V. problem presentation and advice-giving on a home birth helpline

The rate of home births in the UK is very low (around 2%) and many women who would like to give birth at home find it impossible to get midwifery cover or are advised of medical contraindications. The Home Birth Helpline offers support and expertise for women in this situation. Based on the analysis of 80 recorded calls, this article uses conversation analysis (CA) to explore how callers present their reason for calling the helpline, and what this shows about the culturally shared medicalized culture of birth. This research is an example of feminist CA in that it contributes both to the study of childbirth as a key women's health issue and to the study of helpline interaction from a conversation analytic perspectiv

TRANSGRESSION AND BEYOND: DAMBUDZO MARECHERA AND ZIMBABWEAN LITERATURE

PhDRecent criticism has claimed Marechera's unconventionality represents an anomaly in Zimbabwean literature. Problematically, this implies a fundamental separation of the author from the concerns, styles and strategies of other writers. In this thesis I argue, on the contrary, that Marechera demonstrates a propensity for dialogue with other Zimbabwean writers. Moreover, such a dialogue is crucial to the development of a critical discourse capable of addressing elements of contradiction. Returning Marechera to the heart of debate in Zimbabwean literature, the thesis focuses on the meaning of his transgressions, alongside selected texts by other Zimbabwean authors. These include Doris Lessing, Charles Mungoshi, Shimmer Chinodya, Yvonne Vera, Tsitsi Dangarembga, Nevanji Madanhire, Chenjerai Hove, and Stanley Nyamfukudza. I also consider the relevance of lesser-known women's writing and queer narratives, and Marechera's meaning to anti-racist, feminist, and gay liberation initiatives. As a background to my analysis, I ascertain discursive links in an historical sequence of sexual regulation. I argue that the 'black peril' panics in settler society (fear of interracial sex), the rounding-up of single women deemed to be prostitutes in the 1980s, and the anti-gay campaigns of the mid-1990s are all underpinned by a moral discourse which continuously reproduces an ideology of racial, social and sexual hygiene. Marechera's writing refuses this ideology, I claim, but his transgressions are rarely straightforward and frequently misunderstood. His treatment of interracial sexuality deeply problematises conventional concepts and representations of racial identity: his controversial characterisations of women subvert traditional patriarchalist iconographies of womanhood; and his treatment of queer issues (unprecedented in Zimbabwean literature) destabilises assumptions of heteronormativity. Despite such radicalism, however, Marechera's writing, moving beyond transgression. remains notoriously inconsistent and therefore resistant, I argue, to assimilation by progressive political projects. Although Marechera complicates debates, dialogue with the author is crucial, I nevertheless maintain, precisely for this reason.Westfield Tlust Research Student shi

Reflective Practice as a Tool to Overcome the Barriers to Adverse Childhood Experiences Screening in Adults

Problem: There is a significant dose-dependent relationship between traumatic experiences faced in childhood and poor adult health outcomes including substance abuse, chronic psychological and physical disease, and early mortality. Childhood trauma alters the chemistry of the developing brain and body, negatively influencing long-term health. The Adverse Childhood Experiences (ACE) screening tool is a binary response questionnaire consisting of ten questions that assess for history of childhood trauma. Despite mounting evidence to support the use of this tool and the great potential to enhance preventive, trauma-informed care, screening of adults for Adverse Childhood Experiences in primary care is not common practice. Perceived barriers to implementation cited by providers include time constraints, lack of training and confidence in screening and management of patients with a history of childhood trauma. Duchesne Clinic began the process of screening for ACEs by admission staff during the qualifying process. However, providers required support and guidance as they began to discuss the screening results with their patients and integrate ACE screening scores into plans of care. Project Aim: The aim of this project was to implement a guided reflective practice intervention with Duchesne Clinic providers to facilitate management of patients with high ACE scores. Project Method: This was a quality improvement (QI) DNP project at a safety net clinic in Kansas City, KS. Pre and post-intervention survey data was analyzed to assess changes in providers’ confidence and perceived barriers to management of patients with high ACE scores after four weeks of guided reflective practice intervention. Additionally, thematic analysis was performed to identify themes expressed by the providers in their reflection of their encounters with patients and their perceptions regarding management of patients with high ACE scores. Findings: Each of the seven questions on the ACE Provider Questionnaire yielded mean gains ranging between 0.25 to 1.2. A thematic analysis of the notes taken during all the interviews over the four-week guided reflective practice intervention produced the following themes: time as a barrier; feeling unprepared and unable to help patients with trauma history; re-traumatization; and strategies and tools for caring for patients with a history of trauma. Conclusions: Guided reflective practice was a successful tool to assist the providers at Duchesne Clinic to gain confidence and reduce the barriers to caring for patients with high ACE scores. Additionally, the sessions facilitated rich, honest and productive conversations between the Project Director, the Medical Director of Duchesne and each of the five providers and yielded a set of best practices for ACE screening and management at Duchesne Clinic

Offering patients choices: A pilot study of interactions in the seizure clinic

Using conversation analysis (CA), we studied conversations between one United Kingdom-based epilepsy specialist and 13 patients with seizures in whom there was uncertainty about the diagnosis and for whom different treatment and investigational options were being considered. In line with recent communication guidance, the specialist offered some form of choice to all patients: in eight cases, a course of action was proposed, to be accepted or rejected, and in the remaining five, a "menu" of options was offered. Even when presenting a menu, the specialist sometimes conveyed his own preferences in how he described the options, and in some cases the menu was used for reasons other than offering choice (e.g., to address patient resistance). Close linguistic and, interactional analysis of clinical encounters can show why doctors may feel they are offering choices when patients report that the decision was clinician dominated. (C) 2010 Elsevier Inc. All rights reserved

Automated Multi-Frequency Antenna System for Stratospheric Research Balloon Telemetry

Because flight radios must be lightweight, they tend to be low power, thus, the HARBOR team requires line-of-sight antenna tracking for data collection and interfacing capabilities. This new system provides automated tracking of the near-spacecraft during the entire flight. The previous system required visual contact with the flight package to allow manual pointing of the antenna. Difficult in the best of situations, manual tracking completely fails when there is cloud cover

A structural and biochemical model of processive chitin synthesis

Chitin synthases (CHS) produce chitin, an essential component of the fungal cell wall. The molecular mechanism of processive chitin synthesis is not understood, limiting the discovery of new inhibitors of this enzyme class. We identified the bacterial glycosyltransferase NodC as an appropriate model system to study the general structure and reaction mechanism of CHS. A high throughput screening-compatible novel assay demonstrates that a known inhibitor of fungal CHS also inhibit NodC. A structural model of NodC, on the basis of the recently published BcsA cellulose synthase structure, enabled probing of the catalytic mechanism by mutagenesis, demonstrating the essential roles of the DD and QXXRW catalytic motifs. The NodC membrane topology was mapped, validating the structural model. Together, these approaches give insight into the CHS structure and mechanism and provide a platform for the discovery of inhibitors for this antifungal target

Initiating end-of-life decisions with parents of infants receiving neonatal intensive care

Abstract Objective: To investigate whether parent-initiated or doctor-initiated decisions about limiting life-sustaining treatment (LST) in neonatal care has consequences for how possible courses of action are presented. Method: Formal conversations (n=27) between doctors and parents of critically ill babies from two level 3 neonatal intensive care units were audio or video recorded. Sequences of talk where decisions about limiting LST were presented were analysed using Conversation Analysis and coded using a Conversation Analytic informed coding framework. Relationships between codes were analysed using Fisher’s exact test. Results: When parents initiated the decision point, doctors subsequently tended to refer to or list available options. When doctors initiated, they tended to use ‘recommendations’ or ‘single-option’ choice (conditional) formats (p=0.017) that did not include multiple treatment options. Parent initiations overwhelmingly concerned withdrawal, as opposed to withholding of LST (p=0.030). Conclusion: Aligning parents to the trajectory of the news about their baby’s poor condition may influence how the doctor subsequently presents the decision to limit LST, and thereby the extent to which parents are invited to participate in shared decision-making. Practice implications: Explicitly proposing treatment options may provide parents with opportunities to be involved in treatment decisions for their critically ill babies, thereby fostering shared decision-making

Memory in Interaction: An Analysis of Repeat Calls to a Home Birth Helpline

Drawing on a corpus of 80 calls to a Home Birth helpline, we use conversation analysis to analyze how callers and call takers display to one another that they are talking for a second or subsequent time. We focus in particular on the role of memory in these interactions. We show how caller and call taker are oriented to remembering at the beginning of calls as displayed in what we call the recognition-solicit pre-sequence, how participants are oriented to issues of forgetting and remembering during the course of repeat calls, and how remembering and forgetting are made manifest in interaction. Our analysis shows how the human capacity to remember and propensity to forget have reverberating implications in calling for help

Phase II double-blind placebo-controlled randomized study of armodafinil for brain radiation-induced fatigue

BACKGROUND: Common acute-term side effects of brain radiotherapy (RT) include fatigue, drowsiness, decreased physical functioning, and decreased quality of life (QOL). We hypothesized that armodafinil (a wakefulness-promoting drug known to reduce fatigue and increase cognitive function in breast cancer patients receiving chemotherapy) would result in reduced fatigue and sleepiness for patients receiving brain RT. METHODS: A phase II, multi-institutional, placebo-controlled randomized trial assessed feasibility of armodafinil 150 mg/day in participants receiving brain RT, from whom we obtained estimates of variability for fatigue, sleepiness, QOL, cognitive function, and treatment effect. RESULTS: From September 20, 2010, to October 20, 2012, 54 participants enrolled with 80% retention and 94% self-reported compliance. There were no grade 4-5 toxicities, and the incidence of grade 2-3 toxicities was similar between treatment arms, the most common of which were anxiety and nausea (15%), headaches (19%), and insomnia (20%). There were no statistically significant differences in end-RT or 4 week post-RT outcomes between armodafinil and placebo in any outcomes (Functional Assessment of Chronic Illness Therapy [FACIT]-Fatigue, Brief Fatigue Inventory, Epworth Sleepiness Scale, FACT-Brain, and FACIT-cognitive function). However, in participants with more baseline fatigue, those treated with armodafinil did better than those who received the placebo on the end-RT assessments for several outcomes. CONCLUSION: Armodafinil 150 mg/day was well tolerated in primary brain tumor patients undergoing RT with good compliance. While there was no overall significant effect on fatigue, those with greater baseline fatigue experienced improved QOL and reduced fatigue when using armodafinil. These data suggest that a prospective, phase III randomized trial is warranted for patients with greater baseline fatigue

Rectus sheath haematoma or leaking aortic aneurysm - a diagnostic challenge: a case report

© 2009 Shaw et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens