Dealing with the distress of people with intellectual disabilities reporting sexual assault and rape

When police officers interview people with intellectual disabilities who allege sexual assault and rape, they must establish rapport with the interviewee but deal with their distress in a way that does not compromise the interview’s impartiality and its acceptability in court. Inspection of 19 videotaped interviews from an English police force’s records reveals that the officers deal with expressed distress by choosing among three practices: minimal (e.g. okay) or no acknowledgement, acknowledging the expressed emotion as a matter of the complainant’s difficulty in proceeding (e.g. take your time) and rarely (and only if the complainants were apparently unable to resume their talk) explicit reference to their emotion (e.g. it’s obviously upsetting for you). We discuss these practices as ways of managing the conflicting demands of rapport and evidence-gathering

Short-term outcome of treatment limitation discussions for newborn infants, a multicentre prospective observational cohort study

Objective To determine the short-term outcomes of babies for whom clinicians or parents discussed the limitation of life-sustaining treatment (LST). Design Prospective multicentre observational study. Setting Two level 3, six level 2 and one level 1 neonatal units in the North-East London Neonatal Network. Participants A total of 87 babies including 68 for whom limiting LST was discussed with parents and 19 babies died without discussion of limiting LST in the labour ward or neonatal unit. Outcome measures Final decision reached after discussions about limiting LST and neonatal unit outcomes (death or survived to discharge) for babies. Results Withdrawing LST, withholding LST and do not resuscitate (DNR) order was discussed with 48, 16 and 4 parents, respectively. In 49/68 (72%) cases decisions occurred in level 3 and 19 cases in level 2 units. Following the initial discussions, 34/68 parents made the decision to continue LST. In 33/68 cases, a second opinion was obtained. The parents of 14/48 and 2/16 babies did not agree to withdraw and withhold LST, respectively. Forty-seven out of 87 babies (54%) died following limitation of LST, 28/87 (32%) died receiving full intensive care support, 5/87 (6%) survived following a decision to limit LST and 7/87 (8%) babies survived following decision to continue LST. Conclusions A significant proportion of parents chose to continue treatment following discussions regarding limiting LST for their babies, and a proportion of these babies survived to neonatal unit discharge. The long-term outcomes of babies who survive following limiting LST discussion need to be investigated

The Conversation Analytic Role-play Method (CARM): A Method for Training Communication Skills as an Alternative to Simulated Role-play

This an Accepted Manuscript of an article published by Taylor & Francis in Research on Language and Social Interaction on 06-08-2014, available online: http://www.tandfonline.com/10.1080/08351813.2014.925663.The Conversation Analytic Role-play Method (CARM) is an approach to training, based on conversation analytic evidence about the problems and roadblocks that can occur in institutional interaction. Traditional training often relies on role-play, but that differs systematically from the actual events it is meant to mimic and prepare for. In contrast, CARM uses animated audio- and video-recordings of real-time, actual encounters. CARM provides a unique framework for discussing and evaluating, in slow motion, actual talk as people do their jobs. It also provides an evidence base for making decisions about effective practice and communication policy in organizations. This article describes CARM's distinctive practices and its impact on professional development across different organizations. Data are in British English

Parental involvement in neonatal critical care decision-making

The article analyses the decision-making process between doctors and parents of babies in neonatal intensive care. In particular, it focuses on cases in which the decision concerns the redirection of care from full intensive care to palliative care at the end of life. Thirty one families were recruited from a neonatal intensive care unit in England and their formal interactions with the doctor recorded. The conversations were transcribed and analysed using conversation analysis. Analysis focused on sequences in which decisions about the redirection of care were initiated and progressed. Two distinct communicative approaches to decision-making were used by doctors: ‘making recommendations’ and ‘providing options’. Different trajectories for parental involvement in decision-making were afforded by each design, as well as differences in terms of the alignments, or conflicts, between doctors and parents. ‘Making recommendations’ led to misalignment and reduced opportunities for questions and collaboration; ‘providing options’ led to an aligned approach with opportunities for questions and fuller participation in the decision-making process. The findings are discussed in the context of clinical uncertainty, moral responsibility and the implications for medical communication training and guidance

Management of diarrhea in patients with HER2-positive breast cancer treated with neratinib: A case series and summary of the literature

INTRODUCTION: Neratinib and neratinib-based combinations have demonstrated efficacy for treatment of human epidermal growth factor receptor 2-positive (HER2+) early-stage and metastatic breast cancers. However, diarrhea has been reported as a common adverse event leading to neratinib discontinuation. Results from the CONTROL trial suggest that proactive diarrhea management with antidiarrheal prophylaxis or dose escalation of neratinib from a lower starting dose to the full FDA-approved dose of 240 mg/day can reduce the incidence, duration, and severity of neratinib-associated diarrhea in patients with early-stage breast cancer. Dose escalation has been included in the FDA-approved label for both early-stage and metastatic HER2+ breast cancer since June 2021. CASE SERIES: This series of five cases details real-world clinical implementation of strategies for management of neratinib-induced diarrhea in patients with early-stage and metastatic HER2+ breast cancer, including a patient with a pre-existing gastrointestinal disorder. MANAGEMENT AND OUTCOME: In four of five cases, diarrhea was managed with neratinib dose escalation, and antidiarrheal prophylaxis with loperamide plus colestipol was used in the remaining case. Management of diarrhea allowed all patients to remain on therapy. DISCUSSION: This case series shows that neratinib-associated diarrhea can be managed effectively with neratinib dose escalation from a lower initial starting dose and/or prophylactic antidiarrheal medications in a real-world clinical setting. The findings highlight the importance of patient-provider communication in proactive management of adverse events. Widespread implementation of the strategies described here may improve adherence and thereby clinical outcomes for patients with HER2+ breast cancer treated with neratinib

Impact echo data from bridge deck testing: Visualization and interpretation

Accurate assessment of the condition of bridges leads to their economic management. Ultrasonic seismic methods can be successfully used for this purpose through evaluation of changes in material characteristics and detection of the development of defects and zones of deterioration. The impact echo (IE) method is of special benefit in evaluation of corrosion-induced deck delamination, due to the method's nondestructive nature, speed of evaluation, and ability to detect delaminated zones at various stages of deterioration: from initial to progressed and developed. The traditional approach in condition assessment of bridge decks by IE on the basis of review of individual test point records and a new automated approach based on three-dimensional (3-D) data visualization are presented. The developed 3-D visualization platform allows both the advanced presentation and interpretation of IE data. The data presentation is provided as 3-D translucent visualizations of reflectors in a bridge deck section and horizontal and vertical cross sections through all distinctive zones, including a zone of delamination. The associated interpretation platform allows both (a) the overall assessment of the condition of the deck, through cumulative distributions and histograms of reflection intensity, and (b) identification of deteriorated zones of the deck for repair or rehabilitation in an efficient and intuitive way. The visualization platform effectively enables an IE device to be used as a type of bridge deck sonar device

The acquisition of Sign Language: The impact of phonetic complexity on phonology

Research into the effect of phonetic complexity on phonological acquisition has a long history in spoken languages. This paper considers the effect of phonetics on phonological development in a signed language. We report on an experiment in which nonword-repetition methodology was adapted so as to examine in a systematic way how phonetic complexity in two phonological parameters of signed languages — handshape and movement — affects the perception and articulation of signs. Ninety-one Deaf children aged 3–11 acquiring British Sign Language (BSL) and 46 hearing nonsigners aged 6–11 repeated a set of 40 nonsense signs. For Deaf children, repetition accuracy improved with age, correlated with wider BSL abilities, and was lowest for signs that were phonetically complex. Repetition accuracy was correlated with fine motor skills for the youngest children. Despite their lower repetition accuracy, the hearing group were similarly affected by phonetic complexity, suggesting that common visual and motoric factors are at play when processing linguistic information in the visuo-gestural modality

The (In)Authenticity of Simulated Talk: Comparing Role-Played and Actual Interaction and the Implications for Communication Training

This article was published in the journal, Research on Language and Social Interaction [Taylor & Francis (Routledge)] and the definitive version is available at: http://dx.doi.org/10.1080/08351813.2013.780341How authentic is simulated, or role-played, interaction, of the kind produced in communication training contexts? The article addresses this question by comparing actual and role-played police investigative interviews. Both types of interviews were recorded by the police: real ones to fulfill British legal requirements and training ones to maximize the authenticity of the training experience. Interview openings were examined using conversation analysis. Officers must adhere to Police and Criminal Evidence Act (2008) guidelines, turning them into spoken actions. The analyses revealed that while, in gross terms, officers in real and simulated interviews opened interviews by formulating the same actions (e.g., identifying copresent parties), differences were observable in their design and organization. In simulations, actions were more elaborate or exaggerated; that is, they were made interactionally visible and “assessable.” Furthermore, some actions were only present in simulations. Implications for the efficacy of role-play methods for training and assessing communication are discussed

Resolving a gender and language problem in women’s leadership:consultancy research in workplace discourse

This article considers the contribution that consultancy research might make to resolving communication problems that women have identified in their leadership practices. Within the intersecting fields of gender and language and workplace discourse, consultancy research-that is, practitioner-commissioned research to resolve work-related, communication problems-is still uncommon. This article presents a study of Monika, a senior leader in an engineering company, who commissioned me to find out why she was experiencing communication problems with her teams. By using interactional sociolinguistic analysis, I was able to show Monika how her authority was being resisted on gendered, linguistic grounds. In making the case for more consultancy research, I discuss how we might use insights from discourse analysis to offer guidance to practitioners seeking our help