“What’ s wrong with that woman?” – Positioning Theory and Information-Seeking Behaviour

Abstract We offer social positioning theory (Davies and Harre 1990) as a framework for exploring the ways in which the visibility of an individual’ s health status is linked to socially constructed subjectivities that can affect the individual’ s informationseeking behaviour. Qualitative analysis of data from two doctoral studies (collected through participant observation and 40 semi-structured interviews) illustrates the utility of social positioning theory as a framework for studying two specific health contexts: systematic lupus erythematosus, and twin pregnancy. Adopting a ‘ position’ involves the use of discursive practices which define the relations between self and others. Such practices frequently draw upon common social representations of particular phenomena (Van Langehove and Harre 1994). Our findings indicate that the visibility of health status is related to subject positioning, and that positioning theory offers insight into the mutually specifying correspondence between local discursive practices and styles of information behavior. The pregnant woman’ s expanding abdomen makes her health status evident to others, often positioning her as a willing recipient of advice and information (Browner and Press 1997). Cultural assumptions associated with “ twins” can both facilitate and constrain the woman’ s information seeking (“ Better you than me.” ). However, the stock of shared cultural understandings associated with lupus is comparatively sparse (Senecal 1991). Symptoms such as hair loss, skin rash, and weight gain may therefore lead to positions which are experienced by novice patients as stigmatizing (“ What’ s wrong with that woman?” ). Even when evident symptoms disappear, the stigmatized position can be maintained through secrecy (“ No one can tell I have lupus.” ). In these situations, information-seeking is relegated to the confidential encounters characteristic of expert disciplinary regimes. As a heuristic tool, then, positioning theory provides an opportunity for analysis of the means by which the information-seeking subject is configured through discursive encounters

Simultaneous ultrasound identification of acute appendicitis, septic thrombophlebitis of the portal vein and pyogenic liver abscess

A 17-year-old youth from a rural background presented to a secondary hospital with a 3-week history of epigastric pain, constipation and weight loss. He had a temperature of 40°C, marked right upper quadrant tenderness and a white cell count of 21.1 ´ 109/l. The chest and abdominal radiographs were normal, but an abdominal ultrasound scan showed two small areas of low echogenicity in the left lobe of the liver consistent with abscesses (Fig. 1). The main portal vein was distended, measuring 16 mm in diameter, and contained echogenic material indicative of thrombus (Fig. 2). In the right iliac fossa there were features of an inflamed appendix, as demonstrated by an 8 mm diameter tubular, non-compressible, fluid-filled viscus, with a distal blind end and an echogenic focus filling the lumen proximally (Fig. 3). A diagnosis was made of acute appendicitis, complicated by septic thrombophlebitis of the portal vein (pylephlebitis) and pyogenic liver abscesses. Appendicectomy was performed later that day, revealing an inflamed appendix, confirmed histologically. The patient was treated with perioperative intravenous triple antibiotics and commenced on anticoagulants following surgery. Discharge was on the 10th postoperative day. Regular out-patient follow-up documented progressive decrease in the size of the portal vein thrombus and the liver abscesses. The abdominal ultrasound scan 4 months post-surgery demonstrated a completely normal upper abdome

Fast simulation of a quantum phase transition in an ion-trap realisable unitary map

We demonstrate a method of exploring the quantum critical point of the Ising universality class using unitary maps that have recently been demonstrated in ion trap quantum gates. We reverse the idea with which Feynman conceived quantum computing, and ask whether a realisable simulation corresponds to a physical system. We proceed to show that a specific simulation (a unitary map) is physically equivalent to a Hamiltonian that belongs to the same universality class as the transverse Ising Hamiltonian. We present experimental signatures, and numerical simulation for these in the six-qubit case.Comment: 12 pages, 6 figure

Spatial heterogeneity of tectonic stress and friction in the crust

The complex geometry of faults, seismicity, and diversity of earthquake mechanisms suggest that the stress and strength in Earth's crust are spatially heterogeneous. We investigated the degree of heterogeneity using the following two end-member models. In one end-member model, we assumed that the orientation of stress is uniform in the crust as is assumed in many stress inversion studies. In this model, the variability of earthquake mechanisms means that friction during faulting must vary for each event. We computed friction μ from the ratio of the resolved shear stress to the effective normal stress on the fault plane with the assumption of hydrostatic pore pressure. The values of μ vary over a large range from 0 to 1.5. In the other extreme model we assumed optimally oriented slip and a constant μ = 0.6, as is suggested by Byerlee's law, for all the earthquakes, and determined the local stress orientation for each earthquake. The orientation of the stress changes drastically from one earthquake to another, and the assumption of uniform stress field commonly used in stress inversion is not warranted. An important conclusion is that a regionally uniform stress field and constant friction on optimally oriented faults are mutually exclusive. The actual situation in the crust is most likely to be intermediate between these two end-member models. From the existing data alone, we cannot determine the degree of heterogeneity uniquely, but both μ and the local stress field near earthquake faults are likely to vary substantially, and studies on earthquake rupture dynamics must take these heterogeneities into consideration

Identifying factors likely to influence compliance with diagnostic imaging guideline recommendations for spine disorders among chiropractors in North America: a focus group study using the Theoretical Domains Framework

Background: The Theoretical Domains Framework (TDF) was developed to investigate determinants of specific clinical behaviors and inform the design of interventions to change professional behavior. This framework was used to explore the beliefs of chiropractors in an American Provider Network and two Canadian provinces about their adherence to evidence-based recommendations for spine radiography for uncomplicated back pain. The primary objective of the study was to identify chiropractors’ beliefs about managing uncomplicated back pain without xrays and to explore barriers and facilitators to implementing evidence-based recommendations on lumbar spine xrays. A secondary objective was to compare chiropractors in the United States and Canada on their beliefs regarding the use of spine x-rays. Methods: Six focus groups exploring beliefs about managing back pain without x-rays were conducted with a purposive sample. The interview guide was based upon the TDF. Focus groups were digitally recorded, transcribed verbatim, and analyzed by two independent assessors using thematic content analysis based on the TDF. Results: Five domains were identified as likely relevant. Key beliefs within these domains included the following: conflicting comments about the potential consequences of not ordering x-rays (risk of missing a pathology, avoiding adverse treatment effects, risks of litigation, determining the treatment plan, and using x-ray-driven techniques contrasted with perceived benefits of minimizing patient radiation exposure and reducing costs; beliefs about consequences); beliefs regarding professional autonomy, professional credibility, lack of standardization, and agreement with guidelines widely varied (social/professional role & identity); the influence of formal training, colleagues, and patients also appeared to be important factors (social influences); conflicting comments regarding levels of confidence and comfort in managing patients without x-rays (belief about capabilities); and guideline awareness and agreements (knowledge). Conclusions: Chiropractors’ use of diagnostic imaging appears to be influenced by a number of factors. Five key domains may be important considering the presence of conflicting beliefs, evidence of strong beliefs likely to impact the behavior of interest, and high frequency of beliefs. The results will inform the development of a theorybased survey to help identify potential targets for behavioral-change strategies

The Search for Invariance: Repeated Positive Testing Serves the Goals of Causal Learning

Positive testing is characteristic of exploratory behavior, yet it seems to be at odds with the aim of information seeking. After all, repeated demonstrations of one’s current hypothesis often produce the same evidence and fail to distinguish it from potential alternatives. Research on the development of scientific reasoning and adult rule learning have both documented and attempted to explain this behavior. The current chapter reviews this prior work and introduces a novel theoretical account—the Search for Invariance (SI) hypothesis—which suggests that producing multiple positive examples serves the goals of causal learning. This hypothesis draws on the interventionist framework of causal reasoning, which suggests that causal learners are concerned with the invariance of candidate hypotheses. In a probabilistic and interdependent causal world, our primary goal is to determine whether, and in what contexts, our causal hypotheses provide accurate foundations for inference and intervention—not to disconfirm their alternatives. By recognizing the central role of invariance in causal learning, the phenomenon of positive testing may be reinterpreted as a rational information-seeking strategy

The largest deep-ocean silicic volcanic eruption of the past century

© The Author(s), 2018. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Science Advances 4 (2018): e1701121, doi:10.1126/sciadv.1701121.The 2012 submarine eruption of Havre volcano in the Kermadec arc, New Zealand, is the largest deep-ocean eruption in history and one of very few recorded submarine eruptions involving rhyolite magma. It was recognized from a gigantic 400-km2 pumice raft seen in satellite imagery, but the complexity of this event was concealed beneath the sea surface. Mapping, observations, and sampling by submersibles have provided an exceptionally high fidelity record of the seafloor products, which included lava sourced from 14 vents at water depths of 900 to 1220 m, and fragmental deposits including giant pumice clasts up to 9 m in diameter. Most (>75%) of the total erupted volume was partitioned into the pumice raft and transported far from the volcano. The geological record on submarine volcanic edifices in volcanic arcs does not faithfully archive eruption size or magma production.This research was funded by Australian Research Council Postdoctoral fellowships (DP110102196 and DE150101190 to R. Carey), a short-term postdoctoral fellowship grant from the Japan Society for the Promotion of Science (to R. Carey), National Science Foundation grants (OCE1357443 to B.H., OCE1357216 to S.A.S., and EAR1447559 to J.D.L.W.), and a New Zealand Marsden grant (U001616 to J.D.L.W.). J.D.L.W. and A.M. were supported by a research grant and PhD scholarship from the University of Otago. R.W. was supported by NIWA grant COPR1802. J.D.L.W. and F.C.-T. were supported by GNS Science grants CSA-GHZ and CSA-EEZ. M.J. was supported by the U.S. Department of Defense (DoD) through the National Defense Science and Engineering Graduate Fellowship (NDSEG) Program

IMPLEmenting a clinical practice guideline for acute low back pain evidence-based manageMENT in general practice (IMPLEMENT) : cluster randomised controlled trial study protocol

Background: Evidence generated from reliable research is not frequently implemented into clinical practice. Evidence-based clinical practice guidelines are a potential vehicle to achieve this. A recent systematic review of implementation strategies of guideline dissemination concluded that there was a lack of evidence regarding effective strategies to promote the uptake of guidelines. Recommendations from this review, and other studies, have suggested the use of interventions that are theoretically based because these may be more effective than those that are not. An evidencebased clinical practice guideline for the management of acute low back pain was recently developed in Australia. This provides an opportunity to develop and test a theory-based implementation intervention for a condition which is common, has a high burden, and for which there is an evidence-practice gap in the primary care setting. Aim: This study aims to test the effectiveness of a theory-based intervention for implementing a clinical practice guideline for acute low back pain in general practice in Victoria, Australia. Specifically, our primary objectives are to establish if the intervention is effective in reducing the percentage of patients who are referred for a plain x-ray, and improving mean level of disability for patients three months post-consultation. Methods/Design: This study protocol describes the details of a cluster randomised controlled trial. Ninety-two general practices (clusters), which include at least one consenting general practitioner, will be randomised to an intervention or control arm using restricted randomisation. Patients aged 18 years or older who visit a participating practitioner for acute non-specific low back pain of less than three months duration will be eligible for inclusion. An average of twenty-five patients per general practice will be recruited, providing a total of 2,300 patient participants. General practitioners in the control arm will receive access to the guideline using the existing dissemination strategy. Practitioners in the intervention arm will be invited to participate in facilitated face-to-face workshops that have been underpinned by behavioural theory. Investigators (not involved in the delivery of the intervention), patients, outcome assessors and the study statistician will be blinded to group allocation. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN012606000098538 (date registered 14/03/2006).The trial is funded by the NHMRC by way of a Primary Health Care Project Grant (334060). JF has 50% of her time funded by the Chief Scientist Office3/2006). of the Scottish Government Health Directorate and 50% by the University of Aberdeen. PK is supported by a NHMRC Health Professional Fellowship (384366) and RB by a NHMRC Practitioner Fellowship (334010). JG holds a Canada Research Chair in Health Knowledge Transfer and Uptake. All other authors are funded by their own institutions

Glacier loss and hydro-social risks in the Peruvian Andes

Accelerating glacier recession in tropical highlands and in the Peruvian Andes specifically is a manifestation of global climate change that is influencing the hydrologic cycle and impacting water resources across a range of socio-environmental systems. Despite predictions regarding the negative effects of long-term glacier decline on water availability, many uncertainties remain regarding the timing and variability of hydrologic changes and their impacts. To improve context-specific understandings of the effects of climate change and glacial melt on water resources in the tropical Andes, this article synthesizes results from long-term transdisciplinary research with new findings from two glacierized Peruvian watersheds to develop and apply a multi-level conceptual framework focused on the coupled biophysical and social determinants of water access and hydro-social risks in these contexts. The framework identifies several interacting variables—hydrologic transformation, land cover change, perceptions of water availability, water use and infrastructure in local and regional economies, and water rights and governance—to broadly assess how glacier change is embedded with social risks and vulnerability across diverse water uses and sectors. The primary focus is on the Santa River watershed draining the Cordillera Blanca to the Pacific. Additional analysis of hydrologic change and water access in the geographically distinct Shullcas River watershed draining the Huaytapallana massif towards the city of Huancayo further illuminates the heterogeneous character of hydrologic risk and vulnerability in the Andes