Experience as Evidence: The Dialogic Construction of Health Professional Knowledge through Patient Involvement

This article investigates how healthcare professionals articulate the relationship between patient experience and ‘evidence’, creating hybrid forms of knowledge. We propose a Bakhtinian dialogical framework to theorise this process. Drawing on ethnographic work from patient involvement initiatives in England, we show how patient experiences are re-articulated by professionals who add their own intentions and accents in a dialogical process which incorporates diverse forms of knowledge and the conflicting demands of healthcare services. In this process, patient experiences become useful epistemic commodities, helping professionals to respond to workplace pressures by abstracting experiences from patients’ biographies, instrumentalising experiences and privileging ‘disembodied’ forms of involvement. Understanding knowledge as relational and hybrid helps move beyond the assumption that there is a clear dichotomy between ‘objective science’ and ‘subjective experience’. This article illuminates how new knowledge is produced when professionals engage with ‘lay’ patient knowledge, and helps inform the sociology of knowledge production more widely

New chemical profiles for the asteroseismology of ZZ Ceti stars

We compute new chemical profiles for the core and envelope of white dwarfs appropriate for pulsational studies of ZZ Ceti stars. These profiles are extracted from the complete evolution of progenitor stars, evolved through the main sequence and the thermally-pulsing asymptotic giant branch (AGB) stages, and from time-dependent element diffusion during white dwarf evolution. We discuss the importance of the initial-final mass relationship for the white dwarf carbon-oxygen composition. In particular, we find that the central oxygen abundance may be underestimated by about 15% if the white dwarf mass is assumed to be the hydrogen-free core mass before the first thermal pulse. We also discuss the importance for the chemical profiles expected in the outermost layers of ZZ Ceti stars of the computation of the thermally-pulsing AGB phase and of the phase in which element diffusion is relevant. We find a strong dependence of the outer layer chemical stratification on the stellar mass. In particular, in the less massive models, the double-layered structure in the helium layer built up during the thermally-pulsing AGB phase is not removed by diffusion by the time the ZZ Ceti stage is reached. Finally, we perform adiabatic pulsation calculations and discuss the implications of our new chemical profiles for the pulsational properties of ZZ Ceti stars. We find that the whole $g-$mode period spectrum and the mode-trapping properties of these pulsating white dwarfs as derived from our new chemical profiles are substantially different from those based on chemical profiles widely used in existing asteroseismological studies. Thus, we expect the asteroseismological models derived from our chemical profiles to be significantly different from those found thus far.Comment: 12 pages, 11 figures, 1 table. To be published in Ap

Conceptualising the 'community' as a recipient of money - A critical literature review, and implications for health and inequalities

© 2015 Elsevier Ltd. There is increasing attention on how money may bring about positive changes to health, and money-based development approaches are becoming more commonplace at the 'community' level, including in high-income countries. However, little attention has been paid to how the 'community' might be varyingly conceptualised in these scenarios, or to the potential implications of this for interpreting the impacts of such health improvement approaches. This paper presents a critical interpretive review of literature presenting different scenarios from high-income countries in which the 'community' receives money, to explore how 'community' is conceptualised in relation to this process. Some texts gave explicit definitions of 'community', but multiple other conceptualisations were interpreted across all texts, conveyed through the construction of 'problematics', and descriptions of how and why money was given. The findings indicate that the flow of money shapes how conceptualisations of 'community' are produced, and that the implicit power relations and inequalities can construct and privilege particular sets of identities and relationships throughout the process. This highlights implications for approaching public health evaluations of giving money to 'communities', and for better understanding how it might bring about change to health and inequalities, where the 'community' cannot be interpreted merely as a setting or recipient of such an intervention, but something constructed and negotiated through the flow of money itself

Communicating and understanding pain: Limitations of pain scales for patients with sickle cell disorder and other painful conditions.

Pain communication in healthcare is challenging. We examine use of pain scales to communicate pain severity via a case study of people with sickle cell disorder (SCD). We show how pain communication involves complex social interactions between patients, healthcare professionals and significant others - none of which are included in pain ratings. Failure to account for relational aspects of pain may cause problems for any patient. For SCD, mutual distrust shapes pain communication, further complicating clinical assessments. Moreover, SCD pain is particularly severe, making ratings hard to interpret compared with ratings from non-SCD patients, potentially exacerbating problems in managing pain relief

El rey o el papa. La crisis de lealtades del alto clero español a través de la controversia de 1799 en la Rota de la Nunciatura

Este texto examina la crisis del marco de doble lealtad que, durante el Antiguo Régimen, había vinculado al alto clero simultáneamente a la Corona y a la Santa Sede. La aproximación al desequilibrio de esta fidelidad compartida se realiza desde el nivel micro, tomando como ejemplo la controversia que tuvo lugar en la Rota de la nunciatura de España como consecuencia del real decreto de 5 de septiembre de 1799, en virtud del cual los obispos y algunos tribunales regios ejercerían, durante la vacante de la silla pontificia ocasionada por la muerte de Pío VI, algunas facultades reservadas a la Santa Sede. El seguimiento detallado de las trayectorias previas de los participantes en la controversia explica, en buena medida, la postura eclesiológica que sostuvieron.This paper examines the crisis in the long-term relationship model between the Spanish upper clergy, the Crown and the Papacy. Throughout the ancien régime, the high-ranking secular clergy divided its loyalty between two sovereign powers without any major problem. But this double loyalty underwent a crisis in the second half of the eighteenth century, aggravated by the French Revolution and the international political context. The controversy that arose between the members of the Spanish Rota tribunal concerning the royal decree of 1799, which ordered bishops and some royal courts to assume functions reserved to the Holy See, shows on a micro level the factors that led people to choose one loyalty over another

Understanding the health-care experiences of people with sickle cell disorder transitioning from paediatric to adult services: This Sickle Cell Life, a longitudinal qualitative study

Background Transitions from paediatric to adult health-care services cause problems worldwide, particularly for young people with long-term conditions. Sickle cell disorder brings particular challenges needing urgent action. Objectives Understand health-care transitions of young people with sickle cell disorder and how these interact with broader transitions to adulthood to improve services and support. Methods We used a longitudinal design in two English cities. Data collection included 80 qualitative interviews with young people (aged 13–21 years) with sickle cell disorder. We conducted 27 one-off interviews and 53 repeat interviews (i.e. interviews conducted two or three times over 18 months) with 48 participants (30 females and 18 males). We additionally interviewed 10 sickle cell disease specialist health-care providers. We used an inductive approach to analysis and co-produced the study with patients and carers. Results Key challenges relate to young people’s voices being ignored. Participants reported that their knowledge of sickle cell disorder and their own needs are disregarded in hospital settings, in school and by peers. Outside specialist services, health-care staff refuse to recognise patient expertise, reducing patients’ say in decisions about their own care, particularly during unplanned care in accident and emergency departments and on general hospital wards. Participants told us that in transitioning to adult care they came to realise that sickle cell disorder is poorly understood by non-specialist health-care providers. As a result, participants said that they lack trust in staff’s ability to treat them correctly and that they try to avoid hospital. Participants reported that they try to manage painful episodes at home, knowing that this is risky. Participants described engaging in social silencing (i.e. reluctance to talk about and disclose their condition for fear that others will not listen or will not understand) outside hospital; for instance, they would avoid mentioning cell sickle disorder to explain fatigue. Their self-management tactics include internalising their illness experiences, for instance by concealing pain to protect others from worrying. Participants find that working to stay healthy is difficult to reconcile with developing identities to meet adult life goals. Participants have to engage in relentless self-disciplining when trying to achieve educational goals, yet working hard is incompatible with being a ‘good adult patient’ because it can be risky for health. Participants reported that they struggle to reconcile these conflicting demands. Limitations Our findings are derived from interviews with a group of young people in England and reflect what they told us (influenced by how they perceived us). We do not claim to represent all young people with sickle cell disorder. Conclusions Our findings reveal poor care for young people with sickle cell disorder outside specialist services. To improve this, it is vital to engage with young people as experts in their own condition, recognise the legitimacy of their voices and train non-specialist hospital staff in sickle cell disorder care. Young people must be supported both in and outside health-care settings to develop identities that can help them to achieve life goals. Future work Future work should include research into the understanding and perceptions of sickle cell disease among non-specialist health-care staff to inform future training. Whole-school interventions should be developed and evaluated to increase sickle cell disorder awareness. 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. 44. See the NIHR Journals Library website for further project information

Electrochemical devices for cholesterol detection

Cholesterol can be considered as a biomarker of illnesses such as heart and coronary artery diseases or arteriosclerosis. Therefore, the fast determination of its concentration in blood is interesting as a means of achieving an early diagnosis of these unhealthy conditions. Electrochemical sensors and biosensors have become a potential tool for selective and sensitive detection of this biomolecule, combining the analytical advantages of electrochemical techniques with the selective recognition features of modified electrodes. This review covers the different approaches carried out in the development of electrochemical sensors for cholesterol, differentiating between enzymatic biosensors and non-enzymatic systems, highlighting lab-on-a-chip devices. A description of the different modification procedures of the working electrode has been included and the role of the different functional materials used has been discussed

Fertility regulation as identity maintenance: Understanding the social aspects of birth control

We take a dialogical approach to exploring fertility regulation practices and show how they can maintain or express social identity. We identify three themes in educated Ghanaian women’s accounts of how they navigate conflicting social demands on their identity when trying to regulate fertility: secrecy and silence – hiding contraception use and avoiding talking about it; tolerating uncertainty – such as using unreliable but more socially acceptable contraception; and wanting to be fertile and protecting menses. Family planning programmes that fail to tackle such social-psychological obstacles to regulating fertility will risk reproducing social spaces where women struggle to claim their reproductive rights

Evolution of white dwarf stars with high-metallicity progenitors: the role of 22Ne diffusion

Motivated by the strong discrepancy between the main sequence turn-off age and the white dwarf cooling age in the metal-rich open cluster NGC 6791, we compute a grid of white dwarf evolutionary sequences that incorporates for the first time the energy released by the processes of 22Ne sedimentation and of carbon/oxygen phase separation upon crystallization. The grid covers the mass range from 0.52 to 1.0 Msun, and it is appropriate for the study of white dwarfs in metal-rich clusters. The evolutionary calculations are based on a detailed and self-consistent treatment of the energy released from these two processes, as well as on the employment of realistic carbon/oxygen profiles, of relevance for an accurate evaluation of the energy released by carbon/oxygen phase separation. We find that 22Ne sedimentation strongly delays the cooling rate of white dwarfs stemming from progenitors with high metallicities at moderate luminosities, whilst carbon/oxygen phase separation adds considerable delays at low luminosities. Cooling times are sensitive to possible uncertainties in the actual value of the diffusion coefficient of 22Ne. Changing the diffusion coefficient by a factor of 2, leads to maximum age differences of approx. 8-20% depending on the stellar mass. We find that the magnitude of the delays resulting from chemical changes in the core is consistent with the slow down in the white dwarf cooling rate that is required to solve the age discrepancy in NGC 6791.Comment: 10 pages, 6 figures, to be published in The Astrophysical Journa

Determination of aluminium using different techniques based on the Al(III)-morin complex

Three different methods for the determination of Al(III) in aqueous samples were compared. The different described procedures were based on the formation of the Al(III)-morin complex. UV–Vis spectrophotometry, spectrofluorimetry and differential pulse adsorptive stripping voltammetry (DPAdSV) techniques were compared under optimized experimental conditions. The DPAdSV method showed a better performance for the analysis of Al(III) in terms of capability of detection (70 nM) in comparison with the value obtained for UV–Vis spectrophotometric (300 nM) and spectrofluorimetic (110 nM) techniques. Thus, DPAdSV method was selected for the analysis of aluminium in river, tap and bottled water samples under the following optimized experimental conditions: pH = 4.4, deposition potential = +243 mV, deposition time = 210 s, giving satisfactory results