Panning for Gold: The Standardizing Work of Filling “Autistic” Shells – Using institutional ethnography to explore textually mediated health relations in the diagnostic process of autism.

Health reform practices in Canada and elsewhere have restructured the purpose and use of diagnostic labels and the processes of naming such labels. Diagnoses are no longer only a means to tell doctors and patients what may be wrong and indicate potential courses of treatment; some diagnoses activate specialized services and supports for persons with a disability and those who provide care for them. In British Columbia, a standardized process of diagnosis with the outcome of an autism spectrum disorder gives access to government provided health care and educational services and supports. Such processes enter individuals into a complex of text mediated relations, regulated by the principles of evidence-based medicine. However, the diagnosis of autism in children is notoriously uncertain. Because of this ambiguity, standardizing the diagnostic process creates a hurdle in gaining help and support for parents who have children with problems that could lead to a diagnosis on the autism spectrum. Such processes and their organizing relations are problematized, explored and explicated below. Grounded in the epistemological and ontological shift offered by Dorothy E. Smith (1987; 1990a; 1999; 2005), this article reports on the findings of an institutional ethnographic study that explored the diagnostic process of autism in British Columbia. More specifically, this article focuses on the processes involved in going from mothers talking from their experience about their childrens problems to the formalized and standardized, and thus “virtually” produced, diagnoses that may or may not give access to services and supports in different systems of care. Two psychologists, a developmental pediatrician, a social worker – members of a specialized multidisciplinary assessment team – and several mothers of children with a diagnosis on the autism spectrum were interviewed. The implications of standardizing the diagnosis process of a disability that is not clear-cut and has funding attached are discussed. This ethnography also provides a glimpse of the implications of current and ongoing reforms in the state-supported health care system in British Columbia, and more generally in Canada, for people’s everyday doings.

Combinations of Prompt and Target Response Modalities and Their Impact on Emergent Relations and Teaching Efficiency.

In the present study, native Spanish speakers were taught a small English vocabulary (Spanish-to-English intraverbals). Four different training conditions were created by combining textual and echoic prompts with written and vocal target responses. The efficiency of each training condition was examined by analysing emergent relations (i.e., tacts) and the total number of sessions required to reach mastery under each training condition. All combinations of prompt-response modalities generated increases in correct responding on tests for emergent relations but when target responses were written, mastery criterion was reached faster. Results are discussed in terms of efficiency for emergent relations and recommendations for future directions are provided.

Perspectives on social citizenship in the EU – from status positivus to status socialis activus via two forms of transnational solidarity

Ever since the inauguration of EU citizenship, elements of social citizenship have been on the agenda of European integration. European level social benefits were proposed early on, and demands for collective labour rights have followed suit. This chapter uses the theoretical umbrella of transnational social citizenship in order to link transnational access to social benefits and collective labour rights. It promotes transnational rights as the best way to conceptualise EU social citizenship as an institution enabling the enjoyment of EU integration without being forced to forego social rights at other levels. Such a perspective sits well in a collection on EU citizenship and federalism, since it simultaneously challenges demands of renationalisation of social rights in the EU and pleas to reduce EU-level citizenship rights to a merely liberal dimension. Social citizenship as promoted here requires an interactive conceptualisation of regulatory and judicial powers at different levels of government as typical for federal systems.
In linking citizenship with human rights the chapter highlights different statuses of citizens. It argues that the rights constituted by social citizenship derive from a status positivus and a status socialis activus, expanding the time-honoured categories of Jellinek. This concept is developed further by linking the notions of receptive solidarity to the status positivus and the notion of participative solidarity to the status socialis activus. In relation to European Union citizenship it promotes a sustainable transnational social citizenship catering for receptive and participative solidarity.
These ideas contrast with most current discourses on EU citizenship. The stress on social citizenship takes issue with a retreat to mere liberalist notions of EU-level citizenship, and the stress on rights takes issue with conceptualising EU citizenship as a community bond with obligations, downplaying the empowering potential of rights. The difficulty of conceptualising transnational social citizenship is to avoid, on the one hand, taking up the tune of populist discourses imagining those moving beyond state borders as a threat to national social citizenship and, on the other hand, to reject the legitimate fears of those remaining at home of creating rupture in the social fabric of Europe’s society. Promoting transnational social citizenship rights based on receptive and participative solidarity the present chapter aims to contribute to avoiding these pitfalls.

EU Social and Labour Rights and EU Internal Market Law: Study for the EMPL Committee

EU Social and Labour Rights have developed incrementally, originally through a set of legislative initiatives creating selective employment rights, followed by a non-binding Charter of Social Rights. Only in 2009, social and labour rights became legally binding through the Charter of Fundamental Rights for the European Union (CFREU). By contrast, the EU Internal Market - an area without frontiers where goods, persons, services and capital can circulate freely – has been enshrined in legally enforceable Treaty provisions from 1958. These comprise the economic freedoms guaranteeing said free circulation and a system ensuring that competition is not distorted within the Internal Market (Protocol 27 to the Treaty of Lisbon). Tensions between Internal Market law and social and labour rights have been observed in analyses of EU case law and legislation. This study explores responses by socio-economic and political actors at national and EU levels to such tensions, focusing on collective labour rights, rights to fair working conditions and rights to social security and social assistance (Articles 12, 28, 31, 34 Charter of Fundamental Rights for the European Union). On the basis of the current Treaties and the CFREU, the constitutionally conditioned Internal Market emerges as a way to overcome the perception that social and labour rights limit Internal Market law, or vice versa. On this basis, alternative responses to perceived tensions are proposed, focused on posting of workers, furthering fair employment conditions through public procurement and enabling effective collective bargaining and industrial action in the Internal Market.

Plus Ça Change: The 2014 Local Elections in Northern Ireland

The local government elections of 22 May 2014 in Northern Ireland were the first to be held under revised district boundaries, with 11 'super councils' replacing the 26-council model used since 1973. Despite the structural reform, little changed in terms of political party support. Although they suffered some losses, the Democratic Unionist Party and Sinn Féin remained firmly entrenched as the two dominant players at local government level in Northern Ireland. The Ulster Unionist Party enjoyed only a marginal increase in its vote share, while the Social Democratic and Labour Party recorded one of the worst electoral performances in its history. Elsewhere, the Traditional Unionist Voice enjoyed a 'breakthrough' election and the Alliance Party defied widely held predictions that it would suffer at the polls as a result of its role in the Union flag crisis. The campaign was overshadowed by both the concurrent European Parliament contest and several crises of power-sharing at Stormont. As a result, distinctly local government issues received scant and fleeting attention. The contest saw the lowest local election turnout in Northern Ireland's history, continuing a general trend of increasing voter apathy in the province.

The common vaginal commensal bacterium Ureaplasma parvum is associated with chorioamnionitis in extreme preterm labour

OBJECTIVE: To assess the association of vaginal commensal and low grade pathogenic bacteria including Ureaplasma parvum, Ureaplasma urealyticum, Mycoplasma hominis, Mycoplasma genitalium, Group B Streptococcus (GBS), and Gardnerella vaginalis, in women who delivered preterm at less than 37 weeks gestation in the presence or absence of inflammation of the chorioamnionitic membranes.

METHODS: A case control study involving women who delivered before 37 weeks gestation with and without inflammation of chorioamnionitic membranes. A total of 57 placental samples were histologically examined for polymorphonuclear leukocyte infiltration of placental tissue for evidence of chorioamnionitis, and by type-specific nucleic acid amplification for evidence of infection with one or more of the target bacteria. Demographic data was collected for each mother.

RESULTS: Amongst the 57 placental samples, 42.1% had chorioamnionitis and 24.6% delivered in the second trimester of pregnancy; U. parvum, U. urealyticum, G. vaginalis and GBS were all detected in the study with respective prevalence of 19.3%, 3.5%, 17.5% and 15.8%; M.genitalium and M. hominis were not detected. U. parvum was significantly associated with chorioamnionitis (p value = 0.02; OR 5.0; (95% CI 1.2-21.5) and was more common in women who delivered in the second (35.7%) compared to the third trimester of pregnancy (13.9%). None of the other bacteria were associated with chorioamnionitis or earlier delivery and all G.vaginalis positive women delivered in the third trimester of pregnancy (p value 0.04).

CONCLUSIONS: The detection of U. parvum in placental tissue was significantly associated with acute chorioamnionitis in women presenting in extreme preterm labour.