Visualising Conversation Structure across Time: Insights into Effective Doctor-Patient Consultations

Effective communication between healthcare professionals and patients is critical to patients’ health outcomes. The doctor/patient dialogue has been extensively researched from different perspectives, with findings emphasising a range of behaviours that lead to effective communication. Much research involves self-reports, however, so that behavioural engagement cannot be disentangled from patients’ ratings of effectiveness. In this study we used a highly efficient and time economic automated computer visualisation measurement technique called Discursis to analyse conversational behaviour in consultations. Discursis automatically builds an internal language model from a transcript, mines the transcript for its conceptual content, and generates an interactive visual account of the discourse. The resultant visual account of the whole consultation can be analysed for patterns of engagement between interactants. The findings from this study show that Discursis is effective at highlighting a range of consultation techniques, including communication accommodation, engagement and repetition

The moral muteness of managers: an Anglo-American phenomenon? German and British managers and their moral reasoning about environmental sustainability in business

Several studies in the Anglo-American context have indicated that managers present themselves as morally neutral employees who act only in the best interest of the company by employing objective skills. The reluctance of managers to use moral arguments in business is further accentuated in the now common argument presented as a neutral fact that the company must always prioritise shareholder value. These and other commercial aims are seen as an objective reality in business, whilst questions about sustainability, environmental problems or fair trade are seen as emotional or moral ones; a phenomenon described as ‘moral muteness’. This research explores whether this ‘moral muteness’ is an Anglo-American phenomenon and/or whether managers in other countries - in this case Germany - might express themselves in a different way. The focus is on moral arguments around environmental sustainability and the implications of this study for cross-cultural management. This article is based on a qualitative, comparative cross-cultural study of British and German managers in the Food Retail and Energy Sectors. In line with the studies mentioned above, British managers placed a strong emphasis on their moral neutrality. In contrast, German managers tended to use moral arguments when discussing corporate greening, often giving such arguments more weight than financial arguments. Overall, the study suggests that the ‘moral muteness’ of managers is a British phenomenon and quite distinct from the German approach. The article ends in a short exploration of how this understanding can help managers better manage people, organisations and change across cultures

A dust-parallax distance of 19 megaparsecs to the supermassive black hole in NGC 4151

The active galaxy NGC 4151 has a crucial role as one of only two active galactic nuclei for which black hole mass measurements based on emission line reverberation mapping can be calibrated against other dynamical methods. Unfortunately, effective calibration requires an accurate distance to NGC 4151, which is currently not available. Recently reported distances range from 4 to 29 megaparsecs (Mpc). Strong peculiar motions make a redshift-based distance very uncertain, and the geometry of the galaxy and its nucleus prohibit accurate measurements using other techniques. Here we report a dust-parallax distance to NGC 4151 of $D_A = 19.0^{+2.4}_{-2.6}$ Mpc. The measurement is based on an adaptation of a geometric method proposed previously using the emission line regions of active galaxies. Since this region is too small for current imaging capabilities, we use instead the ratio of the physical-to-angular sizes of the more extended hot dust emission as determined from time-delays and infrared interferometry. This new distance leads to an approximately 1.4-fold increase in the dynamical black hole mass, implying a corresponding correction to emission line reverberation masses of black holes if they are calibrated against the two objects with additional dynamical masses.Comment: Authors' version of a letter published in Nature (27 November 2014); 8 pages, 5 figures, 1 tabl

Determinants of adults' intention to vaccinate against pandemic swine flu

This article has been made available through the Brunel Open Access Publishing Fund.This article has been made available through the Brunel Open Access Publishing Fund.Background: Vaccination is one of the cornerstones of controlling an influenza pandemic. To optimise vaccination rates in the general population, ways of identifying determinants that influence decisions to have or not to have a vaccination need to be understood. Therefore, this study aimed to predict intention to have a swine influenza vaccination in an adult population in the UK. An extension of the Theory of Planned Behaviour provided the theoretical framework for the study. Methods: Three hundred and sixty two adults from the UK, who were not in vaccination priority groups, completed either an online (n = 306) or pen and paper (n = 56) questionnaire. Data were collected from 30th October 2009, just after swine flu vaccination became available in the UK, and concluded on 31st December 2009. The main outcome of interest was future swine flu vaccination intentions. Results: The extended Theory of Planned Behaviour predicted 60% of adults’ intention to have a swine flu vaccination with attitude, subjective norm, perceived control, anticipating feelings of regret (the impact of missing a vaccination opportunity), intention to have a seasonal vaccine this year, one perceived barrier: “I cannot be bothered to get a swine flu vaccination” and two perceived benefits: “vaccination decreases my chance of getting swine flu or its complications” and “if I get vaccinated for swine flu, I will decrease the frequency of having to consult my doctor,” being significant predictors of intention. Black British were less likely to intend to have a vaccination compared to Asian or White respondents. Conclusions: Theoretical frameworks which identify determinants that influence decisions to have a pandemic influenza vaccination are useful. The implications of this research are discussed with a view to maximising any future pandemic influenza vaccination uptake using theoretically-driven applications.This article is available through the Brunel Open Access Publishing Fund

Meeting the global protein supply requirements of a growing and ageing population

\ua9 The Author(s) 2024.Human dietary patterns are a major cause of environmental transformation, with agriculture occupying ~ 50% of global land space, while food production itself is responsible for ~ 30% of all greenhouse gas emissions and 70% of freshwater use. Furthermore, the global population is also growing, such that by 2050, it is estimated to exceed ~ 9 billion. While most of this expansion in population is expected to occur in developing countries, in high-income countries there are also predicted changes in demographics, with major increases in the number of older people. There is a growing consensus that older people have a greater requirement for protein. With a larger and older population, global needs for protein are set to increase. This paper summarises the conclusions from a Rank Prize funded colloquium evaluating novel strategies to meet this increasing global protein need

Relation of gallbladder function and Helicobacter pylori infection to gastric mucosa inflammation in patients with symptomatic cholecystolithiasis

Background. Inflammatory alterations of the gastric mucosa are commonly caused by Helicobacter pylori (Hp) infection in patients with symptomatic gallstone disease. However, the additional pathogenetic role of an impaired gallbladder function leading to an increased alkaline duodenogastric reflux is controversially discussed. Aim:To investigate the relation of gallbladder function and Hp infection to gastric mucosa inflammation in patients with symptomatic gallstones prior to cholecystectomy. Patients: Seventy-three patients with symptomatic gallstones were studied by endoscopy and Hp testing. Methods: Gastritis classification was performed according to the updated Sydney System and gallbladder function was determined by total lipid concentration of gallbladder bile collected during mainly laparoscopic cholecystectomy. Results: Fifteen patients revealed no, 39 patients mild, and 19 moderate to marked gastritis. No significant differences for bile salts, phospholipids, cholesterol, or total lipids in gallbladder bile were found between these three groups of patients. However, while only 1 out of 54 (< 2%) patients with mild or no gastritis was found histologically positive for Hp, this infection could be detected in 14 (74%) out of 19 patients with moderate to marked gastritis. Conclusion: Moderate to marked gastric mucosa inflammation in gallstone patients is mainly caused by Hp infection, whereas gallbladder function is not related to the degree of gastritis. Thus, an increased alkaline duodenogastric reflux in gallstone patients seems to be of limited pathophysiological relevance. Copyright (c) 2006 S. Karger AG, Basel

Prevalence of pancreatic, hepatic and renal microscopic lesions in post-mortem samples from Cavalier King Charles spaniels.

OBJECTIVES: The objective of this study was to describe the prevalence of microscopic pancreatic, hepatic and renal lesions in post-mortem samples from Cavalier King Charles spaniels. METHODS: The prevalence of microscopic lesions was determined by routine histopathology and compared to ante-mortem clinical signs. RESULTS: There was evidence of chronic pancreatitis in 51·9% of the cases, and age correlated with severity. Renal lesions were diagnosed in 52·2% of cases, most of which were inflammatory. Ante-mortem diagnosis of pancreatic and renal disease was 25 and 16·7%, respectively. Primary hepatic lesions were diagnosed in 11·1% of cases; secondary hepatic lesions were diagnosed in 64·8%. CLINICAL SIGNIFICANCE: Pancreatic and renal lesions are common in Cavalier King Charles spaniels, but they have similar rates of hepatic disease as the general population. The increasing prevalence of pancreatic lesions with age suggests that it might be a progressive condition.A.C.C. Kent is very grateful to the Alice Noakes Trust for sponsorship of his Senior Clinical Training Scholarship.This is the author accepted manuscript. It is currently under an indefinite embargo pending publication by Wiley