Homogeneity and heterogeneity in disciplinary discourse : tracking the management of intertextuality in undergraduate academic lectures

Using a corpus of twenty-four lectures drawn from The BASE corpus, this study is an analysis and inter-disciplinary comparison of the management of Intertextuality in the genre of the undergraduate lecture. Theorising Intertextuality as central within the discursive (re-)construction of disciplinary knowledge, the investigation of Intertextuality is viewed as the investigation of the discursively-mediated interaction(s) of a current lecturer with original knowledge-constituting discourses, and with their agents too, of an academic community. As there is no holistic and comprehensive methodology for assessing the management of Intertextuality in academic discourse both qualitatively and quantitatively, this study uses two further lectures to devise such a methodology. This involves segregating lecture discourse into consistent independent units and then coding each unit according both to its function in the discourse and the participant voice(s) behind it. Applying this comprehensive scheme shows that independent units in lecture discourse are classifiable under three broad functional areas, Intertextuality (units realising propositional input), Intratextuality (units realising the mechanics of text and discursive interaction), and Metatextuality (units realising unit-length evaluation of emerging discourse). These functional areas and the functions within them are manageable via different participant voice(s), the manifestations and pragmatic effects of which in discourse vary, meaning the management of Intertextuality can be assessed qualitatively and quantitatively using the coherent, consistent and data-driven coding scheme derived from these analyses. This methodology, applied qualitatively and quantitatively to the corpus, reveals management similarities broadly between Arts & Humanities and Social Sciences lectures, typically a dialogic management, and management differences broadly between these two groupings and Physical Sciences lectures, typically a monophonic management. These management choices are understood as both constituted by and as reconstitutive of the social and epistemological landscapes behind lectures, meaning the management of Intertextuality is viewed as the dominant influence in shaping disciplinary discourse

Effect of a Ward-Based Program on Hospital-Associated Complications and Length of Stay for Older Inpatients: The Cluster Randomized CHERISH Trial

Importance: Hospital-associated complications of older people (HAC-OPs) include delirium, hospital-associated disability, incontinence, pressure injuries, and falls. These complications may be preventable by age-friendly principles of care, including early mobility, good nutrition and hydration, and meaningful cognitive engagement; however, implementation is challenging. Objectives: To implement and evaluate a ward-based improvement program ("Eat Walk Engage") to more consistently deliver age-friendly principles of care to older individuals in acute inpatient wards. Design, Setting, and Participants: This cluster randomized CHERISH (Collaboration for Hospitalised Elders Reducing the Impact of Stays in Hospital) trial enrolled 539 consecutive inpatients aged 65 years or older, admitted for 3 days or more to study wards, from October 2, 2016, to April 3, 2017, with a 6-month follow-up. The study wards comprised 8 acute medical and surgical wards in 4 Australian public hospitals. Randomization was stratified by hospital, providing 4 clusters in intervention and in control groups. Statistical analysis was performed from August 28, 2018, to October 17, 2021, on an intention-to-treat basis. Intervention: A trained facilitator supported a multidisciplinary work group on each intervention ward to improve the care practices, environment, and culture to support key age-friendly principles. Main Outcomes and Measures: Primary outcomes were incidence of any HAC-OP and length of stay. Secondary outcomes were incidence of individual HAC-OPs, facility discharge, 6-month mortality, and all-cause readmission. Outcomes were analyzed at the individual level, adjusted for confounders and clustering. Results: A total of 265 participants on 4 intervention wards (124 women [46.8%]; mean [SD] age, 75.9 [7.3] years) and 274 participants on 4 control wards (145 women [52.9%]; mean [SD] age, 78.0 [8.2] years) were enrolled. The composite primary outcome of any HAC-OP occurred for 115 of 248 intervention participants (46.4%) and 129 of 249 control participants (51.8%) (intervention group: adjusted odds ratio, 1.07; 95% CI, 0.71-1.61). The median length of stay was 6 days (IQR, 4-9 days) for the intervention group and 7 days (IQR, 5-10 days) for the control group (adjusted hazard ratio, 0.96; 95% credible interval, 0.80-1.15). The incidence of delirium was significantly lower for intervention participants (adjusted odds ratio, 0.53; 95% CI, 0.31-0.90). There were no significant differences in other individual HAC-OPs, facility discharge, mortality, or readmissions. Conclusions and Relevance: The Eat Walk Engage program did not reduce the composite primary outcome of any HAC-OP or length of stay, but there was a significant reduction in the incidence of delirium. Trial Registration: anzctr.org.au Identifier: ACTRN12615000879561.</p

Opinions of Youngsters with Congenital Below-Elbow Deficiency, and Those of Their Parents and Professionals Concerning Prosthetic Use and Rehabilitation Treatment

<p>Background: Youngsters with unilateral congenital below-elbow deficiency (UCBED) seem to function well with or without a prosthesis. Reasons for rejecting prostheses have been reported earlier, but unfortunately not those of the children themselves. Furthermore, reasons for acceptance are underexplored in the literature.</p><p>Objectives: To investigate opinions of children and early and late adolescents with UCBED, and those of their parents and healthcare professionals, concerning (1) reasons to wear or not to wear prostheses and (2) about rehabilitation care.</p><p>Methods: During one week of online focus group interviews, 42 children of 8-12 y/o, early and late adolescents of 13-16 and 17-20 y/o, 17 parents, and 19 healthcare professionals provided their opinions on various topics. This study addresses prosthetic use or non-use of prosthetics and rehabilitation care. Data were analyzed using the framework approach.</p><p>Results: Cosmesis was considered to be the prime factor for choosing and wearing a prosthesis, since this was deemed especially useful in avoiding stares from others. Although participants functioned well without prostheses, they agreed that it was an adjuvant in daily-life activities and sports. Weight and limited functionality constituted rejection reasons for a prosthesis. Children and adolescents who had accepted that they were different no longer needed the prosthesis to avoid being stared at. The majority of participants highly valued the peer-to-peer contact provided by the healthcare professionals.</p><p>Conclusions: For children and adolescents with UCBED, prostheses appeared particularly important for social integration, but much less so for functionality. Peer-to-peer contact seemed to provide support during the process of achieving social integration and should be embedded in the healthcare process.</p>