Rhetoric and reality: critical review of language policy and legislation governing official minority language use in health and social care in Wales

A concerted attempt is being made by the Welsh Government to revitalize the Welsh language in Wales through language legislation and policy initiatives. This paper explores the political rhetoric and practical reality of these recent legislative developments, as they pertain to the health care sector. It offers a qualitative analysis of written evidence provided by key stakeholders during the consultation process on the new legally-binding requirements of Welsh Language Standards for health care providers in Wales. We argue that these meso-level service providers are critical linchpins within the health care system and that it is at the meso level that full tensions between the macro rhetoric and micro reality occur. This contribution highlights shortcomings and barriers to Welsh language service provision in health care in Wales and recommends the adoption of wide-ranging, holistic approaches to language planning that meet the language needs of patients outlined by the Welsh Government.Le gouvernement gallois mène présentement une action concertée en vue de revitaliser la langue galloise au pays de Galles grâce à des mesures législatives et à des initiatives stratégiques en matière linguistique. Cet article explore la rhétorique politique et la réalité pratique de ces récents développements législatifs en ce qui a trait aux soins de santé. Il propose une analyse qualitative des preuves écrites fournies par les principales parties prenantes lors du processus de consultation sur les nouvelles exigences juridiquement contraignantes des normes de conduite concernant l’emploi de la langue galloise, applicables aux prestataires de soins de santé. Nous soutenons que ces prestataires de services de niveau intermédiaire sont des pivots essentiels du système de santé et que c’est au niveau intermédiaire que les tensions entre macro-rhétorique et micro-réalité se produisent. Notre analyse met en évidence les lacunes et les obstacles à la prestation de services en gallois dans les soins de santé au pays de Galles et recommande l’adoption d’approches holistiques dans la planification linguistique qui répondent aux besoins linguistiques des patients décrits par le gouvernement.Gwelir ymgais gan Lywodraeth Cymru i adfywio’r Gymraeg yng Nghymru trwy bolisi iaith a deddfwriaeth. Mae’r papur hwn yn archwilio i’r rhethreg wleidyddol a’r realiti ymarferol y datblygiadau deddfwriaethol diweddar hyn, yn benodol yn y sector gofal iechyd. Mae’r papur hwn yn cynnig dadansoddiad o’r dystiolaeth ysgrifenedig a gasglwyd gan rhanddeiliaid yn ystod y broses ymgynghori i ofynion cyfreithiol Safonau’r Iaith Cymraeg ar gyfer darparwyr gofal iechyd yng Nghymru. Rydym yn dadlau fod y darparwyr gwasanaethau lefel meso hyn yn gyswllt hanfodol yn y system gofal iechyd a’i bod yn lleoliad ble mae tensiynau rhwng rhethreg lefel macro Llywodraeth Cymru a realiti lefel micro’r darparwyr gwasanaeth iechyd yn cael ei amlygu. Mae’r cyfraniad hwn yn tynnu sylw at ddiffygion a rhwystrau i ddarpariaeth gwasanaethau iaith Cymraeg mewn gofal iechyd yng Nghymru ac yn argymell mabwysiadu dulliau cyfannol eang o gynllunio iaith sy’n diwallu anghenion iaith cleifion a amlinellwyd gan Lywodraeth Cymru

Does Language Dominance Affect Cognitive Performance In Bilinguals? Lifespan Evidence From Preschoolers Through Older Adults On Card Sorting, Simon, And Metalinguistic Tasks

This study explores the extent to which a bilingual advantage can be observed for three tasks in an established population of fully fluent bilinguals from childhood through adulthood. Welsh-English simultaneous and early sequential bilinguals, as well as English monolinguals, aged 3 years through older adults, were tested on three sets of cognitive and executive function tasks. Bilinguals were Welsh-dominant, balanced, or English-dominant, with only Welsh, Welsh and English, or only English at home. Card sorting, Simon, and a metalinguistic judgment task (650, 557, and 354 participants, respectively) reveal little support for a bilingual advantage, either in relation to control or globally. Primarily there is no difference in performance across groups, but there is occasionally better performance by monolinguals or persons dominant in the language being tested, and in one case-in one condition and in one age group-lower performance by the monolinguals. The lack of evidence for a bilingual advantage in these simultaneous and early sequential bilinguals suggests the need for much closer scrutiny of what type of bilingual might demonstrate the reported effects, under what conditions, and why.published_or_final_versio

Torsades de pointes during laparoscopic adrenalectomy of a pheochromocytoma: a case report

<p>Abstract</p> <p>Introduction</p> <p>Torsades de pointes is a rare but potentially lethal arrhythmia. The amount of literature available on Torsades de pointes occurring in patients with pheochromocytoma is limited, and we found no literature describing this dysrhythmia in a patient with pheochromocytoma under anesthesia.</p> <p>Case presentation</p> <p>We describe the case of a 42-year-old Caucasian woman without QT prolongation preoperatively with recurrent Torsades de pointes during laparoscopic removal of a pheochromocytoma. Torsades de pointes mainly occurs in the setting of a prolonged QT interval. This patient neither had a prolonged QT preoperatively nor was her family history suspect for a congenital long QT syndrome. Most likely, our patient had an acquired long QT syndrome, elicited by the combination of flecainide, hypomagnesemia and adrenergic stimulation during manipulation of the tumor.</p> <p>Conclusion</p> <p>We show that in the case of a surgical pheochromocytoma removal, perioperative conditions can elicit an acquired or previously unknown congenital long QT syndrome. Therefore, preoperative α- and β-blockade is advised, QT-prolonging drugs should be avoided and potassium and magnesium plasma levels should be kept at normal to high levels.</p

Is there an optimal preoperative management strategy for phaeochromocytoma/paraganglioma?

Phaeochromocytomas and paragangliomas (PPGLs) are catecholamine secreting neuroendocrine tumours that predispose to haemodynamic instability. Currently, surgery is the only available curative treatment, but carries potential risks including hypertensive and hypotensive crises, cardiac arrhythmias, myocardial infarction and stroke, due to tumoral release of catecholamines during anaesthetic induction and tumour manipulation. The mortality associated with surgical resection of PPGL has significantly improved from 20-45% in the early 20th century (Apgar & Papper, AMA Archives of Surgery, 1951, 62, 634) to 0-2·9% in the early 21st century (Kinney et al. Journal of Cardiothoracic and Vascular Anesthesia, 2002, 16, 359), largely due to availability of effective pharmacological agents and advances in surgical and anaesthetic practice. However, surgical resection of PPGL still poses significant clinical management challenges. Preoperatively, alpha-adrenoceptor blockade is the mainstay of management, although various pharmacological strategies have been proposed, based largely on reports derived from retrospective data sets. To date, no consensus has been reached regarding the 'ideal' preoperative strategy due, in part, to a paucity of data from high-quality evidence-based studies comparing different treatment regimens. Here, based on the available literature, we address the Clinical Question: Is there an optimal preoperative management strategy for PPGL?National Institute for Health Research Cambridge Biomedical Research Centr