Challenging Social Cognition Models of Adherence:Cycles of Discourse, Historical Bodies, and Interactional Order

Attempts to model individual beliefs as a means of predicting how people follow clinical advice have dominated adherence research, but with limited success. In this article, we challenge assumptions underlying this individualistic philosophy and propose an alternative formulation of context and its relationship with individual actions related to illness. Borrowing from Scollon and Scollon’s three elements of social action – “historical body,” “interaction order,” and “discourses in place” – we construct an alternative set of research methods and demonstrate their application with an example of a person talking about asthma management. We argue that talk- or illness-related behavior, both viewed as forms of social action, manifest themselves as an intersection of cycles of discourse, shifting as individuals move through these cycles across time and space. We finish by discussing how these dynamics of social action can be studied and how clinicians might use this understanding when negotiating treatment with patients

Towards a sociocultural understanding of children’s voice

While ‘voice’ is frequently invoked in discussions of pupils’ agency and empowerment, less attention has been paid to the dialogic dynamics of children’s voices and the sociocultural features shaping their emergence. Drawing on linguistic ethnographic research involving recent recordings of ten and eleven year-old children’s spoken language experience across the school day, this article examines how pupils’ voices are configured within institutional interactional contexts which render particular kinds of voice more or less hearable, and convey different kinds of value. Analysis shows how children appropriate and reproduce the authoritative voices of education, popular culture and parents in the course of their induction into social practices. At the same time they also express varying degrees of commitment to these voices and orchestrate their own and other people’s voices within accounts and anecdotes, making voice appropriation an uneven, accumulative process shot through with the dynamics of personal and peer-group experience. The examination of children’s dialogue from different contexts across the school day highlights the situated semiotics of voice and the heteroglossic development of children’s speaking consciousness

Communicative competence and institutional affiliation: interactional processes of identity construction by immigrant students in Catalonia

The growing presence of children of immigrant families in the public school system in the bilingual region of Catalonia provides us with an opportunity to study how young multilingual and multicultural speakers construct their social competencies and their identity within the specific context of a gate-keeping social institution such as the school. The study reported in this paper approaches language learning as a process of socialisation that involves not only learning how to make sense of linguistic signs but also learning how to enact different social roles in particular institutions. The analysis focuses on the interactional profiles of two immigrant students in two types of communicative activities that are representative of the school context: responding to questions from an adult and cooperating with a peer in the resolution of a learning task. By shifting the focus of analysis from a decontextualised notion of communicative competence to the notion of 'institutionally affiliated communicative competence' and concentrating on issues such as the (1) the relationship between knowledge and participation, (2) language choice inside and outside school and (3) definitions of correctness in language use, the study reveals how the two students construct a highly 'affiliated' identit

Social participation for older people with aphasia: The impact of communication disability on friendships

Purpose: The language changes experienced by a person with aphasia following a stroke often have sudden and long-lasting negative impact on friendships. Friendship relationships are core to social engagement, quality of life, and emotional well-being. The aims of this study were to describe everyday communication with friends for older people with and without aphasia and to examine the nature of actual friendship conversations involving a person with aphasia. Method: This naturalistic inquiry drew data from two phases of research: a participant observation study of 30 older Australians, 15 of whom had aphasia following a stroke, and a collective case study using stimulated recall to examine friendship conversations involving an older person with aphasia. Results: People with aphasia communicated with fewer friends and had smaller social networks. "Friendship" was a core domain of communication for older people and participation in leisure and educational activities was focal in everyday communication with friends. Case study data of conversations between three older people with aphasia and their friends illuminated features of "time," the role of humour, and friends having shared interests. Conclusion: Aphasia has been found to impact on friendships. A need exists for research and intervention programs to address communication with friends for older people with aphasia

Meaning between, in, and around words, gestures and postures: multimodal meaning making in children's classroom communication

The view of language from a social semiotic perspective is clear. Language is one of many semiotic resources we employ in our communicative practices. That is to say that while language is at times dominant, it always operates within a multimodal frame and furthermore, at times modes other than language are dominant. The proposed 2014 National Curriculum for the UK, on the other hand, values pupils' face-to-face classroom interaction in terms of standard spoken English (i.e. in terms of the mode of language alone). This paper offers examples demonstrating how embodied modes such as gesture, posture, facial expression, gaze and haptics work in conjunction with speech in children's collaborative construction of knowledge. In other words, what may have been previously conceived as gaps and silences - often interpreted as an absence of language - are in fact instantiations of the work of semiotic modes other than language. In order to consider this closely, this paper offers evidence from a multimodal micro-analysis of pupil-to-pupil, face-to-face interaction in one science lesson in a Year Five UK Primary classroom. It demonstrates how children's meaning-making is achieved through apt use of all available semiotic resources

Ancillary Therapy and Supportive Care of Chronic Graft-versus-Host Disease: National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: V. Ancillary Therapy and Supportive Care Working Group Report

AbstractThe Ancillary Therapy and Supportive Care Working Group had 3 goals: (1) to establish guidelines for ancillary therapy and supportive care in chronic graft-versus-host disease (GVHD), including treatment for symptoms and recommendations for patient education, preventive measures, and appropriate follow-up; (2) to provide guidelines for the prevention and management of infections and other common complications of treatment for chronic GVHD; and (3) to highlight the areas with the greatest need for clinical research. The definition of “ancillary therapy and supportive care” embraces the most frequent immunosuppressive or anti-inflammatory interventions used with topical intent and any other interventions directed at organ-specific control of symptoms or complications resulting from GVHD and its therapy. Also included in the definition are educational, preventive, and psychosocial interventions with this same objective. Recommendations are organized according to the strength and quality of evidence supporting them and cover the most commonly involved organs, including the skin, mouth, female genital tract, eyes, gastrointestinal tract, and lungs. Recommendations are provided for prevention of infections, osteoporosis, and steroid myopathy and management of neurocognitive and psychosocial adverse effects related to chronic GVHD. Optimal care of patients with chronic GVHD often requires a multidisciplinary approach