Self-generated expressions of residual complaints following brain injury

Following brain injury there is often a prolonged period of deteriorating psychological condition, despite neurological stability or improvement. This is presumably consequent to the remission of anosognosia and the realisation of permanently worsened status. This change is hypothesised to be directed partially by the socially mediated processes which play a role in generating self-awareness and which here direct the reconstruction of the self as a permanently injured person. However, before we can understand this process of redevelopment, we need an unbiassed technique to monitor self-awareness. Semi-structured interviews were conducted with 30 individuals with long-standing brain injuries to capture their spontaneous complaints and their level of insight into the implications of their difficulties. The focus was on what the participants said in their own words, and the extent to which self-knowledge of difficulties was spontaneously salient to the participants. Their responses were subjected to content analysis. Most participants were able to say that they had brain injuries and physical difficulties, many mentioned memory and attentional problems and a few made references to a variety of emotional disturbances. Content analysis of data from unbiassed interviews can reveal the extent to which people with brain injuries know about their difficulties. Social constructionist accounts of self-awareness and recovery are supported.

Decision making in childhood asthma exacerbation – a clinical judgement analysis

Background: Clinical decisions which impact directly on patient safety and quality of care are made during acute asthma attacks by individual doctors on the basis of their knowledge and experience. These include administration of systemic corticosteroids (CS), oral antibiotics, and admission to hospital. Clinical judgement analysis provides a methodology for comparing decisions between practitioners with different training and experience, and improving decision making. Methods: Stepwise linear regression was used to select clinical cues based on visual analogue scale assessments of the propensity of 62 clinicians to prescribe a short course of oral CS (decision 1), a course of antibiotics (decision 2), and/or admit to hospital (decision 3) for 60 â??paperâ?? patients. Results:When compared by specialty, paediatriciansâ?? models for decision 1 were more likely to include as a cue level of alertness (54% v. 16%); for decision 2 presence of crepitations (49% v. 16%), and less likely to include inhaled CS (8% v. 40%), respiratory rate (0% v. 24%), and air entry (70% v. 100%). When compared to other grades, the models derived for decision 3 by consultants/general practitioners were more likely to include wheeze severity as a cue (39% v. 6%). Conclusions: Clinicians differed in their use of individual cues and the number included in their models. Patient safety and quality of care will benefit from clarification of decision making strategies as general learning points during medical training, in the development of guidelines and care pathways, and by clinicians developing self-awareness of their own preferences.

Right-left discrimination among medical students: Getting it right all of the time?

Objective To determine medical students’ self awareness and ability to discriminate right from left; to identify characteristics associated with this ability; and to identify any techniques used to aid discrimination. Design Questionnaire and psychometric study. Setting Undergraduate medical school, Northern Ireland. Participants 290 first year undergraduate students. Main outcome measure Medical students’ ability to discriminate right from left using the Bergen right-left discrimination test. Results Test scores ranged from 31 to 143 on a scale of 0- 144 (mean 112 (standard deviation 22.2)). Male students significantly outperformed female students (117.18 (26.96) v 110.80 (28.94)). Students who wanted to be surgeons performed significantly better than those who wanted to be general practitioners or medical doctors (119.87 (25.15) v 110.55 (27.36) v 112.50 (26.88)). The interaction effect for sex and career wishes was not significant (P=0.370). Students who used learnt techniques to help them discriminate scored significantly less than those who did not (P

Mandated prevention in child welfare: Considerations from a framework shaping ethical inquiry

Summary: This article outlines a framework for approaching ethical dilemmas arising from the development, evaluation and implementation of child welfare policies. As such, it is relevant to policy-makers, social researchers and social workers. The central tenets of the framework are developed by drawing on ideas from moral philosophy and critical social theory. These ideas are presented as axioms, theorems and corollaries, a format which has been employed in the social sciences to offer a rational justification for a set of claims. • Findings: This process of reasoning leads to four principle axioms that are seen to shape the ethical scrutiny of social policy: 1) problematizing knowledge; 2) utilizing structured forms of inquiry to enhance understanding; 3) engendering enabling communication with those affected by the ethical concern; and 4) enhancing self-awareness. • Applications: The four axioms are then applied, by way of example, to the current and contentious, 'third way' policy of mandated prevention in child welfare, where the aim is to obviate deleterious outcomes in later life. It is argued that the framework can be applied beyond this specific concern to other pressing, ethical challenges in child welfare.

Parent Issues: How Life on Mars Negotiates a Television Generation Gap

In defining what he termed 'Television's Second Golden Age', Robert J.Thompson refers to characteristics such as being 'not regular TV', internal continuity, mixed genres but an aspiration towards 'realism', complex writing, self-consciousness and intertextuality. Such characteristics are displayed by the BBC series Life on Mars (2006-2007) which intermingles the Seventies tough cop show with psychological fantasy. This chapter examines the way that the series can be understood as a dramatisation of the negotiation that the creators undertook with their Seventies source material to update it for the values and qualities of contemporary television drama. It will emphasise the importance of television in the generation of the imagined 1973 and its characters, but also as an ongoing connection between the real and the imagined within the programme, including forming a breach of the boundaries between the two. Sam's actions within his Seventies world to remake it to include his own ideas of justice and due process while retaining the passion and freedom of action that the milieu provides will also be be examined in relation to the series' creators' needs to remake the Seventies tough-cop show in the light of modern social and media mores. The paper will also consider how Sam has to come to terms with his father's crimes, as the series' creators had to come to terms with the 'crimes' of taste, morality and approach of their 'parent' programmes from the Seventies' Golden Age.

The spirit of palliative practice:A qualitative inquiry into the spiritual journey of palliative care physicians

Objective: Much is known about the important role of spirituality in the delivery of multidimensional care for patients at the end of life. Establishing a strong physician-patient relationship in a palliative context requires physicians to have the self-awareness essential to establishing shared meaning and relationships with their patients. However, little is known about this phenomenon and therefore, this study seeks a greater understanding of physician spirituality and how caring for the terminally ill influences this inner aspect. Method: A qualitative descriptive study was used involving face-to-face interviews with six practicing palliative care physicians. Results: Conceptualized as a separate entity from religion, spirituality was described by participants as a notion relating to meaning, personal discovery, self-reflection, support, connectedness, and guidance. Spirituality and the delivery of care for the terminally ill appeared to be interrelated in a dynamic relationship where a physician's spiritual growth occurred as a result of patient interaction and that spiritual growth, in turn, was essential for providing compassionate care for the palliative patient. Spirituality also served as an influential force for physicians to engage in self-care practices. Significance of results: With spirituality as a pervasive force not only in the lives of palliative care patients, but also in those of healthcare providers, it may prove to be beneficial to use this information to guide future practice in training and education for palliative physicians in both the spiritual care of patients and in practitioner self care. Copyright © Cambridge University Press 2010.

Dense subgraphs on dynamic networks

In distributed networks, it is often useful for the nodes to be aware of dense subgraphs, e.g., such a dense subgraph could reveal dense substructures in otherwise sparse graphs (e.g. the World Wide Web or social networks); these might reveal community clusters or dense regions for possibly maintaining good communication infrastructure. In this work, we address the problem of self-awareness of nodes in a dynamic network with regards to graph density, i.e., we give distributed algorithms for maintaining dense subgraphs that the member nodes are aware of. The only knowledge that the nodes need is that of the dynamic diameter D, i.e., the maximum number of rounds it takes for a message to traverse the dynamic network. For our work, we consider a model where the number of nodes are fixed, but a powerful adversary can add or remove a limited number of edges from the network at each time step. The communication is by broadcast only and follows the CONGEST model. Our algorithms are continuously executed on the network, and at any time (after some initialization) each node will be aware if it is part (or not) of a particular dense subgraph. We give algorithms that (2 + e)-approximate the densest subgraph and (3 + e)-approximate the at-least-k-densest subgraph (for a given parameter k). Our algorithms work for a wide range of parameter values and run in O(D log n) time. Further, a special case of our results also gives the first fully decentralized approximation algorithms for densest and at-least-k-densest subgraph problems for static distributed graphs. © 2012 Springer-Verlag.

Brief announcement: Maintaining large dense subgraphs on dynamic networks

In distributed networks, some groups of nodes may have more inter-connections, perhaps due to their larger bandwidth availability or communication requirements. In many scenarios, it may be useful for the nodes to know if they form part of a dense subgraph, e.g., such a dense subgraph could form a high bandwidth backbone for the network. In this work, we address the problem of self-awareness of nodes in a dynamic network with regards to graph density, i.e., we give distributed algorithms for maintaining dense subgraphs (subgraphs that the member nodes are aware of). The only knowledge that the nodes need is that of the dynamic diameter D, i.e., the maximum number of rounds it takes for a message to traverse the dynamic network. For our work, we consider a model where the number of nodes are fixed, but a powerful adversary can add or remove a limited number of edges from the network at each time step. The communication is by broadcast only and follows the CONGEST model in the sense that only messages of O(log n) size are permitted, where n is the number of nodes in the network. Our algorithms are continuously executed on the network, and at any time (after some initialization) each node will be aware if it is part (or not) of a particular dense subgraph. We give algorithms that approximate both the densest subgraph, i.e., the subgraph of the highest density in the network, and the at-least-k-densest subgraph (for a given parameter k), i.e., the densest subgraph of size at least k. We give a (2 + e)-approximation algorithm for the densest subgraph problem. The at-least-k-densest subgraph is known to be NP-hard for the general case in the centralized setting and the best known algorithm gives a 2-approximation. We present an algorithm that maintains a (3+e)-approximation in our distributed, dynamic setting. Our algorithms run in O(Dlog n) time. © 2012 Authors.

A strategy for maintaining student wellbeing

Pre-registration nursing programmes place many challenges on students and these can affect their health and wellbeing. The wellness recovery action plan (WRAP) is a strengths-focused technique to reduce stress and improve health and wellbeing that was initially used in mental health care. This article discusses the potential for using WRAPs to support student nurses, as well as those studying other health professions. They can be used to enhance students’ educational and clinical self-awareness, reduce anxiety and vulnerability, and enhance resilience, enabling them to cope more effectively with educational and personal challenges.

Authorizing a tradition: Theory, criticism and (self-) canonization in French Caribbean writing

As critics have noted, Antillean literature has developed in tandem with a strong (self-) critical and theoretical body of work. The various attempts to theorize Antillean identity (négritude, antillanité, créolité) have been controversial and divisive, and the literary scene has been characterized as explosive, incestuous and self-referential. Yet writers aligned with, or opposed to, a given theory often have superior visibility. Meanwhile writers who claim to operate outside the boundaries of theory, such as Maryse Condé, are often canny theoretical operators who, from prestigious academic or cultural positions, manipulate readers’ responses and their own self-image through criticism. While recent polemics have helped to raise the critical stock of the islands generally, they have particularly enhanced the cultural capital of Chamoiseau and Condé, whose literary antagonism is in fact mutually sustaining. Both writers, through a strong awareness of (and contribution to) the critical field in which their work is read, position themselves as canonical authors.