A sociological exploration of the tensions related to interprofessional collaboration in acute-care discharge planning

Patient discharge is a key concern in hospitals, particularly in acute care, given the multifaceted and challenging nature of patients' healthcare needs. Policies on discharge have identified the importance of interprofessional collaboration, yet research has described its limitations in this clinical context. This study aimed to extend our understanding of interprofessional interactions related to discharge in a general internal medicine setting by using sociological theories to illuminate the existence of, and interplay between, structural factors and microlevel practices. An ethnographic approach was employed to obtain an in-depth insight into healthcare providers' perspectives, behaviours, and interactions regarding discharge. Data collection involved observations, interviews, and document analysis. Approximately 65 hours of observations were undertaken, 23 interviews were conducted with healthcare providers, and government and hospital discharge documents were collected. Data were analysed using a directed content approach. The findings indicate the existence of a medically dominated division of healthcare labour in patient discharge with opportunities for some interprofessional negotiations; the role of organizational routines in facilitating and challenging interprofessional negotiations in patient discharge; and tensions in organizational priorities that impact an interprofessional approach to discharge. The findings provide insight into the various levels at which interventions can be targeted to improve interprofessional collaboration in discharge while recognizing the organizational tensions that challenge an interprofessional approach

Functional recovery is considered the most important target: a survey of dedicated professionals

Background: The aim of this study was to survey the relative importance of postoperative recovery targets and perioperative care items, as perceived by a large group of international dedicated professionals. Methods: A questionnaire with eight postoperative recovery targets and 13 perioperative care items was mailed to participants of the first international Enhanced Recovery After Surgery (ERAS) congress and to authors of papers with a clear relevance to ERAS in abdominal surgery. The responders were divided into categories according to profession and region. Results: The recovery targets ‘To be completely free of nausea’, ‘To be independently mobile’ and ‘To be able to eat and drink as soon as possible’ received the highest score irrespective of the responder's profession or region of origin. Equally, the care items ‘Optimizing fluid balance’, ‘Preoperative counselling’ and ‘Promoting early and scheduled mobilisation’ received the highest score across all groups. Conclusions: Functional recovery, as in tolerance of food without nausea and regained mobility, was considered the most important target of recovery. There was a consistent uniformity in the way international dedicated professionals scored the relative importance of recovery targets and care items. The relative rating of the perioperative care items was not dependent on the strength of evidence supporting the items

Transitions through lifelong learning: Implications for learning analytics

The ability to develop new skills and competencies is a central concept of lifelong learning. Research to date has largely focused on the processes and support individuals require to engage in upskilling, re-learning or training. However, there has been limited attention examining the types of support that are necessary to assist a learner's transition from “old” workplace contexts to “new”. Professionals often undergo significant restructuring of their knowledge, skills, and identities as they transition between career roles, industries, and sectors. Domains such as learning analytics (LA) have the potential to support learners as they use the analysis of fine-grained data collected from education technologies. However, we argue that to support transitions throughout lifelong learning, LA needs fundamentally new analytical and methodological approaches. To enable insights, research needs to capture and explain variability, dynamics, and causal interactions between different levels of individual development, at varying time scales. Scholarly conceptions of the context in which transitions occur are also required. Our interdisciplinary argument builds on the synthesis of literature about transitions in the range of disciplinary and thematic domains such as conceptual change, shifts between educational systems, and changing roles during life course. We highlight specific areas in research designs and current analytical methods that hinder insight into transformational changes during transitions. The paper concludes with starting points and frameworks that can advance research in this area

Female-perpetrated sexual abuse: a review of victim and professional perspectives

Professional attitudes towards female-perpetrated sexual abuse (FPSA) reportedly reflect he gender-role expectations found in broader society, which cast males almost exclusively as sexual aggressors or willing sexual recipients, females as sexually non-coercive or victims and male-perpetrated sexual abuse as particularly significant or injurious. Such views, however, appear to stand in contrast to the perspectives of individuals who have experienced FPSA. This paper details a systematic review of peer-reviewed quantitative and qualitative literature examining these different (professional and victim) perspectives. Although the methodological shortcomings of primary papers limit the conclusions that can be drawn, the findings suggest that victim and professional perspectives of FPSA remain discrepant; professionals generally considered FPSA as less serious, less harmful and less deserving of investigation than male-perpetrated abuse; while victims of FPSA felt their experiences influenced significantly their psychological wellbeing and abilities to form and maintain interpersonal relationships. These findings are discussed in relation to professional practice and suggestions for future research

Preventing the Selection of "Deaf Embryos" Under the Human Fertilisation and Embryology Act 2008:Problematizing Disability?

Section 14(4) of the Human Fertilisation and Embryology Act 2008 imposes – within the general licensing conditions listed in the Human Fertilisation and Embryology Act 1990 – a prohibition to prevent the selection and implantation of embryos for the purpose of creating a child who will be born with a “serious disability.” This article offers a perspective that demonstrates the problematic nature of the consultation, review, and legislative reform process surrounding s 14(4). The term “serious disability” is not defined within the legislation, but we highlight the fact that s 14(4) was passed with the case of selecting deaf children in mind. We consider some of the literature on the topic of disability and deafness, which, we think, casts some doubt on the view that deafness is a “serious disability.” The main position we advance is that the lack of serious engagement with alternative viewpoints during the legislative process was unsatisfactory. We argue that the contested nature of deafness necessitates a more robust consultation process and a clearer explanation and defence of the normative position that underpins s 14(4)

Differential adeno-associated virus mediated gene transfer to sensory neurons following intrathecal delivery by direct lumbar puncture

<p>Abstract</p> <p>Background</p> <p>Neuronal transduction by adeno-associated viral (AAV) vectors has been demonstrated in cortex, brainstem, cerebellum, and sensory ganglia. Intrathecal delivery of AAV serotypes that transduce neurons in dorsal root ganglia (DRG) and spinal cord offers substantial opportunities to 1) further study mechanisms underlying chronic pain, and 2) develop novel gene-based therapies for the treatment and management of chronic pain using a non-invasive delivery route with established safety margins. In this study we have compared expression patterns of AAV serotype 5 (AAV5)- and AAV serotype 8 (AAV8)-mediated gene transfer to sensory neurons following intrathecal delivery by direct lumbar puncture.</p> <p>Results</p> <p>Intravenous mannitol pre-treatment significantly enhanced transduction of primary sensory neurons after direct lumbar puncture injection of AAV5 (rAAV5-GFP) or AAV8 (rAAV8-GFP) carrying the green fluorescent protein (GFP) gene. The presence of GFP in DRG neurons was consistent with the following evidence for primary afferent origin of the majority of GFP-positive fibers in spinal cord: 1) GFP-positive axons were evident in both dorsal roots and dorsal columns; and 2) dorsal rhizotomy, which severs the primary afferent input to spinal cord, abolished the majority of GFP labeling in dorsal horn. We found that both rAAV5-GFP and rAAV8-GFP appear to preferentially target large-diameter DRG neurons, while excluding the isolectin-B4 (IB4) -binding population of small diameter neurons. In addition, a larger proportion of CGRP-positive cells was transduced by rAAV5-GFP, compared to rAAV8-GFP.</p> <p>Conclusions</p> <p>The present study demonstrates the feasibility of minimally invasive gene transfer to sensory neurons using direct lumbar puncture and provides evidence for differential targeting of subtypes of DRG neurons by AAV vectors.</p

Quantum decision making by social agents

The influence of additional information on the decision making of agents, who are interacting members of a society, is analyzed within the mathematical framework based on the use of quantum probabilities. The introduction of social interactions, which influence the decisions of individual agents, leads to a generalization of the quantum decision theory developed earlier by the authors for separate individuals. The generalized approach is free of the standard paradoxes of classical decision theory. This approach also explains the error-attenuation effects observed for the paradoxes occurring when decision makers, who are members of a society, consult with each other, increasing in this way the available mutual information. A precise correspondence between quantum decision theory and classical utility theory is formulated via the introduction of an intermediate probabilistic version of utility theory of a novel form, which obeys the requirement that zero-utility prospects should have zero probability weights.Comment: This paper has been withdrawn by the authors because a much extended and improved version has been submitted as arXiv:1510.02686 under the new title "Role of information in decision making of social agents

AIMD - A validated, simplified framework of interventions to promote and integrate evidence into health practices, systems, and policies

Background: Proliferation of terms describing the science of effectively promoting and supporting the use of research evidence in healthcare policy and practice has hampered understanding and development of the field. To address this, an international Terminology Working Group developed and published a simplified framework of interventions to promote and integrate evidence into health practices, systems, and policies. This paper presents results of validation work and a second international workgroup meeting, culminating in the updated AIMD framework [Aims, Ingredients, Mechanism, Delivery]. Methods: Framework validity was evaluated against terminology schemas (n = 51); primary studies (n = 37); and reporting guidelines (n = 10). Framework components were independently categorized as fully represented, partly represented, or absent by two researchers. Opportunities to refine the framework were systematically recorded. A meeting of the expanded international Terminology Working Group updated the framework by reviewing and deliberating upon validation findings and refinement proposals. Results: There was variation in representativeness of the components across the three types of literature, in particular for the component 'causal mechanisms'. Analysis of primary studies revealed that representativeness of this concept lowered from 92 to 68% if only explicit, rather than explicit and non-explicit references to causal mechanisms were included. All components were very well represented in reporting guidelines, however the level of description of these was lower than in other types of literature. Twelve opportunities were identified to improve the framework, 9 of which were operationalized at the meeting. The updated AIMD framework comprises four components: (1) Aims: what do you want your intervention to achieve and for whom? (2) Ingredients: what comprises the intervention? (3) Mechanisms: how do you propose the intervention will work? and (4) Delivery: how will you deliver the intervention? Conclusions: The draft simplified framework was validated with reference to a wide range of relevant literature and improvements have enhanced useability. The AIMD framework could aid in the promotion of evidence into practice, remove barriers to understanding how interventions work, enhance communication of interventions and support knowledge synthesis. Future work needs to focus on developing and testing resources and educational initiatives to optimize use of the AIMD framework in collaboration with relevant end-user groups

Cultural Evolution as Distributed Computation

The speed and transformative power of human cultural evolution is evident from the change it has wrought on our planet. This chapter proposes a human computation program aimed at (1) distinguishing algorithmic from non-algorithmic components of cultural evolution, (2) computationally modeling the algorithmic components, and amassing human solutions to the non-algorithmic (generally, creative) components, and (3) combining them to develop human-machine hybrids with previously unforeseen computational power that can be used to solve real problems. Drawing on recent insights into the origins of evolutionary processes from biology and complexity theory, human minds are modeled as self-organizing, interacting, autopoietic networks that evolve through a Lamarckian (non-Darwinian) process of communal exchange. Existing computational models as well as directions for future research are discussed.Comment: 13 pages Gabora, L. (2013). Cultural evolution as distributed human computation. In P. Michelucci (Ed.) Handbook of Human Computation. Berlin: Springe