The "unknown territory" of goal-setting: Negotiating a novel interactional activity within primary care doctor-patient consultations for patients with multiple chronic conditions.

Goal-setting is widely recommended for supporting patients with multiple long-term conditions. It involves a proactive approach to a clinical consultation, requiring doctors and patients to work together to identify patient’s priorities, values and desired outcomes as a basis for setting goals for the patient to work towards. Importantly it comprises a set of activities that, for many doctors and patients, represents a distinct departure from a conventional consultation, including goal elicitation, goal-setting and action planning. This indicates that goal-setting is an uncertain interactional space subject to inequalities in understanding and expectations about what type of conversation is taking place, the roles of patient and doctor, and how patient priorities may be configured as goals. Analysing such spaces therefore has the potential for revealing how the principles of goal-setting are realised in practice. In this paper, we draw on Goffman’s concept of ‘frames’ to present an examination of how doctors’ and patients’ sense making of goal-setting was consequential for the interactions that followed. Informed by Interactional Sociolinguistics, we used conversation analysis methods to analyse 22 video-recorded goal-setting consultations with patients with multiple long-term conditions. Data were collected between 2016 and 2018 in three UK general practices as part of a feasibility study. We analysed verbal and non-verbal actions for evidence of GP and patient framings of consultation activities and how this was consequential for setting goals. We identified three interactional patterns: GPs checking and reframing patients’ understanding of the goal-setting consultation, GPs actively aligning with patients’ framing of their goal, and patients passively and actively resisting GP framing of the patient goals. These reframing practices provided “telling cases” of goal-setting interactions, where doctors and patients need to negotiate each other’s perspectives but also conflicting discourses of patient-centredness, population-based evidence for treating different chronic illnesses and conventional doctor-patient relations

Host-pathogen reorganisation during host cell entry by Chlamydia trachomatis

Chlamydia trachomatis is obligate intracellular bacterial pathogen that remains a significant public health burden worldwide. A critical early event during infection is chlamydial entry into non-phagocytic host epithelial cells. Like other Gram-negative bacteria, C. trachomatis uses a type III secretion system (T3SS) to deliver virulence effector proteins into host cells. These effectors trigger bacterial uptake and promote bacterial survival and replication within the host cell. In this review, we highlight recent cryo-electron tomography that has provided striking insights into the initial interactions between Chlamydia and its host. We describe the polarised structure of extracellular C. trachomatis elementary bodies (EBs), and the supramolecular organisation of T3SS complexes on the EB surface, in addition to the changes in host and pathogen architecture that accompany bacterial internalisation and EB encapsulation into early intracellular vacuoles. Finally, we consider the implications for further understanding the mechanism of C. trachomatis entry and how this might relate to those of other bacteria and viruses

The experiences of school staff who work with emotionally based school non-attendance: a psycho-social exploration.

This psycho-social study explored the experiences of school staff who have worked with emotionally based school non-attendance. There is a paucity of qualitative accounts of school staff’s views in this area. Existing research focuses predominantly on the causes, risk and protective factors and the management of school non-attendance. Six participants took part in two interviews where psychoanalytically informed approaches were employed. This included the Grid Elaboration Method and Free Association Narrative Interviewing. The interview transcripts were analysed using Thematic Analysis, which illuminated five overarching themes: relationships between home and school; school factor s; conceptualisation and impact of school non - attendance; tasks and challenges of adolescence and individual journeys and emotions. The themes are discussed in relation to existing research and psychological theory. Consideration is given to the implications for the role of the Educational Psychologist in working with emotionally based school non-attendance. Strengths and limitations of the current study are discussed and ideas for future research are proposed

Peer learning leaders: developing employability through facilitating the learning of other students

Employability is a key theme in higher education and attitudes towards its development have shifted from a focus on technical skills development to a broader focus on values, intellect, social engagement and performance contributing to graduate identity (Hager and Hodkinson, 2009). Peer Assisted Learning (PAL) and Language Conversation Clubs are both examples of student-led peer learning schemes at Bournemouth University (BU), and are reviewed to explore the development of students employed to lead and facilitate group learning sessions. Data from four annual evaluation surveys (n=239) is reviewed in addition to qualitative comments and reflective writing. Peer leaders were found to have developed employability attributes including: leadership, time management and organisation, communication, and cultural awareness. Above all, peer leaders identified with developing confidence in their roles. Comments provided examples of student leaders who had actively selected peer learning as an opportunity to develop their confidence and were able to transfer this to other academic and employment contexts

Adequacy post-Rose v. Council for Better Education in Kentucky public school facilities : a case study

The decision in the 1989 landmark Kentucky case, Rose v. Council for Better Education, initiated many reforms to ensure that children have access to an adequate education, including funding new construction and renovations for school facilities. The purpose of this instrumental, qualitative case study is to describe how the additional state and local funding for a selected Kentucky public school facility affected the provision of an adequate education. The term adequacy is used in the study to mean the fiscal sufficiency to meet a qualitative set of achievement standards required by the state as indicated in the Rose decision. One recently renovated middle school was purposefully selected based on its relatively lower score on the Kentucky School Report. Selected features: (1) security, (2) technological readiness, (3) lighting, (4) thermal comfort and (5) air quality were examined. Interviews, facility observations including photographic images, archival and contemporaneous documents, and reflexive field notes comprised the data collection. District and school administrators, teachers, and other individuals deemed knowledgeable were selected purposefully and by the snowball method for interviews. Observations focused on the five features and their relationship to teaching and learning. Classrooms were observed without students present. Document analysis was used for contextual information about the school district and the school case. Triangulated data were analyzed in an iterative and holistic process to identify common themes. Trustworthiness of the findings was established through triangulation of data, peer debriefing, disconfirming analyses, the rich description, and field notes. The findings suggest that the additional facilities funding since the Rose decision created a teaching and learning environment that supported the tenets of an adequate education that previously had not been realized. Improvements that support an adequate education were found in three of the five features. Evidence of three additional building features emerged (the facility's auditorium renovations, added disability accessibility, and classroom renovations according to content area). Enhancements made to these three additional features added to the educational opportunities afforded to the students. The study adds to the knowledge base on outcomes of Kentucky reforms and the relationship between facilities and opportunities for an adequate education

Setting goals with patients living with multimorbidity: qualitative analysis of general practice consultations

Background Establishing patient goals is widely recommended as a way to deliver care that matters to the individual patient with multimorbidity, who may not be well served by single-disease guidelines. Though multimorbidity is now normal in general practice, little is known about how doctors and patients should set goals together. Aim To determine the key components of the goal-setting process in general practice. Design and setting In-depth qualitative analysis of goal-setting consultations in three UK general practices, as part of a larger feasibility trial. Focus groups with participating GPs and patients. The study took place between November 2016 and July 2018. Method Activity analysis was applied to 10 hours of video-recorded doctor-patient interactions to explore key themes relating to how goal setting was attempted and achieved. Core challenges were identified and focus groups were analysed using thematic analysis. Results A total of 22 patients and five GPs participated. Four main themes emerged around the goal-setting process: patient preparedness and engagement; eliciting and legitimising goals; collaborative action planning; and GP engagement. GPs were unanimously positive about their experience of goal setting and viewed it as a collaborative process. Patients liked having time to talk about what was most important to them. Challenges included eliciting goals from unprepared patients, and GPs taking control of the goal rather than working through it with the patient. Conclusion Goal setting required time and energy from both parties. GPs had an important role in listening and bearing witness to their patients' goals. Goal setting worked best when both GP and patient were prepared in advance

Spontaneous gene flow from rapeseed (Brassica napus) to wild Brassica oleracea

Research on the environmental risks of gene flow from genetically modified (GM) crops to wild relatives has traditionally emphasized recipients yielding most hybrids. For GM rapeseed (Brassica napus), interest has centred on the ‘frequently hybridizing’ Brassica rapa over relatives such as Brassica oleracea, where spontaneous hybrids are unreported in the wild. In two sites, where rapeseed and wild B. oleracea grow together, we used flow cytometry and crop-specific microsatellite markers to identify one triploid F(1) hybrid, together with nine diploid and two near triploid introgressants. Given the newly discovered capacity for spontaneous introgression into B. oleracea, we then surveyed associated flora and fauna to evaluate the capacity of both recipients to harm cohabitant species with acknowledged conservational importance. Only B. oleracea occupies rich communities containing species afforded legislative protection; these include one rare micromoth species that feeds on B. oleracea and warrants further assessment. We conclude that increased attention should now focus on B. oleracea and similar species that yield few crop-hybrids, but possess scope to affect rare or endangered associates