Exponentiable functors between quantaloid-enriched categories

Exponentiable functors between quantaloid-enriched categories are characterized in elementary terms. The proof goes as follows: the elementary conditions on a given functor translate into existence statements for certain adjoints that obey some lax commutativity; this, in turn, is precisely what is needed to prove the existence of partial products with that functor; so that the functor's exponentiability follows from the works of Niefield [1980] and Dyckhoff and Tholen [1987].Comment: 10 pages; correction of flaw in proo

“D’yuh like porridge”: Social talk as a relational, interactional, and clinical component of surgical consultations

Background: Small talk and social talk are often recommended to doctors as rapport building strategies for consultations. These types of talk occur across different activities in clinical consultations. Aim: To explore how small talk and social talk are used in surgical consultations. Methods: Using conversation analysis, we examined the sequential positioning and action ascription of small talk and social talk in a sample of video-recorded surgeon-patient consultations from New Zealand and Australia. Results: Small talk and social talk sequences almost always do more than build rapport in surgical interactions. Rather, they contribute in complex ways to all three institutional agendas of a consultation – clinical, interactional, and relational. Discussion: This study broadens previous topic-based analyses and binary or linear conceptualisations. We show that small talk and social talk provide a rich resource for enabling different actions within consultations as well as managing relationships (e.g. managing transitions between activities, facilitating sensitive discussions or examinations, and supporting treatment planning). Conclusion: This study has provided a basis for further research to more fully understand the complexities of small talk and social talk in clinical consultations, as well as considerations of how such evidence might best be applied within training and assessment for clinicians

"Was That My Misunderstanding?": Managing Miscommunication and Problematic Talk at Work

Where workplace communication is ineffective or problematic there will often be negative outcomes for individuals, teams or organisations as a whole. This thesis examines these issues using data from a variety of New Zealand workplaces, including most importantly an in depth case study of problematic communication in a multicultural factory team. The thesis provides an illustrative analysis of the communication issues that typically arise in these workplaces and the discursive strategies used to manage miscommunication and problematic talk, as well as exploring some of the analytic and theoretical issues which emerge when we attempt to identify instances of miscommunication and diagnose how they came about. The practical implications for workplaces are also discussed. After evaluating previous approaches, the author proposes a comprehensive working model for analysing miscommunication or problematic discourse in workplace interaction which is based on a flexible multi-layered theoretical and methodological framework. The analytic approach taken is to apply the tools of sociolinguistic discourse analysis to data from actual interactions along with associated ethnographic information, in conjunction with a critical analysis of organisational communication practices and processes as seen from a community of practice perspective. A multi-dimensional intertextual approach such as this allows analysis of miscommunication and problematic talk at a number of different levels in order to relate what is happening sequentially and 'on-line' during particular interactions or sequences of interaction to factors such as social identity, group membership, team culture and other aspects of the wider communicative and socio-cultural context

Talking at cross-purposes?: the effect of gender on New Zealand primary schoolchildren's interaction strategies in pair discussions

This thesis explores one aspect of the relationship between sex and language. Twenty pairs of eleven and twelve year old children were tape-recorded during two discussion tasks. Quantitative and qualitative analyses of the data were carried out to investigate to what extent previously reported sex differences in interactional style could be observed in this group of New Zealand school children. Particular attention was paid to the relationship between such differences and the way in which children learn through talk in peer discussion. Two general hypotheses were tested: (i) that girls would tend to use a more collaborative, polite, and affiliative style of interaction, while boys would tend to use a more competitive, task-oriented style, paying less attention to the processes of interaction, and (ii) that the style of interaction associated with females would be more conducive to effective discussion from a pedagogical point of view. There were no significant sex differences in the use of interruptive forms and overlaps. However, the girls produced more talk relative to the boys in the mixed-sex context, supportive minimal responses were distributed differently, suggesting different norms as to their use and function, and there was a marked sex difference in the use of strategies for expressing disagreement: the boys were over four times more likely than the girls to produce bald, unmodified disagreements (approximately half of their total disagreement responses), while over 90% of the girls' disagreement responses were qualified in some way. These differences in style were linked to the results of the qualitative analysis of the data which provided clear evidence that the sex composition of the dyads was an important variable in determining the overall quality of discussion, with the girls more likely to facilitate effective, open-ended, elaborated discussion than the boys

The multimodality and temporality of pain displays

The present paper takes an interactional approach to the problem of communicating pain. We ask how a shared understanding of this subjective and internal experience is accom- plished. The focus is on the multimodal features of pain displays and the way they emerge and progress at the micro level of turn construction and sequence organisation within health care interactions. The setting of the study is family doctor-patient primary care consultations. Using multimodal conversation analysis, we show the emergent, temporal unfolding nature of pain displays. Initially there is an embodied reflex-like action where an immediately prior cause can be attributed retrospectively. An interjection or non-lexical vocalization may follow. An expression of stance on the pain is routinely made as talk is resumed. The other party’s understanding can be shown early in the pain display shaping its unfolding with empathetic vocalizations and/or comforting touch which results in a jointly produced change in the trajectory of action. The implications of the findings for theoretical understandings of sound objects, language and communication, and for clinical practice, are discussed.Funding: NZ Health Research Council; Royal NZ Marsden Fund; University of Otago; Swedish Research CouncilSwedish Research CouncilEuropean Commission [VR 201600827]</p

Integrating Health Navigation and Interpreting Services for Patients with Limited English Proficiency

EXECUTIVE SUMMARY New Zealand’s increasingly diverse population means that many patients come from linguistic and cultural backgrounds that make it more difficult for them to effectively access the New Zealand health system. The clinical risks of inadequate medical communication are well-known and for limited English proficient (LEP) patients, this can result from both linguistic and cultural reasons including simple lack of knowledge about our health system. One approach for addressing this problem has been patient liaison or navigator services aimed at specific ethnic groups, most commonly Maori or Pacific. The provision of effective professional interpreting services in New Zealand has also recently increased. However, research on interpreting in primary care conducted by the ARCH (Applied Research on Communication in Health) Group in 2012-13 found issues with the narrow role boundaries of interpreters; often patients and their health professionals want help with practical matters that lie outside the narrow bounds of interpreting, the kind of assistance that health navigators may provide. Given the recent development of the Pacific Navigation Service for primary health care in Wellington (run by Compass Health and Well Health PHOs under contract to C&CDHB), it was decided to research this group as well as the hospital-based Pacific Health Unit in Wellington to investigate their experience with how their service interfaces with interpreting services. Investigating the experiences of patients and health professionals using the services was unfortunately beyond the scope of this study. While there are well-developed Hauora Maori navigation services, these were not selected for study because the vast majority of Maori patients do not have limited English proficiency and the issue of their interface with interpreters does not therefore arise. This study was conducted in 2015-16. Aim To investigate the interface between health navigators and interpreters in overcoming barriers to health care for patients with Limited English Proficiency (LEP) in the Wellington region. Method We reviewed the international literature on the topic. We conducted individual or group interviews with two managers and six staff of the community-based Pacific Navigation Service (PNS), with the manager and three staff of the Pacific Health Unit (PHU) of Wellington Hospital, and with an independent contractor involved in the process to establish the navigation service. For the purpose of this report, the staff of both services will be referred to as navigators, although this is not the formal title used in the PHU. These interviews elicited views and experiences regarding (i) the barriers to LEP patients obtaining quality health care, and (ii) their own roles, including how these intersect with other support services for this population. We conducted a framework analysis of the interview transcripts, with additional analysis of emergent themes. Key Findings The literature review found a wide range of barriers to health care for patients from culturally and linguistically diverse backgrounds (CALD). These were related both to the design of the health system (for example, complexity, and opening hours and locations of facilities) as well as to characteristics of the communities (for example, language and cultural features). The benefits of having some kind of health worker who is a member of such communities has been recognised for some time as an effective way to help overcome these barriers. The review highlighted the great variety of terms used for similar roles, but key attributes are that these workers are trusted by patients and that they perform a wide range of tasks. The interviewees identified a similar range of barriers to those raised in the literature, plus some additional points such as the often incompatible communication styles of health professionals and of Pacific people in general, and the way that cultural attitudes like a deep sense of pride and a sense of deference to authority common in Pacific cultures can impact on how Pacific people engage with the health system. The range of roles performed by navigators was also similar to those raised in the literature. There was an emphasis on the holistic and wide-ranging nature of the job. There are issues with raising and maintaining awareness of the service and what it does with health professionals and the public, and with resourcing. There was also felt to be some mismatch between the holistic aims of the service and the referral criteria which often focus on a single indicator such as DNA (Did Not Attend). Our research found there is a significant overlap between the roles of navigators and interpreters in the study area, with navigators routinely interpreting for patients, especially in the hospital. Overcoming a language barrier was felt to be a major part of the navigator role, but navigators emphasised that they often did this in a qualitatively different way to that of a professional interpreter. In particular, participants felt that it was important to do more than to only interpret the words of the health professional, often explaining more fully in ways that their community will understand. However, it was also noted that this would not be so necessary if health professionals communicated more clearly using simpler language and visual aids, for example. In order to interpret effectively, navigators felt that some degree of health knowledge was important, as well as the greater depth of relationship afforded by the ongoing contact that a navigator often has with a patient. It was noted that critical conversations (such as informed consent) should require the use of professional interpreters, possibly in addition to a navigator, but that clinicians did not always make use of these. It was acknowledged that some formal training in interpreting is desirable for navigators so that they can have some form of accreditation but there was frustration with the lack of a course tailored to their needs. Interviewees described what they saw as shortcomings in the professional interpreters they had seen in action, and saw the strictly confined role of professional interpreters as an impediment to providing the help needed to get the best outcome for patients. The concept of an explicitly combined navigator/interpreter role was supported, partly because this is what is happening in practice already. Training and formal recognition of this is desirable as well as the formal development of the scope of practice to clearly delineate the role. Limitations of the study The study only investigated the issue from the point of view of those involved in health navigation in a single area of New Zealand (Wellington). The views of interpreters, health professionals and service users were not investigated. Discussion and Conclusions Navigators in the Pacific services studied here have a challenging and complex role. It is evident that they are fulfilling a genuine need in their community. As a group, they need a broad range of skills and attributes, the core of which are strong community networks, sound health knowledge, and well-developed cultural and communication skills. Interpreting is more strongly interwoven into the role of the navigator in these services than the researchers had initially expected. There is some tension between the fact that this is something that navigators do (and do well), and the fact that they do not receive significant interpreting training or official acknowledgement of this aspect of their role. Pacific navigators felt Pacific patients may prefer to be assisted by a navigator (or indeed a family member) rather than a professional interpreter. Navigators expressed concerns about the confidentiality of interpreters and it is likely that their communities have a similar perception. Pacific navigators are perhaps more likely to be trusted by their clients due to their association with a health organisation. Navigators are also able to spend more time with patients than interpreters can, and this allows greater development of personal relationships and encourages the development of trust. The Pacific aversion to using telephones also works against the use of telephone interpreters which is a common way of delivering professional interpreting but not so much for navigation services. It should be noted that there are rare examples where professional interpreters are employed by some general practices that have large numbers of patients from a particular ethnic community, and such interpreters are also able to establish good relationships with patients and have a high degree of trust from their community. Over and above this perceived Pacific dispreference for professional interpreters is the fact that Pacific navigators have a different view of the kind of language help that their community needs, compared to the strictly executed interpreting that is espoused by professional interpreting services. Pacific navigators believe that more is needed for their clientele to communicate health messages effectively and that professional training in health or social work is needed to be able to adequately support their clients. For this reason, they would be in favour of navigators receiving additional training in interpreting on a firm health or social work base, rather than interpreters receiving additional training in health. The desire for specific training in interpreting for navigators came with the proviso that such training needs to be tailored to the requirements of their role. Reading between the lines of the many stories of unnecessary duplication or complexity caused by multiple staff interactions, we would suggest that LEP patients in general, including those within the Pacific community, can be better served by receiving assistance from a single person or team. Such a person or team is better able to get to know LEP patients and their circumstances and be able to assist with overcoming a range of barriers, including the language barrier. This needs to be officially recognised in policies and training. With acknowledgement that multiple roles are performed by a single person or team comes a need for clear communication about these roles. There needs to be explicit discussion of role at a local level with patients, their families and clinicians to ensure that all understand what to expect and what the relevant boundaries are. It is also important that the navigation teams themselves continue their current reported practice of ongoing clarification of roles, as participants at times reported slightly different interpretations of their role boundaries, particularly with respect to assisting clients with non-health agencies. We agree with the research participants about the importance of clear definitions for when a task is beyond the navigators’ scope of practice and should be referred on to an appropriate professional (such as a professional interpreter, social worker etc.). There may be a need for professional supervision to manage these boundaries. While individual navigators need to perform multiples roles, it is also true that the full breadth and depth of skills required by navigators cannot be expected to be present in any one individual but needs to be distributed across a team. This is especially true in terms of language skills. Allocating cases on the basis of best fit of navigator to case, as currently happens within each service, makes sense in this context. For example, cases may be assigned to specific navigators according to their training (nurse or social worker) or previous experience as well as according to their languages so that clients are matched with the most appropriate staff member for their situation. The Pacific community is the only community (or more accurately, set of communities) with LEP patients in the Wellington area that has a formal navigation service. Our findings suggest that Pacific patients are effectively assisted to overcome a range of barriers, including the language barrier, by these services. We would suggest that other CALD/LEP communities beyond the Pacific community would also benefit from such a service in combination with interpreting services. However, while Pacific navigators firmly believe that it is best for navigators to add interpreting skills to their training, rather than trying to train interpreters as navigators, this may not be the case in other CALD communities. Further consultation within such communities or those working with them (interpreters and health professionals) will be required to determine how services should best be designed for them. However, the views of the participants in this study suggest that meaningful health knowledge in those taking on such roles is likely to be a key element. It is also important to delineate the most important barrier(s) affecting the outcome for each presenting client, and tailor the navigator intervention to that barrier. Again, a comprehensive service with well-trained staff covering a range of skills, training and experience would seem to be the best way to make this possible, since there are so many potential barriers to care. The configuration of services – i.e. whether a service is based in a hospital or in the community or spans both – also needs to be sensitive to the best way to address particular barriers. For example, addressing DNA rates at hospital clinics and providing language services to inpatients is best done from within a hospital based service. Following up on families with outstanding immunisations is best done by a community based service. Navigation for a person with a complex condition (cancer or multiple co-morbidities) is best done from a service that is case-based that can span all sectors. The participants highlighted the effectiveness of working in such a way that the diverse needs of clients are met by a team with diverse skills. This strengthens an argument for developing more overlap or integration between the two services (community- and hospital-based) as this would create an even larger pool of skills to draw from. In addition, a more integrated service would also enable greater continuity of care across the settings which would further capitalise on the benefits of stronger individual relationships. Better integration with other services in the community is also desirable. Also worthy of reconsideration may be the current focus on individual clients. Although not a question specifically addressed in this research, participant responses suggested that a household focus could be more useful and cost-effective in addressing barriers for a number of individuals in a single household. Given the family structure of many Pacific households (and probably other CALD communities), a household approach may be more culturally appropriate as well as improving efficiency. Overall, we believe the strengths of the current Pacific navigation services should be built on and lessons learned from their experiences are likely to be useful when considering similar services to assist other CALD communities. Further research into the views of other stakeholders in this area would be very desirable. Recommendations/Implications The following recommendations are suggested by our findings. Recommendations 1-3, it should be noted, are already happening to some degree but are important to highlight so that greater consistency across staff can be achieved. (1) The scopes of practice for the various types of navigators (depending on training and experience in other professions such as nursing and social work) need to be clearly defined and clear guidelines about when to refer on and to whom should continue to be developed. (2) Navigators need to be fully aware of the wide range of roles they perform and to have a clear idea of their individual scope of practice. (3) Navigators need to be aware of what role they are taking with any particular client at any particular time. This should be discussed with patients and health professionals to ensure clarity. They also need to be able to clearly assess when what is required is out of their scope of practice and to bring in additional help, such as professional interpreting services. (4) Systems for training and accrediting navigators as interpreters should be investigated with a view to explicitly incorporating interpreting into the navigator role. (5) Ways of providing navigation in tandem with interpreting should be explored for other communities, with consideration given to appropriate training, recruitment and funding. (6) Further work needs to be done to improve the communication skills of health professionals, including the use of visual aids, writing notes and rephrasing. (7) Professional interpreters need to be made aware of the existence of such health navigation services as there are and trained in when to call them in

Enhancing effective healthcare communication in Australia and Aotearoa New Zealand: Considerations for research, teaching, policy, and practice.

OBJECTIVE In this article we present a conceptual framework for enhancing effective healthcare communication in Australia and Aotearoa New Zealand. METHODS Through an iterative, deliberative dialogue approach, we, as experts from a variety of health professions and academic disciplines, worked together to identify core values and considerations for healthcare communication across numerous health professions and disciplines and within research, teaching, policy, and practice contexts. RESULTS The framework developed includes five core values at its centre: equitable, inclusive, evidence-based, collaborative, reflective. Around this are concentric circles showing key elements of collaborators, modality, context, and purpose. Each of these is explored. CONCLUSION This work may support benchmarking for healthcare providers, researchers, policymakers, and educators across a breadth of professions to help improve communication in clinical practice. The framework will also help to identify areas across disciplines that are shared and potentially idiosyncratic for various professions to promote interprofessional recognition, education, and collaboration. INNOVATION This framework is designed to start conversations, to form the foundation of a dialogue about the priorities and key considerations for developing teaching curricula, professional development, and research programs related to healthcare communication, providing a set of values specifically for the unique contexts of Australia and Aotearoa New Zealand. It can also be used to guide interdisciplinary healthcare professionals in advancing research, teaching, policy, and practice related to healthcare communication

International Society of Human and Animal Mycology (ISHAM)-ITS reference DNA barcoding database - the quality controlled standard tool for routine identification of human and animal pathogenic fungi

Human and animal fungal pathogens are a growing threat worldwide leading to emerging infections and creating new risks for established ones. There is a growing need for a rapid and accurate identification of pathogens to enable early diagnosis and targeted antifungal therapy. Morphological and biochemical identification methods are time-consuming and require trained experts. Alternatively, molecular methods, such as DNA barcoding, a powerful and easy tool for rapid monophasic identification, offer a practical approach for species identification and less demanding in terms of taxonomical expertise. However, its wide-spread use is still limited by a lack of quality-controlled reference databases and the evolving recognition and definition of new fungal species/complexes. An international consortium of medical mycology laboratories was formed aiming to establish a quality controlled ITS database under the umbrella of the ISHAM working group on "DNA barcoding of human and animal pathogenic fungi." A new database, containing 2800 ITS sequences representing 421 fungal species, providing the medical community with a freely accessible tool at http://www.isham.org and http://its.mycologylab.org/ to rapidly and reliably identify most agents of mycoses, was established. The generated sequences included in the new database were used to evaluate the variation and overall utility of the ITS region for the identification of pathogenic fungi at intra-and interspecies level. The average intraspecies variation ranged from 0 to 2.25%. This highlighted selected pathogenic fungal species, such as the dermatophytes and emerging yeast, for which additional molecular methods/genetic markers are required for their reliable identification from clinical and veterinary specimens.This study was supported by an National Health and Medical Research Council of Australia (NH&MRC) grant [#APP1031952] to W Meyer, S Chen, V Robert, and D Ellis; CNPq [350338/2000-0] and FAPERJ [E-26/103.157/2011] grants to RM Zancope-Oliveira; CNPq [308011/2010-4] and FAPESP [2007/08575-1] Fundacao de Amparo Pesquisa do Estado de So Paulo (FAPESP) grants to AL Colombo; PEst-OE/BIA/UI4050/2014 from Fundacao para a Ciencia e Tecnologia (FCT) to C Pais; the Belgian Science Policy Office (Belspo) to BCCM/IHEM; the MEXBOL program of CONACyT-Mexico, [ref. number: 1228961 to ML Taylor and [122481] to C Toriello; the Institut Pasteur and Institut de Veil le Sanitaire to F Dromer and D Garcia-Hermoso; and the grants from the Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq) and the Fundacao de Amparo a Pesquisa do Estado de Goias (FAPEG) to CM de Almeida Soares and JA Parente Rocha. I Arthur would like to thank G Cherian, A Higgins and the staff of the Molecular Diagnostics Laboratory, Division of Microbiology and Infectious Diseases, Path West, QEII Medial Centre. Dromer would like to thank for the technical help of the sequencing facility and specifically that of I, Diancourt, A-S Delannoy-Vieillard, J-M Thiberge (Genotyping of Pathogens and Public Health, Institut Pasteur). RM Zancope-Oliveira would like to thank the Genomic/DNA Sequencing Platform at Fundacao Oswaldo Cruz-PDTIS/FIOCRUZ [RPT01A], Brazil for the sequencing. B Robbertse and CL Schoch acknowledge support from the Intramural Research Program of the NIH, National Library of Medicine. T Sorrell's work is funded by the NH&MRC of Australia; she is a Sydney Medical School Foundation Fellow.info:eu-repo/semantics/publishedVersio