Beyond the 'dyad': a qualitative re-evaluation of the changing clinical consultation.

OBJECTIVE: To identify characteristics of consultations that do not conform to the traditionally understood communication 'dyad', in order to highlight implications for medical education and develop a reflective 'toolkit' for use by medical practitioners and educators in the analysis of consultations. DESIGN: A series of interdisciplinary research workshops spanning 12 months explored the social impact of globalisation and computerisation on the clinical consultation, focusing specifically on contemporary challenges to the clinician-patient dyad. Researchers presented detailed case studies of consultations, taken from their recent research projects. Drawing on concepts from applied sociolinguistics, further analysis of selected case studies prompted the identification of key emergent themes. SETTING: University departments in the UK and Switzerland. PARTICIPANTS: Six researchers with backgrounds in medicine, applied linguistics, sociolinguistics and medical education. One workshop was also attended by PhD students conducting research on healthcare interactions. RESULTS: The contemporary consultation is characterised by a multiplicity of voices. Incorporation of additional voices in the consultation creates new forms of order (and disorder) in the interaction. The roles 'clinician' and 'patient' are blurred as they become increasingly distributed between different participants. These new consultation arrangements make new demands on clinicians, which lie beyond the scope of most educational programmes for clinical communication. CONCLUSIONS: The consultation is changing. Traditional consultation models that assume a 'dyadic' consultation do not adequately incorporate the realities of many contemporary consultations. A paradox emerges between the need to manage consultations in a 'super-diverse' multilingual society, while also attending to increasing requirements for standardised protocol-driven approaches to care prompted by computer use. The tension between standardisation and flexibility requires addressing in educational contexts. Drawing on concepts from applied sociolinguistics and the findings of these research observations, the authors offer a reflective 'toolkit' of questions to ask of the consultation in the context of enquiry-based learning.

The Prisoner Re-Entry Initiative (PRI) Grant Program Iowa Department of Correctional Services, January 2, 2007

The Iowa Department of Corrections (DOC) and the Department of Human Rights, Division of Criminal and Juvenile Justice Planning (CJJP) entered into a contract for services from January 2, 2007 to June 30, 2008 for the purposes of assisting in the evaluation component for the two-year Prison Re-Entry Initiative (PRI) grand awarded to the DOC by the U.S. Office of Justice Programs. The PRI grant period ran from July 2006 through June 2008 and included two primary components. First, all PRI participants returning to Polk County would participate in a Lifeskills curriculum offered through the Des Moines Area Community College (DMACC) at four Iowa prison institutions located at Mitchellville, Newton, Fort Dodge and Rockwell City. Second, all PRI participants returning to Polk County would be referred to The Directors Council (TDC) for cmmunity-based wrap-around services.

Iowa Prisoner Re-Entry Initiative (PRI) Rural Service Delivery Model Iowa Department of Correctional Services, November 2009

The Iowa Department of Corrections (DOC) and the Department of Human Rights, Division of Criminal and Juvenile Justice Planning (CJJP) entered into a contract for services from September 12, 2007 to June 30, 2009 for the purposes of assisting in the evaluation component for the two-year Iowa Prisoner Re-Entry Initiative (PRI) Rural Service Delivery Model. This contract was extended to November 2009. The Rural PRI grant period ran from July 1, 2007 to June 30, 2009 and was extended to November 30, 2009. The purpose of the program was to improve community safety by providing pre-release services and successful transition planning and aftercare services to offenders released from state institutions to the Second Judicial District Department of Correctional Services. Participants included all offenders released to the Second Judicial District during the grant period.

Practicum en re-construcción: Tejiendo colectivamente un modelo de prácticas desde la innovación

Los proyectos forman la identidad de las personas, y las personas construyen la identidad de los proyectos. El objetivo de este artículo, es describir la trayectoria del practicum dentro de los estudios de educación social de la Universidad de Barcelona a partir de identificar los elementos que han impulsado su construcción y reconstrucción. La historia de este practicum se caracteriza por las diferentes decisiones que se han tomado, y los permanentes cuestionamientos de éstas, en los casi veinte años de funcionamiento. Pero, no sólo las decisiones tomadas han supuesto un avance o evolución sino también la forma en que éstas se han tomado. Esta evolución va de la mano de tres planes de estudios que han supuesto la oportunidad de revisar y reflexionar qué era el practicum y qué debería llegar a ser. El presente, pasado y futuro del practicum ha sido un proceso de reconstrucción desde la reflexión y evaluación de los agentes implicados. No ha sido una trayectoria en solitario, sino que ha supuesto un proceso colectivo que ha configurado los diferentes espacios formativos y la función docente de los agentes implicados. El camino que hemos andado, y trazado, nos ha permitido evolucionar en los planteamientos, aprender de la experiencia compartida y construir nuestra identidad. Esta evolución permite configurar las prácticas dentro del Grado de Educación Social a partir del modelo de partenariado de reciprocidad, modelo que se ha de consolidar y sistematizar para seguir innovando colectivamente.

Monitoring detrital input and resuspension effects on sediment trap material using mineralogy and stable isotopes (δ18O and δ13C): the case of Lake Neuchatel (Switzerland)

Isotopic analyses on bulk carbonates are considered a useful tool for palaeoclimatic reconstruction assuming calcite precipitation occurring at oxygen isotope equilibrium with local water and detrital carbonate input being absent or insignificant. We present results from Lake Neuchatel (western Switzerland) that demonstrate equilibrium precipitation of calcite, except during high productivity periods, and the presence of detrital and resuspended calcite. Mineralogy, geochemistry and stable isotope values of Lake Neuchatel trap sediments and adjacent rivers suspension were studied. Mineralogy of suspended matter in the major inflowing rivers documents an important contribution of detrital carbonates, predominantly calcite with minor amounts of dolomite and ankerite. Using mineralogical data, the quantity of allochthonous calcite can be estimated by comparing the ratio ankerite + dolomite/calcite + ankerite + dolomite in the inflowing rivers and in the traps. Material taken from sediment traps shows an evolution from practically pure endogenic calcite in summer (10-20% detrital material) to higher percentages of detrital material in winter (up to 20-40%). Reflecting these mineralogical variations, delta(13)C and delta(18)O values of calcite from sediment traps are more negative in summer than in winter times. Since no significant variations in isotopic composition of lake water were detected over one year, factors controlling oxygen isotopic composition of calcite in sediment traps are the precipitation temperature, and the percentage of resuspended and detrital calcite. Samples taken close to the river inflow generally have higher delta values than the others, confirming detrital influence. SEM and isotopic studies on different size fractions (<2, 2-6, 6-20, 20-60, >60 mu m) of winter and summer samples allowed the recognition of resuspension and to separate new endogenic calcite from detrital calcite. Fractions >60 and (2 mu m have the highest percentage of detritus, Fractions 2-6 and 6-20 mu m are typical for the new endogenic calcite in summer, as given by calculations assuming isotopic equilibrium with local water. In winter such fractions show similar values than in summer, indicating resuspension. Using the isotopic composition of sediment traps material and of different size fractions, as well as the isotopic composition of lake water, the water temperature measurements and mineralogy, we re-evaluated the bulk carbonate potential for palaeoclimatic reconstruction in the presence of detrital and re-suspended calcite. This re-evaluation leads to the following conclusion: (1) the endogenic signal can be amplified by applying a particle-size separation, once the size of endogenic calcite is known from SEM study; (2) resuspended calcite does not alter the endogenic signal, but it lowers the time resolution; (3) detrital input decreases at increasing distances from the source, and it modifies the isotopic signal only when very abundant; (4) influence of detrital calcite on bulk sediment isotopic composition can be calculated. (C) 1998 Elsevier Science B.V. All rights reserved.

L'hôpital public sous l'ère de la nouvelle gouvernance : une "camisole de force" pour le personnel soignant ?

Les réformes du système de la santé, introduisant des objectifs d'efficience et de rentabilité inspirés de la doctrine de la Nouvelle gouvernance publique (NGOP), impactent l'organisation des hôpitaux et ses acteurs. Cette recherche étudie les conséquences de l'implémentation de la logique et des outils managériaux sur la profession d'infirmière en termes de contenu du travail et d'identité professionnelle. La reconfiguration des tâches au sein des structures hospitalières semble réduire l'autonomie de ces acteurs de terrain et affecter le sens que les infirmières donnent à leur travail. Par le prisme du pouvoir discrétionnaire, l'étude montre comment le personnel infirmier, principalement selon ses critères moraux, use de stratégies d'ajustement pour faire coïncider ses valeurs avec l'environnement professionnel. Toutefois, la disjonction entre les impératifs managériaux et les valeurs des infirmières engendre de la souffrance au travail. Dans une approche psychosociale, ce mémoire relie le mal-être des infirmières au concept de la « qualité empêchée » qui dévoile le mécanisme par lequel l'action des infirmières est privée en partie de son contenu.