Coercion in the Community: A Situated Approach to the Examination of Ethical Challenges for Mental Health Social Workers

Increasingly, mental health social workers in the United Kingdom and elsewhere in the world are employing coercive interventions with clients. This paper explores this trend in the context of community-based settings, using national and international research literature on this subject. It begins with a discussion about the complex, contested nature of ideas on coercion. The authors then explore debates about how coercion is perceived and applied in practice. They choose two forms of coercion*/informal types of leverage, and the legally mandated use of Community Treatment Orders*/to highlight the range of ethical problems and dilemmas that confront practitioners in this field. The authors conclude by developing a tentative, explanatory model to explain how and why mental health social workers should consider a more holistic, situated approach to help deal with ethical concerns about the use of coercion.

The experience of cancer cachexia: A qualitative study of advanced cancer patients and their family members

Background
Cachexia in advanced malignancy is a debilitating syndrome which contributes to approximately two million deaths worldwide annually. In spite of advances in understanding the biomedical aspects of cancer cachexia, little attention has been paid to exploring its holistic impact on patients and those who care for them.

Objective
The aim of this paper is to describe the lived experience of cachexia from the perspective of patients with cancer and their family members.

Design
An interpretative phenomenological approach was employed.

Setting and participants
A purposive sampling strategy recruited 15 patients and 12 family members from the Regional Cancer Centre in Northern Ireland.

Method
Each participant was interviewed during 2004/2005 using an unstructured interview. All interviews were recorded and transcribed verbatim. Analysis combined a two stage approach using thematic and interpretative phenomenological analysis.

Results
Analysis generated six superordinate themes that reflected the complex dynamics of the cachexia experience. Themes were: physiological changes in appetite; visuality of cachexia; weight loss interpreted as a bad sign; response from health care professionals; conflict over food; and coping responses.

Conclusions
Findings confirmed that cancer cachexia has far reaching implications for patients and their families, extending beyond physical problems into psychological, social and emotional issues. This insight is a critical first step in the development of more responsive care for these clients.

Professing translation: the acts-in-between

Drawing on scholarship in translation ethics (Berman 1992; Cronin 2003) and performance studies (Conquergood 2002; Jackson 2004), this article approaches translation in the theatre from the double perspective of theory and practice. Professing translation as a model for the resolution of entrenched binaries (scholar/artist; theoretician/practitioner), the author sees the practice of translating for performance not just as a method of discovery or a hermeneutic tool but also as a mode of reflection that brings together both “readerly” and “writerly” approaches to text (Barthes 1974). By drawing on the experience of writing translations of García Lorca for the Belgrade Theatre, Calderón for the Royal Shakespeare Company, and Lope de Vega for the Watermill Theatre and the Washington Shakespeare Theatre, the article attempts to characterise such translation as an act of physical imagination, of a holistic understanding of both language and performance, into which textuality is incorporated and by which it is superseded. © John Benjamins Publishing Company

Sensing Spaces:A Body-oriented Architectural Design Education

The contemporary dominance of visuality has turned our understanding of space into a mode of unidirectional experience that externalizes other sensual capacities of the body while perceiving the built environment. This affects not only architectural practice but also architectural education when an introduction to the concept of space is often challenging, especially for the students who have limited spatial and sensual training. Considering that an architectural work is not perceived as a series of retinal pictures but as a repeated multi-sensory experience, the problem definitions in the design studio need to be disengaged from the dominance of a ‘focused vision’ and be re-constructed in a holistic manner. A method to address this approach is to enable the students to refer to their own sensual experiences of the built environment as a part of their design processes. This paper focuses on a particular approach to the second year architectural design teaching which has been followed in the Department of Architecture at Izmir University of Economics for the last three years. The very first architectural project of the studio and the program, entitled ‘Sensing Spaces’, is conducted as a multi-staged design process including ‘sense games, analyses of organs and their interpretations into space’. The objectives of this four-week project are to explore the sense of space through the design of a three-dimensional assembly, to create an awareness of the significance of the senses in the design process and to experiment with re-interpreted forms of bodily parts. Hence, the students are encouraged to explore architectural space through their ‘tactile, olfactory, auditory, gustative and visual stimuli’. In this paper, based on a series of examples, architectural space is examined beyond its boundaries of structure, form and function, and spatial design is considered as an activity of re-constructing the built environment through the awareness of bodily senses.

Teaching Art History to Design Students

Art History is often seen as a mandatory core course in the curricula of design programs but it is rarely tailored to the needs and goals of such programs. Instead, the traditional chronological organization of lecture topics, invariably beginning with the “Venus of Willendorf” (c. 25,000 BC) is presented in order to impart to the students a supposed holistic “big picture.” This essay outlines the re-structuring of a two-semester first-year faculty-wide introductory art history course, entitled “History of Art and Design,” in the Faculty of Fine Arts and Design at Izmir University of Economics, Izmir, Turkey. The course was re-configured from a conventional chronologically-presented (time-oriented) lecture series to a thematically presented (topic-oriented) lecture series more relevant to the students of the faculty – architecture, interior architecture, graphic design, industrial design, and fashion design students.

Confined Site Construction: A qualitative investigation of critical issues affecting management of Health and Safety

The construction industry is inherently risky, with a significant number of accidents and disasters occurring, particularly on confined construction sites. This research investigates and identifies the various issues affecting successful management of health and safety in confined construction sites. The rationale is that identifying the issues would assist the management of health and safety particularly in inner city centres which are mostly confined sites. Using empiricism epistemology, the methodology was based on qualitative research approach by means of multiple case studies in three different geographical locations of Ireland, UK and USA. Data on each case study were collected through individual interviews and focus group discussion with project participants. The findings suggest that three core issues are the underlying factors affecting management of health and safety on confined construction sites. It include, (i) lack of space, (ii) problem of co-ordination and management of site personnel, and (iii) overcrowding of workplace. The implication of this is that project teams and their organisations should see project processes from a holistic point of view, as a unified single system, where quick intervention in solving a particular issue should be the norm, so as not to adversely affect interrelated sequence of events in project operations. Proactive strategies should be devised to mitigate these issues and may include detail project programming, space management, effective constructability review and efficient co-ordination of personnel, plant and materials among others. The value of this research is to aid management and operation of brownfield sites by identifying issues impacting on health and safety management in project process.

Risks and the financing of PPP: Perspectives from the financiers

Public private partnerships (PPP) are an established model for most governments internationally to provide infrastructure-based services, using private finance. Typically the public authority will sign a contract with a special purpose vehicle (SPV), which, because of the holistic nature of PPP, in turn sub-contracts the finance, design, construction, maintenance and soft services to companies that are often related to its shareholders. Thus there is a considerable network of linked organisations that together procure and provide the PPP project. While there is an increasing body of research that examines these PPP projects, much of it is interview or case study based so that the evidence is drawn from a small number of interviews or cases in specific sectors. It also focuses on the public sector procurer and the private sector contractor in the network of organisations. Although it has been recognised that the perceptions of the financiers may vary from those of other key PPP players there is much less research that focuses on the financiers. In this paper we report the results of a postal questionnaire survey, administered to 109 providers of senior debt and equity, from which the response rate was just less than 40%. We supplement these findings with a small number of illustrative quotes from interviewees, where the cited quote represents a commonly held view. We used SPSS and Nvivo to analyse the data. The findings show that when assessing PPPs financiers perceive a very wide range of risks as important, and that it is important to them that many of these risks are either insured or allocated to sub-contractors. When considering participating in PPPs, financiers agree that working with familiar partners on familiar projects and in familiar sectors is important, which may raise barriers to entry and undermine competitive processes.

Green Owl and the Corn Maiden

Purpose: The purpose of this paper is to engage a different notion of feminism in accounting by addressing the issues of feminism, balance, and integration as a means of understanding differently the world for which one accounts. The ideas are communicated by the sharing of experiences through myth and storytelling.

Design/methodology/approach: An alternative lens for understanding the giving of accounts is proposed, drawing on earlier feminist accounting literature as well as storytelling and myth.

Findings: Including the subjective and intersubjective approaches to experiencing and understanding the world recommends an approach whereby both the feminine-intuitive and the masculine-rational processes are integrated in constructing decision models and accounts.

Research limitations/implications: Through an expanded view of values that can be included in reporting or recounting a different model is seen, and different decisions are enabled. The primary limitation is having to use words to convey one’s subjective and intersubjective understandings. The written medium is not the most natural language for such an undertaking.

Practical implications: By enabling the inclusion of more feminine values, a way is opened to engage more holistically with the society in which decisions are embedded.

Originality/value: Drawing on the storytelling tradition, a holistic model is suggested that can lead to emergence of a more balanced societal reporting.

Keywords: Feminism, Integration, Accounting, Storytelling, Myths

Paper type: Research paper

Cancer Cachexia Care: The Contribution of Qualitative Research to Evidence-Based Practice

Background: Despite its prevalence and prognostic impact, primary cachexia is not well understood. Its potential to cause considerable psychological stress indicates the need for qualitative research to help understand the perspectives of those affected.

Objective: The aims of this study were to describe the perspectives of patients with primary cachexia, of their relatives, and of the healthcare professionals involved in their care and to demonstrate how this evidence can be applied in practice at 4 different levels of application ranging from empathy to coaching.

Methods: A review of the qualitative literature and empirical qualitative investigation was used to understand the experiences of patients and relatives and the perspectives of professionals.

Results: The main worries expressed by patients and relatives concerned appetite loss, changing appearance, prognosis, and social interaction. We also describe their coping responses and their views of professionals’ responses. The main concerns of professionals related to poor communication, lack of clinical guidance, and lack of professional education.

Conclusions: Understanding patients’, families’, and professionals’ perspectives, and mapping that understanding onto what we know about the trajectory and prognosis of the condition, provides the evidence base for good practice. Qualitative research has a central role to play in providing the knowledge base for the nursing care of patients with cachexia.

Implications for Practice: The evidence provided can improve nurses’ insight and assist them in assessment of status, the provision of guidance, and coaching. There is a need for the development of a holistic, information-based integrated care pathway for those with cancer cachexia and their families.

Evidential Holism and Indispensability Arguments

The indispensability argument is a method for showing that abstract mathematical objects exist (call this mathematical Platonism). Various versions of this argument have been proposed (§1). Lately, commentators seem to have agreed that a holistic indispensability argument (§2) will not work, and that an explanatory indispensability argument is the best candidate. In this paper I argue that the dominant reasons for rejecting the holistic indispensability argument are mistaken. This is largely due to an overestimation of the consequences that follow from evidential holism. Nevertheless, the holistic indispensability argument should be rejected, but for a different reason (§3)—in order that an indispensability argument relying on holism can work, it must invoke an unmotivated version of evidential holism. Such an argument will be unsound. Correcting the argument with a proper construal of evidential holism means that it can no longer deliver mathematical Platonism as a conclusion: such an argument for Platonism will be invalid. I then show how the reasons for rejecting the holistic indispensability argument importantly constrain what kind of account of explanation will be permissible in explanatory versions (§4).

Predictive models for deterioration of concrete structures

Permeation characteristics and fracture strength are the fundamental properties of concrete that influence the initiation and extent of damage and can form the basis by which deterioration can be predicted. The relationship between these properties and deterioration mechanisms is discussed along with the different models representing their interaction with the environment. Mehta presented a holistic model of the deterioration of concrete based on the environmental action on the microstructure of concrete. Using a similar approach, a detailed investigation on the causes of concrete deterioration is used to develop a macro-model for each mechanism relating to the physical properties of concrete. A single interaction model is then presented for all types of deterioration, emphasizing the permeation properties of concrete. Data from an in situ investigation of concrete bridges in Northern Ireland is used to validate this model. This is followed by a micro-predictive model which includes an ionic transport sub-model, a deterioration sub-model and a structural sub-model and affords quantitative prediction of the deterioration of concrete structures. The quantitative predictive capabilities of the micro-model are demonstrated with the use of reported experimental data.

Bio-port Free Energy City

In an age of depleting oil reserves and increasing energy demand, humanity faces a stalemate between environmentalism and politics, where crude oil is traded at record highs yet the spotlight on being ‘green’ and sustainable is stronger than ever. A key theme on today’s political agenda is energy independence from foreign nations, and the United Kingdom is bracing itself for nuclear renaissance which is hoped will feed the rapacious centralised system that the UK is structured upon. But what if this centralised system was dissembled, and in its place stood dozens of cities which grow and monopolise from their own energy? Rather than one dominant network, would a series of autonomous city-based energy systems not offer a mutually profitable alternative? Bio-Port is a utopian vision of a ‘Free Energy City’ set in Liverpool, where the old dockyards, redundant space, and the Mersey Estuary have been transformed into bio-productive algae farms. Bio-Port Free Energy City is a utopian ideal, where energy is superfluous; in fact so abundant that meters are obsolete. The city functions as an energy generator and thrives from its own product with minimal impact upon the planet it inhabits. Algaculture is the fundamental energy source, where a matrix of algae reactors swamp the abandoned dockyards; which themselves have been further expanded and reclaimed from the River Mersey. Each year, the algae farm is capable of producing over 200 million gallons of bio-fuel, which in-turn can produce enough electricity to power almost 2 million homes. The metabolism of Free-Energy City is circular and holistic, where the waste products of one process are simply the inputs of a new one. Livestock farming – once traditionally a high-carbon countryside exercise has become urbanised. Cattle are located alongside the algae matrix, and waste gases emitted by farmyards and livestock are largely sequestered by algal blooms or anaerobically converted to natural gas. Bio-Port Free Energy City mitigates the imbalances between ecology and urbanity, and exemplifies an environment where nature and the human machine can function productively and in harmony with one another. According to James Lovelock, our population has grown in number to the point where our presence is perceptibly disabling the planet, but in order to reverse the effects of our humanist flaws, it is vital that new eco-urban utopias are realised.

Selective Orthosteric Free Fatty Acid Receptor 2 (FFA2) Agonists IDENTIFICATION OF THE STRUCTURAL AND CHEMICAL REQUIREMENTS FOR SELECTIVE ACTIVATION OF FFA2 VERSUS FFA3

Free fatty acid receptor 2 (FFA2; GPR43) is a G protein-coupled seven-transmembrane receptor for short-chain fatty acids (SCFAs) that is implicated in inflammatory and metabolic disorders. The SCFA propionate has close to optimal ligand efficiency for FFA2 and can hence be considered as highly potent given its size. Propionate, however, does not discriminate between FFA2 and the closely related receptor FFA3 (GPR41). To identify FFA2-selective ligands and understand the molecular basis for FFA2 selectivity, a targeted library of small carboxylic acids was examined using holistic, label-free dynamic mass redistribution technology for primary screening and the receptor-proximal G protein [S-35] guanosine 5'-(3-O-thio) triphosphate activation, inositol phosphate, and cAMP accumulation assays for hit confirmation. Structure-activity relationship analysis allowed formulation of a general rule to predict selectivity for small carboxylic acids at the orthosteric binding site where ligands with substituted sp(3)-hybridized alpha-carbons preferentially activate FFA3, whereas ligands with sp(2)- or sp-hybridized alpha-carbons prefer FFA2. The orthosteric binding mode was verified by site-directed mutagenesis: replacement of orthosteric site arginine residues by alanine in FFA2 prevented ligand binding, and molecular modeling predicted the detailed mode of binding. Based on this, selective mutation of three residues to their non-conserved counterparts in FFA3 was sufficient to transfer FFA3 selectivity to FFA2. Thus, selective activation of FFA2 via the orthosteric site is achievable with rather small ligands, a finding with significant implications for the rational design of therapeutic compounds selectively targeting the SCFA receptors.

Experiences of carers supporting dying renal patients managed without dialysis

Aim: To explore the impact of being a family carer to patients with stage 5 chronic kidney disease managed without dialysis.
Background: Increasing numbers of patients with renal disease worldwide are making the decision not to embark on dialysis. This group has significant physical and psychological symptom burdens similar to or greater than those in advanced cancer patients. Little is known about the impact on family carers.
Design: Exploratory, qualitative design.
Methods: The study was undertaken with 19 carers caring for patients managed in a Renal Supportive Care Service in the UK between 2006–2008. Sixty-one semi-structured interviews and detailed field notes inform the analysis.
Findings: ‘Caring from diagnosis to death’ was the overarching theme illustrated by three sub-themes: (i) Caregiver's plight – making sense of the disease and potential deterioration; (ii) Having to care indefinitely; and (iii) Avoiding talk of death. ‘Caring from diagnosis to death’ coincides with an original concept analysis of renal supportive care, which is considered an adjunct to the management of patients with renal disease at all stages of their illness.
Conclusion: There is a clear need for further research internationally and theory-based nursing interventions to support carers of patients managed without dialysis. The development of a holistic, integrated care pathway based on carer perspectives, which includes identification of information needs related to original diagnosis, associated comorbidities, treatment options, prognosis, and assistance in developing strategies to manage communication with patients as the end of life approaches, is required.

Public health education for midwives and midwifery students: a mixed methods study

Background: Current national and international maternity policy supports the importance of addressing public health goals and investing in early years. Health care providers for women during the reproductive and early postnatal period have the opportunity to encourage women to make choices that will impact positively on maternal and fetal health. Midwives are in a unique position, given the emphasis of the philosophy of midwifery care on building relationships and incorporating a holistic approach, to support women to make healthy choices with the aim of promoting health and preventing ill health. However, exploration of the educational preparation of midwives to facilitate public health interventions has been relatively limited. The aim of the study was to identify the scope of current midwifery pre registration educational provision in relation to public health and to explore the perspectives of midwives and midwifery students about the public health role of the midwife.

Methods: This was a mixed methods study incorporating a survey of Higher Educational Institutions providing pre registration midwifery education across the UK and focus groups with midwifery students and registered midwives.

Results: Twenty nine institutions (53% response) participated in the survey and nine focus groups were conducted (59 participants). Public health education was generally integrated into pre registration midwifery curricula as opposed to taught as a discrete subject. There was considerable variation in the provision of public health topics within midwifery curricula and the hours of teaching allocated to them. Focus group data indicated that it was consistently difficult for both midwifery students and midwives to articulate clearly their understanding and definition of public health in relation to midwifery.

Conclusions: There is a unique opportunity to impact on maternal and infant health throughout the reproductive period; however the current approach to public health within midwifery education should be reviewed to capitalise on the role of the midwife in delivering public health interventions. It is clear that better understanding of midwifery public health roles and the visibility of public health within midwifery is required in order to maximise the potential contribution of midwives to achieving short and long term public health population goals.