Patient and public involvement in healthcare quality improvement: how organizations can help patients and professionals to collaborate

Citizens across the world are increasingly called upon to participate in healthcare improvement. It is often unclear how this can be made to work in practice. This 4- year ethnography of a UK healthcare improvement initiative showed that patients used elements of organizational culture as resources to help them collaborate with healthcare professionals. The four elements were: (1) organizational emphasis on nonhierarchical, multidisciplinary collaboration; (2) organizational staff ability to model desired behaviours of recognition and respect; (3) commitment to rapid action, including quick translation of research into practice; and (4) the constant data collection and reflection process facilitated by improvement methods.

The aims of early years outdoor education in England: a conceptual and empirical investigation

This paper explores the place of aims in the early years foundation stage outdoor environment in England. Through examining the writing of academics, various themes are identified, and constructed into possible aims. These themes/aims are compared to an empirical study of early years teachers’ attitudes. Data was collected by questionnaire from schools within the University of Reading partnership. There was general agreement between experts and teachers as to the aims. While some respondents were able to explain what the aims of outdoor activity were, a significant number were unable to identify aims; further, a significant number did not distinguish between approach/practice and aims. A lack of understanding and agreement as to what the aims are may indicate teachers are unsure about the purpose of outdoor education for young children. A result of this study is to agree and make explicit the aims for outdoor education in the early years.

Introduction: entire hands and main fingers

The ten-volume edition of The Collected Works of Thomas Heywood, forthcoming from Oxford University Press from 2015 to 2022, will attempt to place Heywood’s plays, poetry, and prose back where they belong: at the centre of the study of early modern English literature, drama, and theatre history. Especially as an actor, playwright, reviser, editor, and historical chronicler, Heywood had the longest and widest-ranging career of his contemporaries and thus can reveal how sixteenth- and seventeenth-century authors and theatrical and literary audiences came to see the practice and production of drama.

Faith and protection: the construction of hope by parents of children with leukemia and their oncologists

Background. Oncologists are criticized for fostering unrealistic hope in patients and families, but criticisms reflect a perspective that is oversimplified and “expert” guidance that is ambiguous or impractical. Our aim was to understand how pediatric oncologists manage parents' hope in practice and to evaluate how they address parents' needs. Methods. Participants were 53 parents and 12 oncologists whom they consulted across six U.K. centers. We audio recorded consultations approximately 1–2, 6, and 12 months after diagnosis. Parents were interviewed after each consultation to elicit their perspectives on the consultation and clinical relationship. Transcripts of consultations and interviews were analyzed qualitatively. Results. Parents needed hope in order to function effectively in the face of despair, and all wanted the oncologists to help them be hopeful. Most parents focused hope on the short term. They therefore needed oncologists to be authoritative in taking responsibility for the child's long-term survival while cushioning parents from information about longer-term uncertainties and being positive in providing information about short-term progress. A few parents who could not fully trust their oncologist were unable to hope. Conclusion. Oncologists' pivotal role in sustaining hope was one that parents gave them. Most parents' “faith” in the oncologist allowed them to set aside, rather than deny, their fears about survival while investing their hopes in short-term milestones. Oncologists' behavior generally matched parents' needs, contradicting common criticisms of oncologists. Nevertheless, oncologists need to identify and address the difficulty that some parents have in fully trusting the oncologist and, consequently, being hopeful.

On systems and quality in typeface design

This text extends some ideas presented in a keynote lecture of the 5th Encontro de Tipografia conference, in Barcelos, Portugal, in November 2014. The paper discusses problems of identifying the location and encoding of design decisions, the implications of digital workflows for capturing knowledge generating through design practice, and the consequences of the transformation of production tools into commodities. It concludes with a discussion of the perception of added value in typeface design.

Sialic acids in biological and therapeutic processes: opportunities and challenges

It is now well documented that carbohydrates play multiple roles in biological processes, and hence are interesting targets for chemical biology and medicinal chemistry programmes. This review focuses on a subset of carbohydrates, specifically sialic acid containing carbohydrates. It highlights their occurrence and diversity, and presents evidence for their roles in a range of biological pathways. It illustrates that they are targets for novel medicinal chemistry strategies for a range of therapeutic areas, including cancer and immunity. Case studies highlight opportunities and challenges in this area, and sialic acid based drugs that have entered clinical practice, and are promising candidates for future disease intervention schemes, are discussed. The review concludes by highlighting perspectives and emerging roles for these targets.

Time is of the essence: a selective review of the fall and rise of brief therapy research

For compelling reasons of equity and the advance of public health, brief psychotherapy has become the dominant format in both practice and research. One consequence of this is the apparent decline of a distinct stream of brief therapy research. However, much of the agenda formerly identified with that research stream is of increasing importance to the field. Time is indeed of the essence in current psychotherapy research. For example, factors conducive to the time efficiency of brief psychodynamic therapy have been described recently. The important question ‘How much therapy is enough?’ has been addressed by studies inspired by the dose-response analysis of Howard and colleagues. The value of ultra-brief interventions has been examined. These issues are considered in a selective review, drawing in particular on the work of the Sheffield/Leeds psychotherapy of depression research group. This research treats the number of treatment sessions as an independent variable, thereby providing a causal analysis of the dose-response relationship over a range from two to 16 sessions, illuminated by a comparative analysis of change processes in treatments of different durations. Its results enable some specification of the extent and nature of incremental benefit derived from additional sessions in the psychotherapy of depression.

Resources, staff beliefs and organizational culture: factors in the use of information and communication technology for adults with intellectual disabilities

Background  Access to, and the use of, information and communication technology (ICT) is increasingly becoming a vital component of mainstream life. First-order (e.g. time and money) and second-order factors (e.g. beliefs of staff members) affect the use of ICT in different contexts. It is timely to investigate what these factors may be in the context of service provision for adults with intellectual disabilities given the role ICT could play in facilitating communication and access to information and opportunities as suggested in Valuing People. Method  Taking a qualitative approach, nine day service sites within one organization were visited over a period of 6 months to observe ICT-related practice and seek the views of staff members working with adults with intellectual disabilities. All day services were equipped with modern ICT equipment including computers, digital cameras, Internet connections and related peripherals. Results  Staff members reported time, training and budget as significant first-order factors. Organizational culture and beliefs about the suitability of technology for older or less able service users were the striking second-order factors mentioned. Despite similar levels of equipment, support and training, ICT use had developed in very different ways across sites. Conclusion  The provision of ICT equipment and training is not sufficient to ensure their use; the beliefs of staff members and organizational culture of sites play a substantial role in how ICT is used with and by service users. Activity theory provides a useful framework for considering how first- and second-order factors are related. Staff members need to be given clear information about the broader purpose of activities in day services, especially in relation to the lifelong learning agenda, in order to see the relevance and usefulness of ICT resources for all service users.

Designing in caves: using immersive visualisations in design practice

This paper describes a study of the use of immersive Virtual reality technologies in the design of a new hospital. It uses Schön’s concept of reflective practice and video-based methods to analyse the ways design teams approach and employ a full scale 3D immersive environment – a CAVE – in collaborative design work. The analysis describes four themes relating to reflective practice occurring in the setting: orienting to the CAVE technology itself, orienting to the representation of the specific design within the CAVE, activities accounting for, or exploring alternatives within the design for the use and users of the space, and more strategic interactions around how to best represent the design and model to the client within the CAVE setting. The analysis also reveals some unique aspects of design work in this environment. Perhaps most significantly, rather than enhancing or adding to an existing understanding of design through paper based or non-immersive digital representations, it is often acting to challenge or surprise the participants as they experience the immersive, full scale version of their own design.

Discovering biomarkers for antidepressant response: protocol from the Canadian biomarker integration network in depression (CAN-BIND) and clinical characteristics of the first patient cohort

Background Major Depressive Disorder (MDD) is among the most prevalent and disabling medical conditions worldwide. Identification of clinical and biological markers (“biomarkers”) of treatment response could personalize clinical decisions and lead to better outcomes. This paper describes the aims, design, and methods of a discovery study of biomarkers in antidepressant treatment response, conducted by the Canadian Biomarker Integration Network in Depression (CAN-BIND). The CAN-BIND research program investigates and identifies biomarkers that help to predict outcomes in patients with MDD treated with antidepressant medication. The primary objective of this initial study (known as CAN-BIND-1) is to identify individual and integrated neuroimaging, electrophysiological, molecular, and clinical predictors of response to sequential antidepressant monotherapy and adjunctive therapy in MDD. Methods CAN-BIND-1 is a multisite initiative involving 6 academic health centres working collaboratively with other universities and research centres. In the 16-week protocol, patients with MDD are treated with a first-line antidepressant (escitalopram 10–20 mg/d) that, if clinically warranted after eight weeks, is augmented with an evidence-based, add-on medication (aripiprazole 2–10 mg/d). Comprehensive datasets are obtained using clinical rating scales; behavioural, dimensional, and functioning/quality of life measures; neurocognitive testing; genomic, genetic, and proteomic profiling from blood samples; combined structural and functional magnetic resonance imaging; and electroencephalography. De-identified data from all sites are aggregated within a secure neuroinformatics platform for data integration, management, storage, and analyses. Statistical analyses will include multivariate and machine-learning techniques to identify predictors, moderators, and mediators of treatment response. Discussion From June 2013 to February 2015, a cohort of 134 participants (85 outpatients with MDD and 49 healthy participants) has been evaluated at baseline. The clinical characteristics of this cohort are similar to other studies of MDD. Recruitment at all sites is ongoing to a target sample of 290 participants. CAN-BIND will identify biomarkers of treatment response in MDD through extensive clinical, molecular, and imaging assessments, in order to improve treatment practice and clinical outcomes. It will also create an innovative, robust platform and database for future research.

Lower serum IgA levels in horses kept under intensive sanitary management and physical training

Quantity and variety of environmental antigens, age, diet, vaccine protocols, exercising practice and mucosal cytokine microenvironment are factors that influence serum immunoglobulin (Ig) levels. IgA, IgG, IgG(T) and IgM were quantified in 60 horses, which were classified into two groups, `intensive` or `relaxed`, according to sanitary standards of the facilities and physical exercise to which animals were subjected to. The `intensive` group presented lower means for all isotypes, but only IgA presented a significant (P < 0.0064) difference when compared to the `relaxed` group. This suggests that mucosal immunity found in the `intensive` group is lower when compared to the `relaxed` group. Our data suggest that athlete horses may be less poised to mount an effective mucosal immunity response to environmental challenges and should not be considered by the same perspectives as a free-ranging horse.

Dissonant Voices : Philosophy, Children's Literature, and Perfectionist Education

Dissonant Voices has a twofold aspiration. First, it is a philosophical treatment of everyday pedagogical interactions between children and their elders, between teachers and pupils. More specifically it is an exploration of the possibilities to go on with dissonant voices that interrupt established practices – our attunement – in behaviour, practice and thinking. Voices that are incomprehensible or expressions that are unacceptable, morally or otherwise. The text works on a tension between two inclinations: an inclination to wave off, discourage, or change an expression that is unacceptable or unintelligible; and an inclination to be tolerant and accept the dissonant expression as doing something worthwhile, but different. The second aspiration is a philosophical engagement with children’s literature. Reading children’s literature becomes a form of philosophising, a way to explore the complexity of a range of philosophical issues. This turn to literature marks a dissatisfaction with what philosophy can accomplish through argumentation and what philosophy can do with a particular and limited set of concepts for a subject, such as ethics. It is a way to go beyond philosophising as the founding of theories that justify particular responses. The philosophy of dissonance and children’s literature becomes a way to destabilise justifications of our established practices and ways of interacting. The philosophical investigations of dissonance are meant to make manifest the possibilities and risks of engaging in interactions beyond established agreement or attunements. Thinking of the dissonant voice as an expression beyond established practices calls for improvisation. Such improvisations become a perfectionist education where both the child and the elder, the teacher and the student, search for as yet unattained forms of interaction and take responsibility for every word and action of the interaction. The investigation goes through a number of picture books and novels for children such as Harry Potter, Garmann’s Summer, and books by Shaun Tan, Astrid Lindgren and Dr. Seuss as well narratives by J.R.R. Tolkien, Henrik Ibsen, Jane Austen and Henry David Thoreau. These works of fiction are read in conversation with philosophical works of, and inspired by, Ludwig Wittgenstein and Stanley Cavell, their moral perfectionism and ordinary language philosophy.

Machine translation and the disruption of foreign language learning activities

This study examines the question of how language teachers in a highly technology-friendly university environment view machine translation and the implications that this has for the personal learning environments of students. It brings an activity-theory perspective to the question, examining the ways that the introduction of new tools can disrupt the relationship between different elements in an activity system. This perspective opens up for an investigation of the ways that new tools have the potential to fundamentally alter traditional learning activities. In questionnaires and group discussions, respondents showed general agreement that although use of machine translation by students could be considered cheating, students are bound to use it anyway, and suggested that teachers focus on the kinds of skills students would need when using machine translation and design assignments and exams to practice and assess these skills. The results of the empirical study are used to reflect upon questions of what the roles of teachers and students are in a context where many of the skills that a person needs to be able to interact in a foreign language increasingly can be outsourced to laptops and smartphones.

Protocols between programs and proofs

In this paper we describe a new protocol that we call the Curry-Howard protocol between a theory and the programs extracted from it. This protocol leads to the expansion of the theory and the production of more powerful programs. The methodology we use for automatically extracting “correct” programs from proofs is a development of the well-known Curry-Howard process. Program extraction has been developed by many authors, but our presentation is ultimately aimed at a practical, usable system and has a number of novel features. These include 1. a very simple and natural mimicking of ordinary mathematical practice and likewise the use of established computer programs when we obtain programs from formal proofs, and 2. a conceptual distinction between programs on the one hand, and proofs of theorems that yield programs on the other. An implementation of our methodology is the Fred system. As an example of our protocol we describe a constructive proof of the well-known theorem that every graph of even parity can be decomposed into a list of disjoint cycles. Given such a graph as input, the extracted program produces a list of the (non-trivial) disjoint cycles as promised.