The Sydney Conservatorium Early Music Ensemble: An activity-theoretical study of the impact of period instruments, historically-informed performance and a unique pedagogy on tertiary group-learning experiences

This PhD thesis is focused on the learning experiences of students in the Sydney Conservatorium Early Music Ensemble (EME). It sheds light on an area that remains relatively under-researched to date: the group-learning experiences of tertiary-level music students. EME provides its members with an opportunity to experiment with period instruments and to explore repertoire from the late Renaissance to early Classical periods with a historically-informed approach to music making. The tutors of the ensemble, all of whom are expert practitioners in the field of historically-informed performance (HIP), have nurtured a pedagogy that embraces elements of informal peer learning and stimulates active participation and collaboration. The main claim of the thesis is that period instruments, HIP, a broadly constructivist tutor approach and collaborative peer learning all play a significant role in stimulating deeper learning and actively engaged music making. As part of the purely qualitative research design twelve EME students are interviewed about their experiences of learning to play period instruments and their perceptions of a collaborative learning environment, including the role of peers and tutors. A series of open-ended interview questions serves to gain insights into the principal research questions: what learning possibilities do the instruments offer and how do the students experience this alongside the mental and physical rigours of HIP, the unique approach of the tutors and interactions with peers? In seeking a theoretical framework to help explore the interrelationships between the materials and the 'actors' in EME, Cultural-Historical Activity Theory (CHAT) offers a particularly helpful perspective. This research approach incorporates both ‘tools’ and the learning community as integral influences in the learning process. As such it facilitates a holistic investigation of the learning and teaching relationships in the specific EME environment and the ‘affordances’ or learning potential of the materials involved. My research claim is firmly supported by the findings in this study. The students provide ample evidence of a broad range of deep learning experiences associated with period instruments and HIP. In addition the benefits of multiple elements of group-learning are identified: a continuum of formal and informal learning, collaborative peer learning, and a reflective tutor approach that embraces active participation. The study contributes to CHAT in the realm of the arts and has positive implications for the role of period instruments, HIP and the value of group-learning situations in western-style conservatoires and other tertiary music institutions

Medicalization of Eating and Feeding

reference articleA variety of developments over the past century have produced the conditions in which eating and feeding are transformed from practices embedded in social or cultural relations into explicit medical practices. The rise of medical science, expansion of the pharmaceutical and food industries, escalating concern over diet‐related diseases and conditions, and growing anxiety over infant and childhood development have contributed to a process of medicalization. Medicalization is a sociological concept that analyses the expansion of medical terminology, interventions, or practitioners into areas of the life that were previously considered outside the medical sphere. For instance, under‐eating has previously been defined using theological language, as an act of fasting demonstrating a saintly character. Such practices are now understood through medical terms of anorexia nervosa, malnutrition, or general diagnoses such as “eating disorders not otherwise specified.” Individuals engaged in under‐ or over‐eating practices are increasingly defined by medical concepts (anorexia nervosa and obesity) and treated in medical spaces (hospitals, clinics, or rehabilitation centres) through medical interventions (pharmaceuticals, surgery, psychotherapy, or dietary regimens). Likewise, infant feeding (breast or formula) is understood as a practice that requires monitoring and instruction from medical practitioners. Further, eating in general is progressively invested with medical significance. Foods and diets are touted as possessing a therapeutic or health enhancing capacity that indicates an individual’s or population’s present and future health. Due to the high regard for, and influence of, medical science in the West, medicalization studies primarily focus on Western contexts. Medicalization does have an impact on non‐Western societies and the developing world, however its influence emanates from Western biomedicine, industries, and policies. There is important work to be done in examining the process of medicalization in non‐Western contexts, however this article is limited to the Western context ( Hunt, 1999). To analyse the medicalization of eating and feeding it is important to first sketch the theoretical and historical background of medicalization as a sociological concept. The relationship between eating and medicine is extensive. In order to focus the discussion, three examples are used – under‐eating, over‐ eating and infant feeding. This background focuses the analysis of the forces driving the medicalization of eating and feeding. Finally, in elaborating the influences and consequences of the medicalization of eating and feeding, some of the central ethical implications are identified and discusse

Essays on equity portfolio management

Essays on Equity Portfolio Management This dissertation contains three essays involving empirical research in the area of equity portfolio management. Specifically, two of the essays contribute to the existing funds management literature by examining issues concerning portfolio performance evaluation and asset allocations. These being, equity fund benchmark mismatching, and equity fund industry allocations during the Australian mining boom. The third essay investigates issues relating to socially responsible investing. The first essay uses Australian equity fund data to examine the appropriateness of equity funds’ self-reported benchmarks. Given the lack of regulation surrounding the benchmarking of Australian managed funds and the absence of publicly available equity style indices, this essay explores if fund benchmarks are able to adequately capture passive investment styles and whether funds are better suited to alternative benchmarks. This essay further explores if funds with inappropriate benchmarks are able to outperform relatively, on account of the strategic nature of managers to report underperforming benchmarks, and whether this influences asset flows. The final essay of this dissertation provides a measure for the value of this non-financial satisfaction that accrues to individuals from investing in a socially responsible manner. This non-financial benefit is referred to as the “psychic dividend” of SRI. Previous studies attempt to quantify this value as the difference in certainty equivalent returns of SRI and non-SRI portfolios. This chapter extends the definition of certainty equivalence to consider constant relative risk aversion and loss aversion

Assessing patient-centred communication in teaching: A systematic review of instruments

Context Patient-centred communication is a key component of patient centredness in medical care. Therefore, adequate education in and assessment of patient-centred communication skills are necessary. In general, feedback on communication skills is most effective when it is provided directly and is systematic. This calls for adequate measurement instruments. Objectives The aim of this study was to provide a systematic review of existing instruments that measure patient centredness in doctor–patient communication and can be used to provide direct feedback. Methods A systematic review was conducted using an extensive validated search strategy for measurement instruments in PubMed, EMBASE, PsycINFO and CINAHL. The databases were searched from their inception to 1 July 2016. Articles describing the development or evaluation of the measurement properties of instruments that measure patient centredness (by applying three or more of the six dimensions of a published definition of patient centredness) in doctor–patient communication and that can be used for the provision of direct feedback were included. The methodological quality of measurement properties was evaluated using the COSMIN checklist. Results Thirteen articles describing 14 instruments measuring patient centredness in doctor–patient communication were identified. These studies cover a wide range of settings and patient populations, and vary in the dimensions of patient centredness applied and in methodological quality on aspects of reliability and validity. Conclusions This review gives a comprehensive overview of all instruments available for the measurement of patient centredness in doctor–patient communication that can be used for the provision of direct feedback and are described in the literature. Despite the widely felt need for valid and reliable instruments for the measurement of patient-centred communication, most of the instruments currently available have not been thoroughly investigated. Therefore, we recommend further research into and enhancement of existing instruments in terms of validity and reliability, along with enhancement of their generalisability, responsiveness and aspects of interpretability in different contexts (real patients, simulated patients, doctors in different specialties, etc.). Comprehensibility and feasibility should also be taken into account.this study was supported by Radboud University Medical Centre (IWOO [EKO project R0002432]

Assessment of medical students' integrated clinical communication skills: Development of a tailor-made assessment tool

Background Since patient-centered communication is directly connected to clinical performance, it should be integrated with medical knowledge and clinical skills. Therefore, clinical communication skills should be trained and assessed as an integral part of the student’s clinical performance. We were unable to identify a tool, which helps when assessing patient-centered communication skills as an integrated component of medical history taking (‘the integrated medical interview’). Therefore, we decided to design a new tailor-made assessment tool, the BOCC (BeOordeling Communicatie en Consultvoering (Dutch), Assessment of Communication and Consultation (English) to help raters assess students’ integrated clinical communication skills with the emphasis on patient-centred communication combined with the correct medical content. This is a first initiative to develop such a tool, and this paper describes the first steps in this process. Methods We investigated the tool in a group of third-year medical students (n = 672) interviewing simulated patients. Internal structure and internal consistency were assessed. Regression analysis was conducted to investigate the relationship between scores on the instrument and general grading. Applicability to another context was tested in a group of fourth-year medical students (n = 374). Results PCA showed five components (Communication skills, Problem clarification, Specific History, Problem influence and Integration Skills) with various Cronbach’s alpha scores. The component Problem Clarification made the strongest unique contribution to the grade prediction. Applicability was good when investigated in another context. Conclusions The BOCC is designed to help raters assess students’ integrated communication skills. It was assessed on internal structure and internal consistency. This tool is the first step in the assessment of the integrated medical interview and a basis for further investigation to reform it into a true measurement instrument on clinical communication skills.This study was supported by the Radboud University Medical Center Nijmegen (EKO grant)

Implementing guidelines and training initiatives to improve cross-cultural communication in primary care consultations: a qualitative participatory European study

Abstract BACKGROUND: Cross-cultural communication in primary care is often difficult, leading to unsatisfactory, substandard care. Supportive evidence-based guidelines and training initiatives (G/TIs) exist to enhance cross cultural communication but their use in practice is sporadic. The objective of this paper is to elucidate how migrants and other stakeholders can adapt, introduce and evaluate such G/TIs in daily clinical practice. METHODS: We undertook linked qualitative case studies to implement G/TIs focused on enhancing cross cultural communication in primary care, in five European countries. We combined Normalisation Process Theory (NPT) as an analytical framework, with Participatory Learning and Action (PLA) as the research method to engage migrants, primary healthcare providers and other stakeholders. Across all five sites, 66 stakeholders participated in 62 PLA-style focus groups over a 19 month period, and took part in activities to adapt, introduce, and evaluate the G/TIs. Data, including transcripts of group meetings and researchers' fieldwork reports, were coded and thematically analysed by each team using NPT. RESULTS: In all settings, engaging migrants and other stakeholders was challenging but feasible. Stakeholders made significant adaptations to the G/TIs to fit their local context, for example, changing the focus of a G/TI from palliative care to mental health; or altering the target audience from General Practitioners (GPs) to the wider multidisciplinary team. They also progressed plans to deliver them in routine practice, for example liaising with GP practices regarding timing and location of training sessions and to evaluate their impact. All stakeholders reported benefits of the implemented G/TIs in daily practice. Training primary care teams (clinicians and administrators) resulted in a more tolerant attitude and more effective communication, with better focus on migrants' needs. Implementation of interpreter services was difficult mainly because of financial and other resource constraints. However, when used, migrants were more likely to trust the GP's diagnoses and GPs reported a clearer understanding of migrants' symptoms. CONCLUSIONS: Migrants, primary care providers and other key stakeholders can work effectively together to adapt and implement G/TIs to improve communication in cross-cultural consultations, and enhance understanding and trust between GPs and migrant patients.The RESTORE project was funded by the EU Seventh Framework Programme (FP7/2007–2013) under Grant Agreement No. 257258. RESTORE: REsearch into Implementation STrategies to support patients of different ORigins and language background in a variety of European primary care setting

The importance of longitudinal studies in family medicine: experiences of two practice-based research networks.

Contains fulltext : 51016.pdf (publisher's version ) (Open Access)BACKGROUND: For evidence-based decision making in family practice, it is essential to know the long-term (natural) course of common diseases and their outcomes under care and treatment. This article, based on a research methodology workshop, aims to raise awareness and interest in longitudinal research in practice-based research networks (PBRNs) among family physicians (FP) and researchers, and to elucidate a number of broad principles that apply to longitudinal research in such settings. METHODS: A workshop discussion of PBRN experts, based on 2 examples of PBRN-based longitudinal studies, focusing on the general methodological principles was held in March 2005 in Colorado Springs, CO. The first study, conducted in a historic cohort, documented long-term outcome of depression in 386 patients in family practice. The second study analyzed consequences of age-associated peripheral neuropathy in a concurrent follow-up study design. It was possible to prospectively follow a cohort of 604 healthy subjects enrolled in the practices by research nurses. Discussion at the workshop was generated around the following methodological topics: study designs, recruitment, retention and tracking of participants, dealing with changes in diagnostic and treatment of standards over time, informed consent, data analysis, and funding issues. Results and CONCLUSIONS: The workshop concluded that, although there are many obstacles to be overcome when conducting longitudinal studies in practice settings, the benefits for our discipline could be substantial. Concurrent and historic cohorts each have advantages and disadvantages. Although tracking patients (and physicians) over time is a challenge, periodic rewards enhance recruitment and retention. Informed consent is critical although ethical requirements may change. Use of standard well-defined definitions promotes consistency of data collection over time, as does training of FPs and staff. Data analysis has become both easier and more sophisticated, and statistical assistance is advised from the outset. Funding remains a challenge, but costs need not be prohibitive. Given its importance, PBRNs should be encouraged to develop methods of long-term data collection on cohorts of patients followed by primary care physicians

Treatment of depression in primary care.

Contains fulltext : 81061.pdf (publisher's version ) (Open Access

[Research report 'the appropriate prescribing of antidepressants in general practice': who is better served by more diagnoses and more antidepressants?]

Recently a report entitled 'The appropriate prescribing of antidepressants in general practice' was published. The researchers conclude that depression and anxiety are still more under-diagnosed than over-diagnosed and that antidepressants are frequently prescribed even when they are not indicated. Why this is so remains unclear. Looking for better interventions to improve treatment and increase therapy compliance, this study reports that many types of intervention could help but it is not very specific on how this could be achieved. Improving communication and knowledge about prescribing and how and when to discontinue treatment, are among the suggestions made in the report. Many questions remain: (a) is under-diagnosis a problem in a condition that often resolves spontaneously with watchful waiting?, (b) why are antidepressants so widely prescribed when their effectiveness is controversial and they have major adverse reactions?, (c) why are other treatment options such as talking therapy and a short period psychological intervention, of which the effectiveness has been established, not more frequently applied

Depression: the long-term perspective. A follow-up study in general practice

Contains fulltext : 144776.pdf (publisher's version ) (Open Access)28 november 2000Promotores : Bosch, W.J.H.M. van den, Zitman, F.G. Co-promotores : Zielhuis, G.A., Hosman, C.M.H., Sir Pereira Gray, D.159 p