Torture-survivors' experiences of healthcare services for pain : a qualitative study

Background: Increasing numbers of torture-survivors are presenting to UK healthcare services with persistent pain. However, there is a paucity of evidence surrounding the management of persistent pain among torture-survivors and their experience of healthcare services for pain is currently unknown. This qualitative study explores their experiences of services for managing pain, to inform clinical practice and service provision. Methods: Thirteen participants were recruited from a specialist pain clinic for torture-survivors in the United Kingdom. Utilising an ethnographic approach, data were collected via clinic appointment observations, interviews and medical records and analysed using inductive thematic analysis. Results: Three themes emerged in relation to torture-survivors’ experiences of healthcare services for pain: the patient–clinician relationship; multiplicity of diagnoses and treatments; lack of service integration. Participants described limited engagement in decision-making processes regarding their care. Lack of recognition of torture experience when diagnosing and treating pain, alongside multiple unsuccessful treatments, led to confusion, frustration and hopelessness. These issues were exacerbated by the disconnect between physical and mental health services. Conclusion: This study provides new insight into the challenges faced by torture-survivors when accessing healthcare services for pain. Our findings suggest current service provision is not meeting their complex needs. Clinical implications include the need for integrated care systems and better recognition of the influence of torture experience on persistent pain. Strategies to engage and empower torture-survivors in the management of their pain are suggested

The cultural politics of 'Implementation Science'

Despite the growing profile of ‘implementation science’, its status as a field of study remains ambiguous. Implementation science originates in the evidence-based movement and attempts to broaden the scope of evidence-based medicine to improve ‘clinical effectiveness’ and close the ‘implementation gap’. To achieve this agenda, implementation science draws on methodologies from the social sciences to emphasise coherence between qualitative and quantitative approaches. In so doing, we ask if this is at the expense of ignoring the dominating tendencies of the evidence-based movement and consider if some of the methodologies being drawn on should be considered irreconcilable with evidence-based methodologies

Social medicine and sociology : the productiveness of antagonisms arising from maintaining disciplinary boundaries

This essay considers the boundaries between the sociology of medicine and social medicine and the reasons distinctions are maintained between the two disciplines. To investigate, the essay asks what constitutes the distinction between social sciences and social medicine, and goes on to question historical distinctions of how foundational sociology is to social medicine; how much autonomy the sociology of medicine should have; contemporary challenges to the relation between sociology and social medicine; and the status of ethics, both traditionally and contemporarily, between sociology and social medicine. In the face of increasing emphases on interdisciplinarity, this essay offers a note of caution by demonstrating how the antagonism between sociology and social medicine is important as a site that produces a necessary polemic. Ultimately, I argue that the social sciences and social medicine are linked in a productive relationship that instates and reinstates their respective functions and values in a process that validates the practice of modern medicine

Children with HIV: the Consolidation of medicine, science and the social into the clinical practice of paediatric HIV

This thesis explores how medicine is practiced in a paediatric HIV clinic in outer London. It draws on ethnographic research that took place in the clinic over the course of a year. The significance of the topic is situated in the complexity of the issues presented clinically by children with HIV in London. During practice recurrent associations of confidentiality, stigma, vulnerability, naivety and innocence emerges around the patient cohort that mainly comprises recent African migrants living their lives in complicated urban environments. These associations are contrasted by the uncompromising requirements of antiretroviral medicine which needs almost perfect dosing adherence in order to suppress the virus. The incompatibilities between complex patient lives and medical requirements must be made compatible through clinical practice. Therefore, the thesis emphasises the clinic as the key site where the ‘cultural’ issues presented by patients are consolidated with drug requirements to form a functional medicine. The argument is informed by discussions around Science and Technology Studies (STS), and the Sociology of Childhood (SoC). These discussions highlight practice as ‘enacted’, where objects such as disease, the body or medicine are not ‘given’ but gain their shape through their recurrent enactions (Mol 2002, Mol and Law 2004). I have used these discussions to argue that medicine and protocol do not pre-exist practice but must be enacted by practitioners and (child) patients in the clinic. Clinical practice is shown in the thesis as consolidating protocol, drug requirements, patients, practitioners and representations of HIV in ongoing clinical enactions to make the antiretroviral medicine amongst the paediatric cohort operational. To do this, the research focuses on a set of procedures enacted in the clinic: disclosure, adherence, HIV as chronic illness and transition. These procedures inform practitioners on how to maintain care and make medical requirements explicit to child patients (and their parents), enforcing behaviour that accords with the goals of antiretroviral medicine. In this way practice and protocol are negotiated and renegotiated to ensure their effectiveness between all of the associations involved in participating with the condition, paediatric HIV and the corresponding medicine. Compared to existing STS on the subject of medicine and the clinic, paediatric HIV practice emphasises the clinic’s role to consolidate seemingly incompatible associations around patients such as stigma, vulnerability and innocence into medical requirements. The result is that STS that advertently or inadvertently implies that medical practice is messy or disjointed are questioned in light of two important features of paediatric HIV. Firstly, that practice must necessarily consolidate disparate patient lives into medical requirements if treatment is to be successful, and secondly, that practitioners must employ a logic to generate a coherent, well-organised clinical practice that is flexible and pliable to diverse eventualities. The significance of this argument demonstrates the clinic’s importance in enacting interventions and attuning medicine, displacing a notion of protocol or guidelines as dictating practice without negotiation, or the belief that the ideal course of clinical practice is fully predefined in protocol. Therefore, the implications of this research underline the clinic as a key site in rationalising how medicine is formulated and applied to patients

An ML Editor based on Proofs-as-Programs

. C Y NTHIA is a novel editor for the functional programming language ML in which each function definition is represented as the proof of a simple specification. Users of C Y NTHIA edit programs by applying sequences of high-level editing commands to existing programs. These commands make changes to the proof representation from which a new program is then extracted. The use of proofs is a sound framework for analysing ML programs and giving useful feedback about errors. Amongst the properties analysed within C Y NTHIA at present is termination. C Y NTHIA has been successfully used in the teaching of ML in two courses at Napier University. 1 Introduction Current programming environments for novice functional programming (FP) are inadequate. This paper describes ways of using mechanised theorem proving to improve the situation, in the context of the language ML [9]. ML is a stronglytyped FP language with type inference [4]. ML incorporates extensive use of pattern match..

DALiuGE: A Graph Execution Framework for Harnessing the Astronomical Data Deluge

The Data Activated Liu Graph Engine - DALiuGE - is an execution framework for processing large astronomical datasets at a scale required by the Square Kilometre Array Phase 1 (SKA1). It includes an interface for expressing complex data reduction pipelines consisting of both data sets and algorithmic components and an implementation run-time to execute such pipelines on distributed resources. By mapping the logical view of a pipeline to its physical realisation, DALiuGE separates the concerns of multiple stakeholders, allowing them to collectively optimise large-scale data processing solutions in a coherent manner. The execution in DALiuGE is data-activated, where each individual data item autonomously triggers the processing on itself. Such decentralisation also makes the execution framework very scalable and flexible, supporting pipeline sizes ranging from less than ten tasks running on a laptop to tens of millions of concurrent tasks on the second fastest supercomputer in the world. DALiuGE has been used in production for reducing interferometry data sets from the Karl E. Jansky Very Large Array and the Mingantu Ultrawide Spectral Radioheliograph; and is being developed as the execution framework prototype for the Science Data Processor (SDP) consortium of the Square Kilometre Array (SKA) telescope. This paper presents a technical overview of DALiuGE and discusses case studies from the CHILES and MUSER projects that use DALiuGE to execute production pipelines. In a companion paper, we provide in-depth analysis of DALiuGE's scalability to very large numbers of tasks on two supercomputing facilities.Comment: 31 pages, 12 figures, currently under review by Astronomy and Computin

Doctor of Education Newsletter 2019

WSU Doctor of Education Inaugural Cohort 2019 Winona State University has an astounding reputation for educational practitioner preparation programs in the College of Education. As the summer of 2019 commences, a new journey begins for the inaugural cohort of doctoral students who embark on their quest to obtain Doctor of Education degrees.https://openriver.winona.edu/educationeddnewsletters/1000/thumbnail.jp

Doctoral Student Perspectives on Motivation and Persistence: Eye-Opening Insights Into the Ideas and Thoughts That Today\u27s Doctoral Students Have About Finishing the Doctoral Degree

It all comes down to this: we have an amazing team of faculty working with us who are present, supportive, intelligent, and motivated to help us succeed. They designed this program with those objectives in mind. We are in good hands, and any questions we have will be answered, so long as we ask them. Having the support system of our faculty, along with the tools we need to be successful, are major parts of the battle, already won. The rest is up to us. - A. Brooke Boultonhttps://openriver.winona.edu/educationeddbooks/1000/thumbnail.jp