The mother the whore & the dandy

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Another Deleuzian Resnais: l'année dernière à Marienbad as conflict between sadism and masochism

The Deleuzian reading of L'Année dernière à Marienbad proposed here draws less on what has become a virtually canonical concept in film studies – Deleuze's time-image – than on a much earlier work by the same author, Masochism, which treats sadism and masochism as qualitatively different symbolic universes. Resnais's film, with its deployment of mirrors and statuary and its suggestion of a contract between the characters A and X, presents striking resemblances to the world of masochism as described by Deleuze (drawing on the work of Theodor Reik). At the same time, the role of the third protagonist, M, like that of Robbe-Grillet who wrote the screenplay, has Sadean overtones, suggesting that it might be possible to read the film with its diegetic ambiguities as a Möbius strip linking the sadistic and the masochistic world not only with each other, but with the crystalline universe of the time-image

Flexible Learning Spaces Evaluation Report

City University, London is tackling the challenge of ensuring the learning spaces provided are able to meet the anticipated increase in technology usage and prevalent pedagogies. There is no longer a standard classroom design that will achieve this goal and therefore it is imperative to pilot and explore a variety of flexible learning spaces. This report feeds back on an evaluation of two flexible learning space approaches piloted in the autumn term of 2012 as alternatives to traditional computer rooms laid out in rows with the lecturer positioned at the front. These approaches are: pop-up computers on circular tables in AG24A; and laptop lockers enabling staff to borrow laptops to use with students on node chairs in AG24B. Each of these approaches also supported the use of students’ own devices in learning spaces. These methods were evaluated using surveys, interviews and an open house forum. The report shares the findings and recommendations from this evaluation and future plans for learning spaces

Research on a non-destructive fluidic storage control device

Fluidic memory device with associated fluidic alpha numerical displa

Test program for transmitter experiment package and heat pipe system for the communications technology satellite

The test program is described for the 200 watt transmitter experiment package and the variable conductance heat pipe system which are components of the high-power transponder aboard the Communications Technology Satellite. The program includes qualification tests to demonstrate design adequacy, acceptance tests to expose latent defects in flight hardware, and development tests to integrate the components into the transponder system and to demonstrate compatibility

Interdisciplinary communication in the intensive care unit

Background. Patient safety research has shown poor communication among intensive care unit (ICU) nurses and doctors to be a common causal factor underlying critical incidents in intensive care. This study examines whether ICU doctors and nurses have a shared perception of interdisciplinary communication in the UK ICU. Methods. Cross-sectional survey of ICU nurses and doctors in four UK hospitals using a previously established measure of ICU interdisciplinary collaboration. Results. A sample of 48 doctors and 136 nurses (47% response rate) from four ICUs responded to the survey. Nurses and doctors were found to have differing perceptions of interdisciplinary communication, with nurses reporting lower levels of communication openness between nurses and doctors. Compared with senior doctors, trainee doctors also reported lower levels of communication openness between doctors. A regression path analysis revealed that communication openness among ICU team members predicted the degree to which individuals reported understanding their patient care goals (adjR2 = 0.17). It also showed that perceptions of the quality of unit leadership predicted open communication. Conclusions. Members of ICU teams have divergent perceptions of their communication with one another. Communication openness among team members is also associated with the degree to which they understand patient care goals. It is necessary to create an atmosphere where team members feel they can communicate openly without fear of reprisal or embarrassment

The presence and potential impact of psychological safety in the healthcare setting: an evidence synthesis

Introduction: Psychological safety is the shared belief that the team is safe for interpersonal risk taking. Its presence improves innovation and error prevention. This evidence synthesis had 3 objectives: explore the current literature regarding psychological safety, identify methods used in its assessment and investigate for evidence of consequences of a psychologically safe environment. Methods: We searched multiple trial registries through December 2018. All studies addressing psychological safety within healthcare workers were included and reviewed for methodological limitations. A thematic analysis approach explored the presence of psychological safety. Content analysis was utilised to evaluate potential consequences. Results: We included 62 papers from 19 countries. The thematic analysis demonstrated high and low levels of psychological safety both at the individual level in study participants and across the studies themselves. There was heterogeneity in responses across all studies, limiting generalisable conclusions about the overall presence of psychological safety. A wide range of methods were used. Twenty-five used qualitative methodology, predominantly semi-structured interviews. Thirty quantitative or mixed method studies used surveys. Ten studies inferred that low psychological safety negatively impacted patient safety. Nine demonstrated a significant relationship between psychological safety and team outcomes. The thematic analysis allowed the development of concepts beyond the content of the original studies. This analytical process provided a wealth of information regarding facilitators and barriers to psychological safety and the development of a model demonstrating the influence of situational context. Discussion: This evidence synthesis highlights that whilst there is a positive and demonstrable presence of psychological safety within healthcare workers worldwide, there is room for improvement. The variability in methods used demonstrates scope to harmonise this. We draw attention to potential consequences of both high and low psychological safety. We provide novel information about the influence of situational context on an individual’s psychological safety and offer more detail about the facilitators and barriers to psychological safety than seen in previous reviews. There is a risk of participation bias - centres involved in safety research may be more aligned to these ideals. The data in this synthesis are useful for institutions looking to improve psychological safety by providing a framework from which modifiable factors can be identified

Antiretroviral therapy in a community clinic - early lessons from a pilot project

Objectives. To report on operational and clinical problems encountered during the first 6 months of a community-based antiretroviral therapy (ART) programme.Methods. ART was implemented in a primary care setting utilising an easily replicable service-delivery model based on a medical officer and nurse. Therapeutic counsellors, themselves HIV-infected, provided counselling and adherence support. Drug and monitoring costs were charitably funded and provincial health authorities supplied the medical infrastructure. The HIV Research Unit, University of Cape Town, supplied training and additional clinical support. Local HIV primary care clinics provided patient referrals. Standardised ART regimens were used with strict entry criteria (AIDS or CD4 count < 200 cells/μl).                                                                    Results. Demand for the service was high. Referred patients had advanced disease (AIDS 57%, median CD4 count 96/μl) and high pre-treatment mortality (83/100 person-years). Mycobacterial disease was a major  contributor to this mortality (40%). Scheduled clinic visit hours were six times higher during recruitment than maintenance. Attributable costs were: drugs 61%, staff 2.7%, viral load and CD4 cell counts 10% and safety monitoring 2%. Viral load after 16 weeks of therapy was < 400 copies/ml in the first 16 patients.Conclusions. ART can be successfully implemented within a primary care setting. Drug purchases and staff salaries drive programme costing. The service model is capable of managing 250 - 300 patients on chronic ART, but staffing needs to be increased during recruitment. Attention must be given to the diagnosis of tuberculosis during screening and early ART. Incorporating therapeutic counsellors into the programme increased community involvement and utilised a valuable and previously untapped resource

Efficient deformable motion correction for 3-D abdominal MRI using manifold regression

We present a novel framework for efficient retrospective respiratory motion correction of 3-D abdominal MRI using manifold regression. K-space data are continuously acquired under free breathing using the stack-of-stars radial gold-en-angle trajectory. The stack-of-profiles (SoP) from all temporal positions are embedded into a common manifold, in which SoPs that were acquired at similar respiratory states are close together. Next, the SoPs in the manifold are clustered into groups using the k-means algorithm. One 3-D volume is reconstructed at the central SoP position of each cluster (a.k.a. key-volumes). Motion fields are estimated using deformable image registration between each of these key-volumes and a reference end-exhale volume. Subsequently, the motion field at any other SoP position in the manifold is derived using manifold regression. The regressed motion fields for each of the SoPs are used to deter-mine a final motion-corrected MRI volume. The method was evaluated on realistic synthetic datasets which were generated from real MRI data and also tested on an in vivo dataset. The framework enables more accurate motion correction compared to the conventional binning-based approach, with high computational efficiency

Do national policies for complaint handling in English hospitals support quality improvement? Lessons from a case study

Background. A range of public inquiries in the English National Health Service have indicated repeating failings in complaint handling, and patients are often left dissatisfied. The complex, bureaucratic nature of complaints systems is often cited as an obstacle to meaningful investigation and learning, but a detailed examination of how such bureaucratic rules, regulations, and infrastructure shape complaint handling, and where change is most needed, remains relatively unexplored. Methods. Through staff interviews and documentary analysis, we examined how complaints are handled, investigated, and monitored within an acute NHS trust rated as well-performing in complaint handling. We sought to examine how national policies structure local practices of complaint handling, how are they understood by those responsible for enacting them within local practice, and if there are any discrepancies between policies-as-intended and their reality in local practice. Results. Findings illustrate four areas of practice where national policies and regulations result in adverse consequences in local practices, and partly function to undermine an improvement-focused approach to complaints. These include muddled routes for raising formal complaints, investigative procedures structured to scrutinize the ‘validity’ of complaints, irreliable data collection systems, and adverse incentives and workarounds resulting from bureaucratic performance targets. Conclusion. This study demonstrates how national policies and regulations for complaint handling can impede, rather than promote, quality improvement in local settings. Accordingly, we propose a number of necessary reforms, including patient involvement in complaints investigations, the establishment of independent investigation bodies, and more meaningful data analysis strategies to uncover and address systemic causes behind recurring complaints