Stand-up comedy: manipulation and influence

This thesis interprets the craft of stand-up comedy as a series of manipulations. In a medium where interaction with the audience IS often unruly, manipulation IS frequently used to maintain the performer's control over his audience, and to persuade them to laugh. Comedians may also go beyond the immediate manipulation of response to have a more significant influence, persuading audiences to subvert their usual standards of morality, and shaping or re-shaping their opinions and attitudes. By examining the work and methodology of practitioners across the current British alternative stand-up comedy scene, I aim to show some of the common manipulations used by stand-up comedians, and to demonstrate the possibilities that this medium has for political efficacy. I argue that stand-up comedy plays a significant role in influencing the attitudes and opinions of individuals, and in negotiating wider social norms

Identifying features associated with higher-quality hospital care and shorter length of admission for people with dementia : a mixed-methods study

Background: Concerns have repeatedly been expressed about the quality of inpatient care that people with dementia receive. Policies and practices have been introduced that aim to improve this, but their impact is unclear. Aims: To identify which aspects of the organisation and delivery of acute inpatient services for people with dementia are associated with higher-quality care and shorter length of stay. Design: Mixed-methods study combining a secondary analysis of data from the third National Audit of Dementia (2016/17) and a nested qualitative exploration of the context, mechanism and outcomes of acute care for people with dementia. Setting: Quantitative data from 200 general hospitals in England and Wales and qualitative data from six general hospitals in England that were purposively selected based on their performance in the audit. Participants: Quantitative data from clinical records of 10,106 people with dementia who had an admission to hospital lasting ≥ 72 hours and 4688 carers who took part in a cross-sectional survey of carer experience. Qualitative data from interviews with 56 hospital staff and seven carers of people with dementia. Main outcome measures: Length of stay, quality of assessment and carer-rated experience. Results: People with dementia spent less time in hospital when discharge planning was initiated within 24 hours of admission. This is a challenging task when patients have complex needs, and requires named staff to take responsibility for co-ordinating the discharge and effective systems for escalating concerns when obstacles arise. When trust boards review delayed discharges, they can identify recurring problems and work with local stakeholders to try to resolve them. Carers of people with dementia play an important role in helping to ensure that hospital staff are aware of patient needs. When carers are present on the ward, they can reassure patients and help make sure that they eat and drink well, and adhere to treatment and care plans. Clear communication between staff and family carers can help ensure that they have realistic expectations about what the hospital staff can and cannot provide. Dementia-specific training can promote the delivery of person-centred care when it is made available to a wide range of staff and accompanied by ‘hands-on’ support from senior staff. Limitations: The quantitative component of this research relied on audit data of variable quality. We relied on carers of people with dementia to explore aspects of service quality, rather than directly interviewing people with dementia. Conclusions: If effective support is provided by senior managers, appropriately trained staff can work with carers of people with dementia to help ensure that patients receive timely and person-centred treatment, and that the amount of time they spend in hospital is minimised. Future work: Future research could examine new ways to work with carers to co-produce aspects of inpatient care, and to explore the relationship between ethnicity and quality of care in patients with dementia. Funding: This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 22. See the NIHR Journals Library website for further project information

Elevated temperature and nutrients lead to increased N2O emissions from salt marsh soils from cold and warm climates

Salt marshes can attenuate nutrient pollution and store large amounts of ‘blue carbon’ in their soils, however, the value of sequestered carbon may be partially offset by nitrous oxide (N2O) emissions. Global climate and land use changes result in higher temperatures and inputs of reactive nitrogen (Nr) into coastal zones. Here, we investigated the combined effects of elevated temperature (ambient + 5℃) and Nr (double ambient concentrations) on nitrogen processing in marsh soils from two climatic regions (Quebec, Canada and Louisiana, U.S.) with two vegetation types, Sporobolus alterniflorus (= Spartina alterniflora) and Sporobolus pumilus (= Spartina patens), using 24-h laboratory incubation experiments. Potential N2O fluxes increased from minor sinks to major sources following elevated treatments across all four marsh sites. One day of potential N2O emissions under elevated treatments (representing either long-term sea surface warming or short-term ocean heatwaves effects on coastal marsh soil temperatures alongside pulses of N loading) offset 15–60% of the potential annual ambient N2O sink, depending on marsh site and vegetation type. Rates of potential denitrification were generally higher in high latitude than in low latitude marsh soils under ambient treatments, with low ratios of N2O:N2 indicating complete denitrification in high latitude marsh soils. Under elevated temperature and Nr treatments, potential denitrification was lower in high latitude soil but higher in low latitude soil as compared to ambient conditions, with incomplete denitrification observed except in Louisiana S. pumilus. Overall, our findings suggest that a combined increase in temperature and Nr has the potential to reduce salt marsh greenhouse gas (GHG) sinks under future global change scenarios

Seclusion and Psychiatric Intensive Care Evaluation Study (SPICES) : Combined qualitative and quantitative approaches to the uses and outcomes of coercive practices in mental health services

BackgroundSeclusion (the isolation of a patient in a locked room) and transfer to a psychiatric intensive care unit (PICU; a specialised higher-security ward with higher staffing levels) are two common methods for the management of disturbed patient behaviour within acute psychiatric hospitals. Some hospitals do not have seclusion rooms or easy access to an on-site PICU. It is not known how these differences affect patient management and outcomes.ObjectivesTo (1) assess the factors associated with the use of seclusion and PICU care, (2) estimate the consequences of the use of these on subsequent violence and costs (study 1) and (3) describe differences in the management of disturbed patient behaviour related to differential availability (study 2).DesignThe electronic patient record system at one trust was used to compare outcomes for patients who were and were not subject to seclusion or a PICU, controlling for variables, including recent behaviours. A cost-effectiveness analysis was performed (study 1). Nursing staff at eight hospitals with differing access to seclusion and a PICU completed attitudinal measures, a video test on restraint-use timing and an interview about the escalation pathway for the management of disturbed behaviour at their hospital. Analyses examined how results differed by access to PICU and seclusion (study 2).ParticipantsPatients on acute wards or PICUs in one NHS trust during the period 2008–13 (study 1) and nursing staff at eight randomly selected hospitals in England, with varying access to seclusion and to a PICU (study 2).Main outcome measuresAggression, violence and cost (study 1), and utilisation, speed of use and attitudes to the full range of containment methods (study 2).ResultsPatients subject to seclusion or held in a PICU were more likely than those who were not to be aggressive afterwards, and costs of care were higher, but this was probably because of selection bias. We could not derive satisfactory estimates of the causal effect of either intervention, but it appeared that it would be feasible to do so for seclusion based on an enriched sample of untreated controls (study 1). Hospitals without seclusion rooms used more rapid tranquillisation, nursing of the patient in a side room accompanied by staff and seclusion using an ordinary room (study 2). Staff at hospitals without seclusion rated it as less acceptable and were slower to initiate manual restraint. Hospitals without an on-site PICU used more seclusion, de-escalation and within-eyesight observation.LimitationsOfficial record systems may be subject to recording biases and crucial variables may not be recorded (study 1). Interviews were complex, difficult, constrained by the need for standardisation and collected in small numbers at each hospital (study 2).ConclusionsClosing seclusion rooms and/or restricting PICU access does not appear to reduce the overall levels of containment, as substitution of other methods occurs. Services considering expanding access to seclusion or to a PICU should do so with caution. More evaluative research using stronger designs is required.FundingThe National Institute for Health Research Health Services and Delivery Research programme

Preaching to the Converted? How Political Comedy Matters

Practitioners, audiences and critics are often dismissive of political comedy’s impact. It is argued that audiences only attend political performances if they already agree with the performer; further, that audiences will not laugh at ideas that they find too subversive. As laughter depends upon consensus and success depends upon laughter, the comedian “merely” preaches to the converted. This article challenges these assumptions by examining the diverse strategies of two political comedians: Mark Thomas and Stewart Lee. Through analysis of performance, and their methodology and intent as related in practitioner interviews, I demonstrate that the nature of consensus in political comedy is more complex than has generally been supposed. Far from being a sign of comedy’s impuissance, consensus is used as a tool to enhance and develop political engagement. I suggest that in order to discover whether political comedy matters, we must first broaden our understanding of how it matters

The Problematization of Sexuality among Women Living with HIV and a New Feminist Approach for Understanding and Enhancing Women’s Sexual Lives

In the context of HIV, women’s sexual rights and sexual autonomy are important but frequently overlooked and violated. Guided by community voices, feminist theories, and qualitative empirical research, we reviewed two decades of global quantitative research on sexuality among women living with HIV. In the 32 studies we found, conducted in 25 countries and composed mostly of cis-gender heterosexual women, sexuality was narrowly constructed as sexual behaviours involving risk (namely, penetration) and physiological dysfunctions relating to HIV illness, with far less attention given to the fullness of sexual lives in context, including more positive and rewarding experiences such as satisfaction and pleasure. Findings suggest that women experience declines in sexual activity, function, satisfaction, and pleasure following HIV diagnosis, at least for some period. The extent of such declines, however, is varied, with numerous contextual forces shaping women’s sexual well-being. Clinical markers of HIV (e.g., viral load, CD4 cell count) poorly predicted sexual outcomes, interrupting widely held assumptions about sexuality for women with HIV. Instead, the effects of HIV-related stigma intersecting with inequities related to trauma, violence, intimate relations, substance use, poverty, aging, and other social and cultural conditions primarily influenced the ways in which women experienced and enacted their sexuality. However, studies framed through a medical lens tended to pathologize outcomes as individual “problems,” whereas others driven by a public health agenda remained primarily preoccupied with protecting the public from HIV. In light of these findings, we present a new feminist approach for research, policy, and practice toward understanding and enhancing women’s sexual lives—one that affirms sexual diversity; engages deeply with society, politics, and history; and is grounded in women’s sexual rights

Why Stand-up Matters: How Comedians Manipulate and Influence

Funny, lively and unpredictable, stand-up comedy is above all a medium to be enjoyed. Popular as a good night out and packing the TV schedules, stand-up permeates British society and culture. Ubiquitous though it is, we are generally reluctant to consider comedy's social consequences. When comedians offend we seem ready to consider the potential for stand-up to do some wider harm, yet we rarely consider the good that it might do. This book looks at the social and political impact of stand-up comedy in both its positive and negative forms. Drawing on exclusive interviews with comedians such as Stewart Lee, Josie Long, Joe Wilkinson and Mark Thomas, and examples of comic material on everything from revolution, terrorism and homosexuality, to knitting and the inefficiency of the home shower, it explores comedy's role in determining our attitudes and opinions. While revealing the conventions comics use to manage audience response, Sophie Quirk demonstrates how comedy audiences allow themselves to be manipulated, and the potential harm – and real benefits – that may arise from 'just' being funny

Comedy clubs offered a better quality of debate than the political stage

EU Referendum Analysis 2016: Media, Voters and the Campaign Released 10 days after the 2016 Referendum on the UK's membership of the EU, this short article argues that comedians offered a more fulsome and honest debate in the run-up to the vote than the political stage would allow. It is one of 80 contributions from 100 academics offering immediate analysis of the Referendum campaign

The Politics of British Stand-up Comedy: The New Altenative

This Palgrave Pivot questions how a new generation of alternative stand-up comedians and the political world continue to shape and influence each other. The Alternative Comedy Movement of the late 1970s and 1980s can be described as a time of unruly experimentation and left-wing radicalism. This book examines how alternative comedians continue to celebrate these characteristics in the twenty-first century, while also moving into a distinct phase of artistic development as the political context of the 1970s and 1980s loses its immediacy. Sophie Quirk draws on original interviews with comedians including Tom Allen, Josie Long, John-Luke Roberts and Tony Law to chart how alternative comedians are shaped by, and in turn respond to, contemporary political challenges from neoliberalism to Brexit, class controversy to commercialism. She argues that many of our assumptions about comedy's politics must be challenged and updated. This book is essential reading for anyone who wants to understand the working methods and values of today's alternative comedians