Pharmaco-epistemology for the prescribing geriatrician

Clinicians are becoming more reliant on their interpretation of clinical trial information to guide prescribing rather than their clinical skills. Thus to improve prescribing, it is increasingly important for clinicians to have an appreciation of epistemology (the science of knowledge and its interpretation) and the broader social context of knowledge. The insights of epistemologists can be useful in understanding the different ways in which clinical trials data are interpreted

The fictive museum

At least since Duchamp's Boîte-en-valise (1935-68), artists have been making work claiming the label of Museum. Marcel Broodthaers, Claes Oldenburg, Ilya Kabakov, and Michael Blum explore this form, alongside David and Diana Wilson and Nobel Prize-winning novelist Orhan Pamuk. Assembling artefacts and labels in carefully authored contexts, these works fuse museum poetics with the means of literature and conceptual art, operating as fictive museums. Adapting the concept of fictive art from Antoinette LaFarge, the thesis develops the fictive as an as-if cognitive mode, problematising distinctions between literal and figurative, and revealing meaning to be an inherently spatial matter. This research identifies, (mis)labels, and takes par t in the fictive museum as a genre of contemporary art practice, accessioning it as a performative method to ask what fictive museums can do. The John Affey Museum (JAM) explores alternative modes of museum poetics to address the same questions. Using social media as performance platforms to restage research-as-practice, JAM forms a collection~assemblage of things: references; images; writing; performances; sculptures; academic publications; temporary exhibitions in gallery and performance spaces; and a long-term installation in Warrington Museum’s ethnology collection. JAM is accompanied by a museum catalogue in the form of an anthology of quotations, and by this thesis, comprising twenty short essays or (mis)labels for the fictive museum. The thesis proposes a sculptural, diagrammatic approach to knowledge production: an Image of thought (Deleuze), reimagined as associative constellation in fictive space

A Critical Edition of Bjarnar saga Hítdœlakappa

The aim of the thesis is a critical edition of Bjarnar saga Hítdœlakappa, providing as definitive a text as possible, based on a thorough examination of all known manuscripts of the saga. Variants and textual notes are furnished, together with a Commentary and translation, which as far as is known is the first in English. Bjarnar saga falls into two overlapping groups of sagas, those concerning poets and those which have for their theme the story of the Icelander who goes abroad, having asked his betrothed to wait for him for three years. He is delayed and in his absence his rival obtains his bride. The end of such tales is frequently tragic, as is the case with Bjarnar saga. With the exception of two fourteenth-century vellum sheets, Warner saga is preserved only in paper manuscripts from the seventeenth century and later, the principal manuscript dating from about 1650. All later copies descend from this manuscript, which, however, is itself incomplete. The lacuna in the middle cannot be filled but it is largely possible to restore the missing opening chapters by using material contained in a version of Oldfs saga helga preserved in manuscripts dating from about 1700. The saga deals with the rivalry of two Icelandic poets in their love for the same woman and in the exercise of their art. Scattered throughout the work are thirty-nine verses attributed to them. These verses are individually discussed in the Commentary, together with the question of their actual authorship. Extensive consideration has been given to the literary relations of Bjarnar saga with other Old Norse literature in endeavouring to arrive at its date of origin. No firm conclusion can be reached but the evidence appears to point to a date of around 1220 and probably to clerical authorship

Deprescribing

Medicines have adverse effects and the use of multiple medicines, polypharmacy, can be associated with poorer outcomes. Health professionals need to recognise when medicines should be ceased and how to deprescribe. Deprescribing could be considered when there is polypharmacy, adverse drug reactions, ineffective treatment, falls or when treatment goals have changed. If patients are slowly weaned off their medicines, withdrawal and rebound syndromes are usually not serious. A cautious approach to deprescribing includes two principles - stop one drug at a time and wean doses slowly over weeks and months

Falling through the gaps: exploring the role of integrated commissioning in improving transition from children’s to adults' services for young people with long-term health conditions in England

Objectives: To explore the role of integrated commissioning in improving the transition of young people with longterm conditions from child to adult services. We aimed to identify organizational and policy gaps around transition services and provide recommendations for integrated commissioning practice. Methods: Semi-structured in-depth interviews were conducted with two groups of participants: (1) twenty-four stakeholders involved in the commissioning and provision of transition services for young people with long-term conditions in two regions in England; (2) five professionals with national roles in relation to planning for transition. Transcripts were interrogated using thematic analysis. Results: There is little evidence of integrated commissioning for transitional care for young people with long-term conditions. Commissioners perceive there to be a lack of national and local policy to guide integrated commissioning for transitional care; and limited resources for transition. Furthermore, commissioning organizations responsible for transition have different cultures, funding arrangements and related practices which make inter- and intra-agency co-ordination and cross-boundary continuity of care difficult to achieve. Conclusions: Integrated commissioning may be an effective way to achieve successful transitional care for young people with long-term health conditions. However, this innovative relational approach to commissioning requires a national steer together with recognition of common values and joint ownership between relevant stakeholders

First year student expectations: Results from a university-wide student survey

Although much has been written on the first-year experience of students at higher education institutions, less attention has been directed to the expectations of students when they enter an institution for the first time. This paper provides additional insights into the expectations of students at an Australian university and highlights areas in which students’ expectations may not necessarily align with the realities of common university practices. By providing opportunities for students to articulate their expectations, staff are able to use the responses for a constructive dialogue and work towards a more positive alignment between perceived expectations and levels of student satisfaction with their experience.Geoffrey Crisp, Edward Palmer, Deborah Turnbull, Ted Nettelbeck, Lynn Ward, Amanda LeCouteur, Aspa Sarris, Peter Strelan, and Luke Schneide

Negotiating behavioural change: therapists' proposal turns in cognitive behavioural therapy

Cognitive behavioural therapy (CBT) is an internationally recognised method for treating depression. However, many of the techniques involved in CBT are accomplished within the therapy interaction in diverse ways, and with varying consequences for the trajectory of therapy session. This paper uses conversation analysis to examine some standard ways in which therapists propose suggestions for behavioural change to clients attending CBT sessions for depression in Australia. Therapists' proposal turns displayed their subordinate epistemic authority over the matter at hand, and emphasised a high degree of optionality on behalf of the client in accepting their suggestions. This practice was routinely accomplished via three standard proposal turns: (1) hedged recommendations; (2) interrogatives; and (3) information-giving. These proposal turns will be examined in relation to the negotiation of behavioural change, and the implications for CBT interactions between therapist and client will be discussed. Copyrigh