Classifying clinical decision making:interpreting nursing intuition, heuristics and medical diagnosis

This is the second of two linked papers exploring decision making in nursing. The first paper, 'Classifying clinical decision making: a unifying approach' investigated difficulties with applying a range of decision-making theories to nursing practice. This is due to the diversity of terminology and theoretical concepts used, which militate against nurses being able to compare the outcomes of decisions analysed within different frameworks. It is therefore problematic for nurses to assess how good their decisions are, and where improvements can be made. However, despite the range of nomenclature, it was argued that there are underlying similarities between all theories of decision processes and that these should be exposed through integration within a single explanatory framework. A proposed solution was to use a general model of psychological classification to clarify and compare terms, concepts and processes identified across the different theories. The unifying framework of classification was described and this paper operationalizes it to demonstrate how different approaches to clinical decision making can be re-interpreted as classification behaviour. Particular attention is focused on classification in nursing, and on re-evaluating heuristic reasoning, which has been particularly prone to theoretical and terminological confusion. Demonstrating similarities in how different disciplines make decisions should promote improved multidisciplinary collaboration and a weakening of clinical elitism, thereby enhancing organizational effectiveness in health care and nurses' professional status. This is particularly important as nurses' roles continue to expand to embrace elements of managerial, medical and therapeutic work. Analysing nurses' decisions as classification behaviour will also enhance clinical effectiveness, and assist in making nurses' expertise more visible. In addition, the classification framework explodes the myth that intuition, traditionally associated with nurses' decision making, is less rational and scientific than other approaches.

Interpreting "D.I.Y." documents:severance, release, trusts, certainty, vesting and undue influence

Comments on the Chancery Division decision in Wallbank v Price on whether a home-made ("DIY") document signed by a wife and purporting to revoke her rights as a beneficial joint tenant in the matrimonial home, which was acquired under the right-to-buy scheme, should be set aside for duress or undue influence. Details the court's analysis of the principles supporting a successful claim of undue influence, the nature of the DIY document, its meaning and its effect. Considers possible reasons for the parties' use of the document. Cases Wallbank v Price (2007) EWHC 3001 (Ch); (2008) 2 FLR 501 (Ch D (Birmingham)) : Royal Bank of Scotland Plc v Etridge (No.2) (2001) UKHL 44; (2002) 2 AC 773 (HL) : Paul v Constance (1977) 1 WLR 527 (CA (Civ Div)) Statutes Housing Act 1985

Translating Nietzsche, mediating literature: Alexander Tille and the limits of Anglo-German intercultural transfer

Dr. Alexander Tille (1866–1912) was one of the key-figures in Anglo-German intercultural transfer towards the end of the 19th century. As a lecturer in German at Glasgow University he was the first to translate and edit Nietzsche’s work into English. Writers such as W. B. Yeats were influenced by Nietzsche and used Tille’s translations. Tille’s social Darwinist reading of the philosopher’s oeuvre, however, had a narrowing impact on the reception of Nietzsche in the Anglo-Saxon world for decades. Through numerous publications Tille disseminated knowledge about British authors (e.g., Robert Louis Stevenson, William Wordsworth) in Germany and about German authors (e.g., Johann Wolfgang von Goethe) in Britain. His role as mediator also extended into areas such as history, religion, and industry. During the Boer war, however, Tille’s outspoken pro-German nationalism brought him in conflict with his British host society. After being physically attacked by his students he returned to Germany and published a highly anglophobic monograph. Tille personifies the paradox of Anglo-German relations in the pre-war years, which deteriorated despite an increase in intercultural transfer and knowledge about the respective Other.

The early career researcher's toolkit:translating tissue engineering, regenerative medicine and cell therapy products

Although the importance of translation for the development of tissue engineering, regenerative medicine and cell-based therapies is widely recognized, the process of translation is less well understood. This is particularly the case among some early career researchers who may not appreciate the intricacies of translational research or make decisions early in development which later hinders effective translation. Based on our own research and experiences as early career researchers involved in tissue engineering and regenerative medicine translation, we discuss common pitfalls associated with translational research, providing practical solutions and important considerations which will aid process and product development. Suggestions range from effective project management, consideration of key manufacturing, clinical and regulatory matters and means of exploiting research for successful commercialization.

Re -"interpreting" the conquest: European and Amerindian translators and go -betweens in the colonization of the Americas, 1492--1675

This dissertation aims to recover the lives and careers of those Amerindians and Europeans who voluntarily or involuntarily took on the role of intercultural interpreters in the contact, conquest, and early colonial period in the Americas between 1492 and 1675. It intends to prove that these so-called “marginal” figures assumed roles that went far beyond those of linguistic and cultural translators, and often had a decisive impact on early Indian-colonial relations. ^ In the course of my research, I consulted hundreds of published sixteenth- and seventeenth-century chronicles, narratives, and memoirs in my search for references to interpreters. I augmented these accounts with information derived from unpublished archival documents, drawn primarily from the Archivo General de Indias, in Seville, Spain. ^ I organized my findings in theme-driven chapters that begin with a consideration of the historiography of that subject. Each chapter is further subdivided into chronologically-arranged historical vignettes that focus on the interpreters who mediated between the Spanish, Portuguese, French, English and Dutch and the various Native American polities and cultures. ^ I found that colonial authorities and Amerindian communities alike recognized the absolute necessity of recruiting competent and loyal interpreters and go-betweens, and that both sides tried to secure their loyal service by means both fair and foul. Although pressured, pushed, and pulled in contrary directions, most interpreters recognized the pivotal position they held in cross-cultural negotiations and rarely remained passive pawns in the contests between the forces of domination and defense. ^ All across the Americas, interpreters used their linguistic and diplomatic skills, and their intimate knowledge of the “other” not simply to facilitate conquest or spearhead the opposition, but to transform themselves from “culture brokers” into “power brokers.” Many of the decisive events that shaped colonial-Indian relations turned on the actions of these culturally-ambiguous individuals, a fact bemoaned and begrudgingly acknowledged by most of the contemporary conquistadors, chroniclers, and colonial founders, and recognized by this author. ^

Effects of real -time captioning and sign language interpreting on the learning of college students who are deaf or hard of hearing

College personnel are required to provide accommodations for students who are deaf and hard of hearing (D/HoH), but few empirical studies have been conducted on D/HoH students as they learn under the various accommodation conditions (sign language interpreting, SLI, real-time captioning, RTC, and both). Guided by the experiences of students who are D/HoH at Miami-Dade College (MDC) who requested RTC in addition to SLI as accommodations, the researcher adopted Merten’s transformative-emancipatory theoretical framework that values perceptions and voice of students who are D/HoH. A mixed methods design addressed two research questions: Did student learning differ for each accommodation? What did students experience while learning through accommodations? Participants included 30 students who were D/HoH (60% women). They represented MDC’s majority minority population: 10% White (non-Hispanic), 20% Black (non-Hispanic, including Haitian/Caribbean), 67% Hispanic, and 3% other. Hearing loss, ranged from severe-profound (70%) to mild-moderate (30%). All were able to communicate with American Sign Language: Learning was measured while students who were D/HoH viewed three lectures under three accommodation conditions (SLI, RTC, SLI+RTC). The learning measure was defined as the difference in pre- and post-test scores on tests of the content presented in the lectures. Using repeated measure ANOVA and ANCOVA, confounding variables of fluency in American Sign Language and literacy skills were treated as covariates. Perceptions were obtained through interviews and verbal protocol analysis that were signed, videotaped, transcribed, coded, and examined for common themes and metacognitive strategies. No statistically significant differences were found among the three accommodations on the learning measure. Students who were D/HoH expressed thoughts about five different aspects of their learning while they viewed lectures: (a) comprehending the information, (b) feeling a part of the classroom environment, (c) past experiences with an accommodation, (d) individual preferences for an accommodation, (e) suggestions for improving an accommodation. They exhibited three metacognitive strategies: (a) constructing knowledge, (b) monitoring comprehension, and (c) evaluating information. No patterns were found in the types of metacognitive strategies used for any particular accommodation. The researcher offers recommendations for flexible applications of the standard accommodations used with students who are D/HoH.

Interpreting Human Genetic Variation through Genomics and In Vivo Models

Improvements in genomic technology, both in the increased speed and reduced cost of sequencing, have expanded the appreciation of the abundance of human genetic variation. However the sheer amount of variation, as well as the varying type and genomic content of variation, poses a challenge in understanding the clinical consequence of a single mutation. This work uses several methodologies to interpret the observed variation in the human genome, and presents novel strategies for the prediction of allele pathogenicity.

Using the zebrafish model system as an in vivo assay of allele function, we identified a novel driver of Bardet-Biedl Syndrome (BBS) in CEP76. A combination of targeted sequencing of 785 cilia-associated genes in a cohort of BBS patients and subsequent in vivo functional assays recapitulating the human phenotype gave strong evidence for the role of CEP76 mutations in the pathology of an affected family. This portion of the work demonstrated the necessity of functional testing in validating disease-associated mutations, and added to the catalogue of known BBS disease genes.

Further study into the role of copy-number variations (CNVs) in a cohort of BBS patients showed the significant contribution of CNVs to disease pathology. Using high-density array comparative genomic hybridization (aCGH) we were able to identify pathogenic CNVs as small as several hundred bp. Dissection of constituent gene and in vivo experiments investigating epistatic interactions between affected genes allowed for an appreciation of several paradigms by which CNVs can contribute to disease. This study revealed that the contribution of CNVs to disease in BBS patients is much higher than previously expected, and demonstrated the necessity of consideration of CNV contribution in future (and retrospective) investigations of human genetic disease.

Finally, we used a combination of comparative genomics and in vivo complementation assays to identify second-site compensatory modification of pathogenic alleles. These pathogenic alleles, which are found compensated in other species (termed compensated pathogenic deviations [CPDs]), represent a significant fraction (from 3 – 10%) of human disease-associated alleles. In silico pathogenicity prediction algorithms, a valuable method of allele prioritization, often misrepresent these alleles as benign, leading to omission of possibly informative variants in studies of human genetic disease. We created a mathematical model that was able to predict CPDs and putative compensatory sites, and functionally showed in vivo that second-site mutation can mitigate the pathogenicity of disease alleles. Additionally, we made publically available an in silico module for the prediction of CPDs and modifier sites.

These studies have advanced the ability to interpret the pathogenicity of multiple types of human variation, as well as made available tools for others to do so as well.

Culture in Transfer: Translation and Transcultural Communication International Conference

It is widely acknowledged that interpreters need to have knowledge of the cultures represented by the languages they work with (e.g. Roy 2002, Angelelli 2004, Wadensjŏ 2008). However, it is not clear what interpreters are expected to do with this knowledge. Some scholars recommend that interpreters be cultural mediators (e.g. Katan 2004 & 2014). As an attempt to examine existing guidelines on interpreters’ roles in the face of cultures/cultural issues, the research reported in this paper compares and contrasts the codes of conduct for interpreters from a number of associations and institutions in the UK, the US and China. The research has collected three different sets of data and has sought to investigate (1) in what ways interpreters are expected to do with their knowledge of cultures; (2) to what extent interpreters’ role as cultural mediators is referred to or defined in these codes of conduct; and (3) whether or not relevant guidelines are practically helpful for interpreters to deal with the range of cultural issues they may encounter in interpreting. Data analysis suggests that while cultural knowledge is a requisite for interpreters, the expectation for them to be cultural mediators may depend on the types of interpreting setting they work with and further guidelines are needed so that interpreters are clear on what they are required to do in dealing with cultural issues. The paper then discusses the implications of these findings and points to some directions for future research. Key references Brunette, L., G Bastin, I. Hemlin and H. Clarke (ed.). The Critical Link 3: Interpreters in the Community. Amsterdam/Philadephia: John Benjamins. Hale, S. 2007. Community Interpreting. Hampshire, New York: Palgrave Macmillan. The International Association of Conference Interpreting, 2015. Interpreting Explained. Available from: http://aiic.net/; accessed on 24 June 2015 Katan, David, --- 2004. Translating Cultures: An Introduction for Translators, Interpreters and Mediators. St Jerome. --- 2014. Workshop: Translation at the cross-roads: time for the transcreational turn? University College London. Martín, Mayte C. & Mary Phelan, 2009. Interpreters and Cultural Mediators – different but complementary roles. In: Translocations: Migration and Social Change. ISSN Number: 2009-0420 (online) McDonough Dolmaya, Julie, (2011. Moral ambiguity: Some shortcomings of professional codes of ethics for translators. In: The Journal of Specialised Translation. Issue 15, January 2011 (online). Pöchhacker, F., 2008. Interpreting as Mediation. In: (ed.) Valero Garcés, C. and Martin, A, Crossing Borders in Community Interpreting: definitions and dilemmas, pp. 9-26. John Benjamins Amsterdam and Philadelphia. Roy, Cynthia B., 2002. The Problem with Definitions, Descriptions, and the Role Metaphors of Interpreters. In: (ed.) Pöchhacker, Franz & Miriam Shlesinger, The Interpreting Studies Reader. Routledge. Wadensjö 1998. Interpreting as Interaction. New York: Addison Wesley Longman Inc.

Some Remarks on Quality in Interpreting, Interpreting Modes and the Interpreter’s Role

Quality in interpreting is a hotly debated issue whose complexity is determined by a mix of factors. In this article I analyze it in the light of the role played by interpreters, stressing how the constraints imposed by the different interpreting modes, the different roles actually played by professionals (who become more or less visible, even within the same assignment) and the expectations they generate require the adoption of a flexible perspective when it comes to identifying and assessing quality criteria and drafting professional codes that are open enough to adjust to diverse communicative settings and to the dynamic character of quality.

Peptide Therapeutics and the Pharmaceutical Industry: Barriers Encountered Translating from the Laboratory to Patients

Peptides are receiving increasing interest as clinical therapeutics. These highly tunable molecules can be tailored to biocompatibility and biodegradability with simultaneously selective and potent therapeutic effects. Despite challenges regarding up-scaling and licensing of peptide products, their vast clinical potential is reflected in the 60 plus peptide-based therapeutics already on the market, and the further 500 derivatives currently in developmental stages. Peptides are proving effective for a multitude of disease states including: type 2 diabetes (controlled using the licensed glucagon-like peptide-1 receptor liraglutide); irritable bowel syndrome managed with linaclotide (currently at approval stages); acromegaly (treated with octapeptide somostatin analogues lanreotide and octreotide); selective or broad spectrum microbicidal agents such as the Gram-positive selective PTP-7 and antifungal heliomicin; anticancer agents including goserelin used as either adjuvant or for prostate and breast cancer,and the first marketed peptide derived vaccine against prostate cancer, sipuleucel-T. Research is also focusing on improving the biostability of peptides. This is achieved through a number of mechanisms ranging from replacement of naturally occurring L-amino acid enantiomers with D-amino acid forms, lipidation, peptidomimetics, N-methylation, cyclization and exploitation of carrier systems. The development of self-assembling peptides are paving the way for sustained release peptide formulations and already two such licensed examples exist, lanreotide and octreotide. The versatility and tunability of peptide-based products is resulting in increased translation of peptide therapies, however significant challenges remain with regard to their wider implementation. This review highlights some of the notable peptide therapeutics discovered to date and the difficulties encountered by the pharmaceutica lindustry in translating these molecules to the clinical setting for patient benefit, providing some possible solutions to the most challenging barriers. 

Non-professional interpreting carried out by vets and veterinary staff for British pets' owners in the South of Spain

La presentación está dedicada a la interpretación realizada a diario por el personal veterinario y veterinarios para clientes británicos en la Costa del Sol.

Interpreting and dismissing the relevance of the “wait and wipe” finding from the circumcision studies conducted in Africa

Some of the secondary findings from the circumcision studies conducted in Africa, are both interesting and difficult to explain. This paper focuses on the finding that uncircumcised men who waited for ten minutes after sexual intercourse and then wiped their penises using a dry cloth, had lower rates of HIV infection compared to those who cleaned using a wet cloth or those who cleaned within three minutes of having intercourse. The paper also focuses on the finding on men who became infected and yet they reported no sexual acts or 100% condom use. Interpretations that have been provided so far in trying to explain these two interesting findings are somewhat inadequate. Because of the inadequate interpretation that has been provided, anti-circumcision lobbyist are presenting the “wait and wipe strategy” as an alternative to circumcision for HIV prevention. In this paper, we argue that waiting for ten minutes and wiping with a dry cloth does not prevent men from becoming infected by HIV. We therefore attempt to present some alternative views.

Encounters and content sharing in an urban village : reading texts through an archaeological lens

Archaeology provides a framework of analysis and interpretation that is useful for disentangling the textual layers of a contemporary lived-in urban space. The producers and readers of texts may include those who planned and developed the site and those who now live, visit and work there. Some of the social encounters and content sharing between these people may be artificially produced or manufactured in the hope that certain social situations will occur. Others may be serendipitous. With archaeology’s original focus on places that are no longer inhabited it is often only the remaining artefacts and features of the built environment that form the basis for interpreting the social relationships of past people. Our analysis however, is framed within a contemporary notion of archaeological artefacts in an urban setting. Unlike an excavation, where the past is revealed through digging into the landscape, the application of landscape archaeology within a present day urban context is necessarily more experiential, visual and based on recording and analysing the physical traces of social encounters and relationships between residents and visitors. These physical traces are present within the creative content, and the built and natural elements of the environment. This chapter explores notions of social encounters and content sharing in an urban village by analysing three different types of texts: the design of the built environment; content produced by residents through a geospatial web application; and, print and online media produced in digital storytelling workshops.

Management of sharps in ambulance care : a state-wide survey of paramedic knowledge and reported practice

Paramedics are at high risk of exposure to infectious diseases because they frequently undertake procedures such as the use and disposal of sharps as components of everyday practice. While the literature demonstrates that the management of sharps is problematic across all health disciplines, there is a paucity of research examining sharps management practices in the Australian pre-hospital paramedic context. This study examines knowledge and practices of sharps control among paramedics in Queensland, Australia. A mail survey focusing on infection control knowledge and practices was sent to all clinical personnel of the Queensland Ambulance Service (QAS) (N = 2274). A total of 1258 surveys were returned, a response rate of 55.3%. Participants responded to 12 true/false statements on the management of sharps and three questions about recapping practices. Most respondents were knowledgeable about the correct management of sharps, with a mean of 11.28 (out of 12, SD = 1.32). When gauging reported practices, more than half (59.1%, n = 736) of participants reported recapping a needle, and 38.5% (n = 479) reported never having done so. These results reflect good knowledge of general management of sharps among respondents, but suggest deficits regarding reported practices. The results suggest that a comprehensive ambulance in-service education programme focusing particularly on sharps management is required. The study highlights the need for further research on sharps management practices in the field, identification of barriers to safe sharps practices in pre-hospital settings, and 'best practice' for translating good sharps management knowledge into practice.

Translating tissue engineering technology platforms into cancer research

Technology platforms originally developed for tissue engineering applications produce valuable models that mimic three-dimensional (3D) tissue organization and function to enhance the understanding of cell/tissue function under normal and pathological situations. These models show that when replicating physiological and pathological conditions as closely as possible investigators are allowed to probe the basic mechanisms of morphogenesis, differentiation and cancer. Significant efforts investigating angiogenetic processes and factors in tumorigenesis are currently undertaken to establish ways of targeting angiogenesis in tumours. Anti-angiogenic agents have been accepted for clinical application as attractive targeted therapeutics for the treatment of cancer. Combining the areas of tumour angiogenesis, combination therapies and drug delivery systems is therefore closely related to the understanding of the basic principles that are applied in tissue engineering models. Studies with 3D model systems have repeatedly identified complex interacting roles of matrix stiffness and composition, integrins, growth factor receptors and signalling in development and cancer. These insights suggest that plasticity, regulation and suppression of these processes can provide strategies and therapeutic targets for future cancer therapies. The historical perspective of the fields of tissue engineering and controlled release of therapeutics, including inhibitors of angiogenesis in tumours is becoming clearly evident as a major future advance in merging these fields. New delivery systems are expected to greatly enhance the ability to deliver drugs locally and in therapeutic concentrations to relevant sites in living organisms. Investigating the phenomena of angiogenesis and anti-angiogenesis in 3D in vivo models such as the Arterio-Venous (AV) loop mode in a separated and isolated chamber within a living organism adds another significant horizon to this perspective and opens new modalities for translational research in this field.