part time British Army Reservists

Recent changes in the British Army mean part time Reservists and full time Regulars need to become better integrated. However, there has been a long history of workplace tensions between the full time and part time elements in the British Army. This mirrors those found in many civilian workplaces. Focus group data with 105 full time Regular British Army soldiers confirmed that time and emotional commitment are strongly linked in a full time professional workplace that has strong, definite and enduring boundaries. This, alongside demands for conformity and stratification by rank explained the high risk of marginalization of part time Reservists. The legitimacy of part time Reservists, especially in the combat arms, was often challenged. Using this explanatory framework some implications and practical ways that tensions may be reduced between full time and part time members of the British Army, and other Armed Forces facing similar tensions, were highlighted