Effect of heat treatment on diffusion, internal friction, microstructure and mechanical properties of ultra-fine-grained nickel severely deformed by equal-channel angular pressing

Severe plastic deformation via equal-channel angular pressing was shown to induce characteristic ultra-fast diffusion paths in Ni (Divinski et al., 2011). The effect of heat treatment on these paths, which were found to be represented by deformation-modified general high-angle grain boundaries (GBs), is investigated by accurate radiotracer self-diffusion measurements applying the 63Ni isotope. Redistribution of free volume and segregation of residual impurities caused by the heat treatment triggers relaxation of the diffusion paths. A correlation between the GB diffusion kinetics, internal friction, microstructure evolution and microhardness changes is established and analyzed in detail. A phenomenological model of diffusion enhancement in deformation-modified GBs is proposed.

On laughter and loss. Children's experiences of shared time, parenting and security post-separation

Among the research, practice and socio-legal commentary on the substantial sharing of parenting time after separation, children’s voices about their experiences remain overwhelmingly silent. This article draws on findings of a descriptive phenomenological study which investigated Australian school-aged (8- to 12-year-old) children’s descriptions of two binary phenomena: security and contentment in shared time arrangements, and the absence of security and contentment in shared time parenting. Specifically, this article focuses on exploring parental behaviours and interactions recognised by children as sources of security in shared time lifestyles, through happy and needy times. Central to this is the juxtaposition of the child’s experience of security and shared enjoyment with the present parent, against the absence of security emanating from unresolved longing for the ‘absent’ parent. The article provides an empirically derived formulation of children’s advice to parents about shared time parenting, with relevance for family law related parent education forums.

Implementation of the diabetes and hypertension guideline lifestyle recommendations in urban Mongolia: A qualitative study of primary care providers

Abstract
Background: Hypertension and diabetes, key risk factors for cardiovascular disease, are significant health problems globally. As cardiovascular disease is one of the leading causes of mortality in Mongolia since 2000, clinical guidelines on arterial hypertension and diabetes were developed and implemented in 2011. This paper explores the barriers and enablers influencing the implementation of these guidelines in the primary care setting.
Methods: A phenomenological qualitative study with semi-structured interviews was conducted to explore the implementation of the diabetes and hypertension guidelines at the primary care level, as well as to gain insight into how practitioners view the usability and practicality of the guidelines. Ten family health centres were randomly chosen from a list of all the family health centres (n = 136) located in Ulaanbaatar City. In each centre, a focus group discussion with nurses (n = 20) and individual interviews with practice doctors (n =10) and practice managers (n= 10) were conducted. Data was analysed using a thematic approach utilising the Theoretical Domains Framework.
Results: The majority of the study participants reported being aware of the guidelines and that they had incorporated them into their daily practice. They also reported having attended guideline training sessions which were focused on practice skill development. The majority of participants expressed satisfaction with the wide range of resources that had been supplied to them by the Mongolian Government to assist with the implementation of the guidelines. The resources, supplied from 2011 onwards, included screening devices, equipment for blood tests, medications and educational materials. Other enablers were the participants’ commitment and passion for guideline implementation and their belief in the simplicity and practicality of the guidelines. Primary care providers reported a number of challenges in implementing the guidelines, including frustration caused by increased workload and long waiting times, time constraints, difficulties with conflicting tasks and low patient health literacy.
Conclusions: This study provides evidence that comprehensive and rigorous dissemination and implementation strategies increase the likelihood of successful implementation of new guidelines in low resource primary care settings. It also offers some key lessons that might be carefully considered when other evidence-based clinical guidelines are to be put into effect in low resource settings and elsewhere.

Core components of communication of clinical reasoning: a qualitative study with experienced Australian physiotherapists

Communication is an important area in health professional education curricula, however it has been dealt with as discrete skills that can be learned and taught separate to the underlying thinking. Communication of clinical reasoning is a phenomenon that has largely been ignored in the literature. This research sought to examine how experienced physiotherapists communicate their clinical reasoning and to identify the core processes of this communication. A hermeneutic phenomenological research study was conducted using multiple methods of text construction including repeated semi-structured interviews, observation and written exercises. Hermeneutic analysis of texts involved iterative reading and interpretation of texts with the development of themes and sub-themes. Communication of clinical reasoning was perceived to be complex, dynamic and largely automatic. A key finding was that articulating reasoning (particularly during research) does not completely represent actual reasoning processes but represents a (re)construction of the more complex, rapid and multi-layered processes that operate in practice. These communications are constructed in ways that are perceived as being most relevant to the audience, context and purpose of the communication. Five core components of communicating clinical reasoning were identified: active listening, framing and presenting the message, matching the co-communicator, metacognitive aspects of communication and clinical reasoning abilities. We propose that communication of clinical reasoning is both an inherent part of reasoning as well as an essential and complementary skill based on the contextual demands of the task and situation. In this way clinical reasoning and its communication are intertwined, providing evidence for the argument that they should be learned (and explicitly taught) in synergy and in context.

Learning to reason: a journey of professional socialisation

One of the key attributes that health professional students and new graduates develop during professional socialisation is clinical reasoning ability. Clinical reasoning is a complex skill that is essential for professional practice. There is limited research specifically addressing how physiotherapists learn to reason in the workplace. The research reported in this paper addressed this gap by investigating how experienced physiotherapists learned to reason in daily practice. This learning journey was examined in the context of professional socialisation. A hermeneutic phenomenological research study was conducted using multiple methods of data collection including observation, written reflective exercises and repeated, semi-structured interviews. Data were analysed using phenomenological and hermeneutic strategies involving in-depth, iterative reading and interpretation to identify themes in the data. Twelve physiotherapists with clinical and supervisory experience were recruited from the areas of cardiopulmonary, musculoskeletal and neurological physiotherapy to participate in this study. Participants' learning journeys were diverse, although certain episodes of learning were common or similar. Role models, mentors and colleagues were found to be influential in the development of reasoning. An important implication for the professional socialisation of physiotherapists and other health professionals and for those involved in practice development is the need to recognise and enhance the role of practice communities in the explicit learning of clinical reasoning skills.

Implementation of clinical guidelines on diabetes and hypertension in urban Mongolia: a qualitative study of primary care providers' perspectives and experiences

BACKGROUND: Hypertension and diabetes, key risk factors for cardiovascular disease, are significant health problems globally. As cardiovascular disease is one of the leading causes of mortality in Mongolia since 2000, clinical guidelines on arterial hypertension and diabetes were developed and implemented in 2011. This paper explores the barriers and enablers influencing the implementation of these guidelines in the primary care setting.

METHODS: A phenomenological qualitative study with semi-structured interviews was conducted to explore the implementation of the diabetes and hypertension guidelines at the primary care level, as well as to gain insight into how practitioners view the usability and practicality of the guidelines. Ten family health centres were randomly chosen from a list of all the family health centres (n = 136) located in Ulaanbaatar City. In each centre, a focus group discussion with nurses (n = 20) and individual interviews with practice doctors (n = 10) and practice managers (n = 10) were conducted. Data was analysed using a thematic approach utilising the Theoretical Domains Framework.

RESULTS: The majority of the study participants reported being aware of the guidelines and that they had incorporated them into their daily practice. They also reported having attended guideline training sessions which were focused on practice skill development. The majority of participants expressed satisfaction with the wide range of resources that had been supplied to them by the Mongolian Government to assist with the implementation of the guidelines. The resources, supplied from 2011 onwards, included screening devices, equipment for blood tests, medications and educational materials. Other enablers were the participants' commitment and passion for guideline implementation and their belief in the simplicity and practicality of the guidelines. Primary care providers reported a number of challenges in implementing the guidelines, including frustration caused by increased workload and long waiting times, time constraints, difficulties with conflicting tasks and low patient health literacy.

CONCLUSIONS: This study provides evidence that comprehensive and rigorous dissemination and implementation strategies increase the likelihood of successful implementation of new guidelines in low resource primary care settings. It also offers some key lessons that might be carefully considered when other evidence-based clinical guidelines are to be put into effect in low resource settings and elsewhere.

Feeling it: understanding Korean adoptees' experiences of embodied identity

This paper examines the ways in which transnational Korean adoptees experience identity as an embodied subjective process that is simultaneously contested and objectified by social perceptions of their bodies in their adoptive countries and South Korea. To analyse these lived experiences, I draw primarily on embodiment theories such as Budgeon’s (2003) sociological concept of ‘body as event’ and Csordas’ (2002) cultural phenomenological view of the body not as an object but as a ‘subject of culture’. To analyse processes of (re)embodiment, I draw on Ahmed’s (2007) concepts of ‘space’ and ‘whiteness’. Based on ethnographic data in South Korea and semi-structured interviews with 22 adult Korean adoptees, this paper demonstrates how Korean adoptees’ embodied identities are lived in relation to racialised experiences of belonging and Otherness.

Using voice to make musical and social connections

Community music is a rich and ongoing activity-taking place in formal and informal settings around Australia. This small-scale phenomenological qualitative case study is part of my wider study Spirituality and Wellbeing: Music in the Community that began in 2013. This paper demonstrates that community music making in a regional district in Victoria (Australia) makes it possible for choirs to use their voice to make musical and social connections to self and community that enhances both personal and community wellbeing. In May 2014, I visited three choirs for a week in the city of Warnnambool. Drawing on observation, questionnaires and focus group semi-structured interviews, I analysed the data using Interpretative Phenomenological Analysis. The findings include why people join choirs in regional towns, what they enjoyed that contributed to their wellbeing and why they want to sing about issues that make connections to social justice and sustainability. Though generalisations cannot be made to other towns or choirs, the findings show the need, importance and benefits of connecting to each other and the wider community. Using voice can serve as an effective platform to promote issues in the community such as social justice and the environment. It is hoped that the findings may provide a vehicle for further dialogue where choirs in other settings may experience similar connections to their community.