Panning for Gold: The Standardizing Work of Filling “Autistic” Shells – Using institutional ethnography to explore textually mediated health relations in the diagnostic process of autism.

Health reform practices in Canada and elsewhere have restructured the purpose and use of diagnostic labels and the processes of naming such labels. Diagnoses are no longer only a means to tell doctors and patients what may be wrong and indicate potential courses of treatment; some diagnoses activate specialized services and supports for persons with a disability and those who provide care for them. In British Columbia, a standardized process of diagnosis with the outcome of an autism spectrum disorder gives access to government provided health care and educational services and supports. Such processes enter individuals into a complex of text mediated relations, regulated by the principles of evidence-based medicine. However, the diagnosis of autism in children is notoriously uncertain. Because of this ambiguity, standardizing the diagnostic process creates a hurdle in gaining help and support for parents who have children with problems that could lead to a diagnosis on the autism spectrum. Such processes and their organizing relations are problematized, explored and explicated below. Grounded in the epistemological and ontological shift offered by Dorothy E. Smith (1987; 1990a; 1999; 2005), this article reports on the findings of an institutional ethnographic study that explored the diagnostic process of autism in British Columbia. More specifically, this article focuses on the processes involved in going from mothers talking from their experience about their childrens problems to the formalized and standardized, and thus “virtually” produced, diagnoses that may or may not give access to services and supports in different systems of care. Two psychologists, a developmental pediatrician, a social worker – members of a specialized multidisciplinary assessment team – and several mothers of children with a diagnosis on the autism spectrum were interviewed. The implications of standardizing the diagnosis process of a disability that is not clear-cut and has funding attached are discussed. This ethnography also provides a glimpse of the implications of current and ongoing reforms in the state-supported health care system in British Columbia, and more generally in Canada, for people’s everyday doings.

Supervisor Continuity or Co-Location: Which Matters in Residency Education? Findings From a Qualitative Study of Remote Supervisor Family Physicians in Australia and Canada

Purpose: Changes to health care systems andworking hours have fragmentedresidents’ clinical experiences withpotentially negative effects ontheir development as professionals.Investigation of off-site supervision,which has been implemented in isolatedrural practice, could reveal importantbut less overt components of residencyeducation. 

Method: Insights from sociocultural learningtheory and work-based learning provideda theoretical framework. In 2011–2012,16 family physicians in Australia andCanada were asked in-depth how theyremotely supervised residents’ workand learning, and for their reflectionson this experience. The verbatiminterview transcripts and researchers’memos formed the data set. Templateanalysis produced a description andinterpretation of remote supervision. 

Results: Thirteen Australian family physiciansfrom five states and one territory, andthree Canadians from one province,participated. The main themes werehow remoteness changed the dynamicsof care and supervision; the importanceof ongoing, holistic, nonhierarchical,supportive supervisory relationships; andthat residents learned “clinical courage”through responsibility for patients’ careover time. Distance required supervisorsto articulate and pass on their expertiseto residents but made monitoringdifficult. Supervisory continuityencouraged residents to build on pastexperiences and confront deficiencies. 

Conclusions: Remote supervision enabled residents todevelop as clinicians and professionals.This questions the supremacy of co-locationas an organizing principle forresidency education. Future specialists maybenefit from programs that give themongoing and increasing responsibilityfor a group of patients and supportive.

The Belfast Storytelling Database: A spontaneous social interaction database with laughter focused annotation

To support the endeavor of creating intelligent interfaces between computers and humans the use of training materials based on realistic human-human interactions has been recognized as a crucial task. One of the effects of the creation of these databases is an increased realization of the importance of often overlooked social signals and behaviours in organizing and orchestrating our interactions. Laughter is one of these key social signals; its importance in maintaining the smooth flow of human interaction has only recently become apparent in the embodied conversational agent domain. In turn, these realizations require training data that focus on these key social signals. This paper presents a database that is well annotated and theoretically constructed with respect to understanding laughter as it is used within human social interaction. Its construction, motivation, annotation and availability are presented in detail in this paper.

Herbal treatment in asthma and COPD – current evidence

Asthma and COPD are chronic inflammatory respiratory diseases affecting millions of people worldwide and increasing in prevalence. Current treatment options for both conditions aim to alleviate symptoms, improve patient quality of life and prevent disease progression rather than cure the underlying condition itself. Treatments available to patients include anti-inflammatory therapies, bronchodilators and inhaled corticosteroids. While these treatments have been deemed effective at alleviating disease symptoms and exacerbations they are not without their limitations. Overuse of some therapies can induce adverse effects in some patients such as increased risk of developing pneumonia and cardiac co-morbidities. Along with the risks of side effects not all patients will respond to the current treatment options and therefore there is an unmet need for additional or alternative treatments for asthma and COPD. One such area showing good promise in providing an alternative or add-on therapy is that of phytomedicine. Phytomedicine is defined as a plant-based traditional medical practice that uses various plant materials in modalities considered both preventive and therapeutic. This review focuses on recent human clinical trials using plant-based medicines for the treatment of asthma and COPD.

Sound Art and Spatial Practices: Situating Sound Installation Art Since 1958

This dissertation examines the emergence and development of sound installation art, an under-recognized tradition that has developed between music, architecture, and media art practices since the late 1950s. Unlike many musical works, which are concerned with organizing sounds in time, sound installations organize sounds in space; they thus necessitate new theoretical and analytical models that take into consideration the spatial situated-ness of sound. Existing discourses on “spatial sound” privilege technical descriptions of sound localization. By contrast, this dissertation examines the ways in which concepts of space are socially, culturally, and politically construed, and how spatially-organized sound works reflect and resist these different constructions. Using an interdisciplinary methodology of critical spatial analysis and critical studies in music, this dissertation explores such topics as: conceptions of acoustic space in postwar Western art music, architecture, and media theory; the development of sound installation art in relation to philosophies of everyday life and social space; the historical links between musical performance, conceptual art, and sound sculpture; the body as a site for sound installations; and sonicspatial strategies that confront politics of race and gender. Through these different investigations, this dissertation proposes an “ontopological” model for considering sound: a critical model of analysis and reception that privileges an understanding of sound in relation to ontologies of space and place.

Fear of oxygen therapy for children in Malawi

BACKGROUND: Although pneumonia is a common cause of death in children in Malawi, healthcare staff frequently encounter patients or carers who refuse oxygen therapy. This qualitative study documents factors that influence acceptance or refusal of oxygen therapy for children in Malawi.

METHODS: Nine group interviews involving 86 participants were held in community and hospital settings in rural and urban Malawi. Eleven in-depth interviews of healthcare staff providing oxygen were held in a central hospital. Thematic analysis of transcripts of the audio recordings was carried out to identify recurring themes.

RESULTS: Similar ideas were identified in the group interviews and in-depth staff interviews. Past experiences of oxygen use (direct and indirect, positive and negative) had a strong influence on views of oxygen. A recurrent theme was fear of oxygen, often due to a perceived association between death and recent oxygen use. Fears were intensified by a lack of familiarity with equipment used to deliver oxygen, distrust of medical staff and concerns about cost of oxygen.

CONCLUSIONS: This study identifies reasons for refusal of oxygen therapy for children in a low-income country. Findings from the study suggest that training of healthcare staff to address fears of parents, and information, education and communication (IEC) approaches that improve public understanding of oxygen and provide positive examples of its use are likely to be helpful in improving uptake of oxygen therapy in Malawi.

Institutional Hybridity in Public Sector Reform: Replacement, Blending, or Layering of Administrative Paradigms

Despite an abundance of studies on hybridization and hybrid forms of organizing, scholarly work has failed to distinguish consistently between specific types of hybridity. As a consequence, the analytical category has become blurred and lacks conceptual clarity. Our paper discusses hybridity as the simultaneous appearance of institutional logics in organizational contexts, and differentiates the parallel co-existence of logics from transitional combinations (eventually leading to the replacement of a logic) and more robust combinations in the form of layering and blending. While blending refers to hybridity as an ‘amalgamate’ with original components that are no longer discernible, the notion of layering conceptualizes hybridity in a way that the various elements, or clusters thereof, are added on top of, or alongside, each other, similar to sediment layers in geology. We illustrate and substantiate such conceptual differentiation with an empirical study of the dynamics of public sector reform. In more detail, we examine the parliamentary discourse around two major reforms of the Austrian Federal Budget Law in 1986 and in 2007/2009 in order to trace administrative (reform) paradigms. Each of the three identified paradigms manifests a specific field-level logic with implications for the state and its administration: bureaucracy in Weberian-style Public Administration, market-capitalism in New Public Management, and democracy in New Public Governance. We find no indication of a parallel co-existence or transitional combination of logics, but hybridity in the form of robust combinations. We explore how new ideas fundamentally build on – and are made resonant with – the central bureaucratic logic in a way that suggests layering rather than blending. The conceptual findings presented in our article have implications for the literature on institutional analysis and institutional hybridity.

Mitochondrial Transfer via Tunneling Nanotubes (TNT) is an Important Mechanism by which Mesenchymal Stem Cells Enhance Macrophage Phagocytosis in the in vitro and in vivo Models of ARDS

Mesenchymal stromal cells (MSC) have been reported to improve bacterial clearance in pre-clinical models of Acute Respiratory Distress Syndrome (ARDS) and sepsis. The mechanism of this effect is not fully elucidated yet. The primary objective of this study was to investigate the hypothesis that the anti-microbial effect of MSC in vivo depends on their modulation of macrophage phagocytic activity which occurs through mitochondrial transfer. We established that selective depletion of alveolar macrophages (AM) with intranasal (IN) administration of liposomal clodronate resulted in complete abrogation of MSC anti-microbial effect in the in vivo model of E.coli pneumonia. Furthermore, we showed that MSC administration was associated with enhanced AM phagocytosis in vivo. We showed that direct co-culture of MSC with monocyte-derived macrophages (MDMs) enhanced their phagocytic capacity. By fluorescent imaging and flow cytometry we demonstrated extensive mitochondrial transfer from MSC to macrophages which occurred at least partially through TNT-like structures. We also detected that lung macrophages readily acquire MSC mitochondria in vivo, and macrophages which are positive for MSC mitochondria display more pronounced phagocytic activity. Finally, partial inhibition of mitochondrial transfer through blockage of TNT formation by MSC resulted in failure to improve macrophage bioenergetics and complete abrogation of the MSC effect on macrophage phagocytosis in vitro and the anti-microbial effect of MSC in vivo.

Collectively, this work for the first time demonstrates that mitochondrial transfer from MSC to innate immune cells leads to enhancement in phagocytic activity and reveals an important novel mechanism for the anti-microbial effect of MSC in ARDS.

A rising e-channel tide lifts all boats? the impact of manufacturer multi-channel encroachment on traditional selling and leasing

Organizing and managing channels of distribution is an important marketing task. Due to the emergence of electronic commerce on the Internet, e-channel distribution systems have been adopted by many manufacturers. However, academic and anecdotal evidence both point to the pressures arising from this new e-channel manufacturing environment. Questions marks therefore remain on how the addition of this e-channel affects the traditional marketing strategies of leasing and selling. We set up several two-period dual-channel models in which a manufacturer sells a durable product through both a manufacturer-owned e-channel and an independent reseller (leaser) who adopts selling (leasing) to consumers. Our main results indicate that, direct selling cost aside, product durability plays an important role in shaping the strategies of all members. With either marketing strategy, the additional expansion of an e-channel territory may secure Pareto gains, in which all members benefit.

Theorizing temporary spatial clusters and institutional boundary-work in industrial markets

To better understand the nature of temporary spatial clusters (TSC’s) in industrial marketing settings, this conceptual paper first provides a theoretical synthesis of spatial understanding from the industrial marketing (IM) and economic geography (EG) fields, focusing particularly on Doreen Massey’s work on relational space. This leads to a conceptual schema for organizing the IM literature in terms of spatiality, and which also helps clarify the ontological nature of TSCs. We then move to introduce the notion of institutional boundary-work, drawing on the work of Thomas Gieryn, and Andrea Brighenti’s examination of territorology, to conceptualize the activities of market actors engaged in the ongoing social accomplishment of TSCs. Such activities, we suggest, involve these actors ‘marching’ boundaries to assume network influence and maintain market order in IM settings. In summary, therefore, our paper addresses two fundamental questions: i) How do we conceptualize the form of TSCs in IM settings? And, ii) what function(s) are TSCs performing (and how is this being undertaken) in IM? The paper closes by providing methodological guidance for how a research agenda on TSCs within IM activity might be developed, followed by a summary of the managerial implications that emerge from our theorizations.

A formação como actividade de aprendizagem docente

A partir dos pressupostos da teoria histórico-cultural, e em particular da Teoria da Actividade, desenvolvida por Leontiev, esta pesquisa estudou a aprendizagem docente num projecto de formação e investigação que privilegiou a atividade orientadora de ensino como metodologia de formação. Este desenvolveu-se em São João da Madeira e em Aveiro, com educadoras pertencentes a jardins de infância que mantinham um protocolo de colaboração com a disciplina de prática pedagógica da Licenciatura em Educação de Infância da Universidade de Aveiro. Para a dinâmica de formação, numa metodologia de pesquisa colaborativa, consideraram-se os encontros de formação como um espaço de discussão e reflexão dos pressupostos teóricos e da atividade orientadora de ensino, como desencadeadores de um movimento na aprendizagem docente. Dada a complexidade do objecto de estudo, investigar a aprendizagem docente, procurando compreender os sujeitos no seu próprio movimento de aprendizagem, assumimos o conceito de isolado (Caraça, 1998) como método de análise do fenómeno estudado. Identificamos três isolados que nos pareceram reunir factores determinantes, isto é, aqueles cuja acção de interdependência influiu sensivelmente no fenómeno estudado. O isolado contextual procurou analisar a aprendizagem num contexto próprio do desenvolvimento, considerando que as particularidades de cada contexto interferem no movimento de aprendizagem, definindo as acções e as operações de organização colectiva. A actividade reflexiva e crítica sobre a organização do ensino, sobre a prática e sobre o desenvolvimento docentes, constituiu o isolado reflexivo. Em estreita interdependência com os isolados anteriores, consideramos o isolado conceptual que mostra o movimento de apropriação, pelas educadoras, dos conceitos desenvolvidos ao longo do trabalho de investigação. A análise dos dados apresentou indicadores de mudança de qualidade na aprendizagem das educadoras, desencadeadas e sustentadas pela dinâmica de elaboração, de desenvolvimento e de reflexão de actividades de ensino, desenvolvidas colectivamente. Concluiu-se que a formação possibilitou a mudança nas concepções das educadoras sobre a aprendizagem, sobre a organização do ensino e sobre o seu próprio processo de aprendizagem. As contribuições teóricas da perspectiva histórico-cultural que fundamentam esse trabalho possibilitaram repensar a formação do professor, principalmente no que se refere aos processos de aprendizagem docente.

Educação em ciências no pré-escolar: contributos de um programa de formação de educadores de infância para implementação do trabalho experimental

A educação em ciências em conformidade com as orientações dimanadas do Ministério da Educação deve iniciar-se desde os primeiros anos e por consequência tem de ser uma das áreas a trabalhar no âmbito da educação pré-escolar. No entanto, vários investigadores referem que os educadores não atribuem a devida importância a esta área e explicam que esta postura se pode dever à insegurança científica e didáctica destes profissionais que, por sua vez, pode estar associada à escassez de formação no domínio das ciências durante todo o seu percurso académico. Tendo em conta este contexto, desenvolvemos este estudo de natureza empírica. As questões a que pretendemos dar resposta tinham a ver com: (i) que formação inicial e continuada os educadores tiveram no domínio das ciências?; (ii) quais as suas necessidades para trabalharem esta área no jardim-de-infância?; e (iii) qual o impacte de um programa de formação (PF) nas práticas didáctico-pedagógicas dos educadores? A investigação, de natureza qualitativa, assumiu o formato de estudo de caso e envolveu seis educadoras de infância do Distrito de Bragança. Para desenvolvimento do estudo tivemos em consideração quatro fases: numa primeira começamos por fazer a caracterização das necessidades de formação dos educadores para trabalharem as ciências no pré-escolar; a partir das ideias identificadas concebemos, produzimos e implementamos o PF; posteriormente fizemos o acompanhamento e observação de sessões desenvolvidas pelas educadoras na sala de jardim-deinfância; a quarta fase correspondeu à avaliação do impacte do PF nas práticas didáctico-pedagógicas das educadoras. Utilizámos várias técnicas e instrumentos para recolha dos dados que nos possibilitaram conhecer a formação oferecida aos educadores, ao nível do trabalho experimental de ciências nos cursos de formação inicial e continuada e caracterizar: (i) as concepções sobre CTS antes e após a implementação do PF; e (ii) as práticas didáctico-pedagógicas das educadoras colaboradoras. Os dados recolhidos e, posteriormente, analisados evidenciaram a diminuição do numero de respostas ingénuas permitindo-nos afirmar que o PF contribuiu para que as seis educadoras colaboradoras alterassem as suas concepções sobre CTS e passaram a desenvolver as suas práticas didáctico-pedagógicas na área das ciências de acordo com esta perspectiva. Assim, podemos concluir que o PF teve um impacte muito positivo, pois permitiu às educadoras compreender a importância da abordagem das ciências na educação préescolar e despertar o seu interesse para práticas didáctico-pedagógicas inovadoras com orientação CTS, que privilegiem como estratégia a realização do trabalho prático e experimental. Cotejando minuciosamente o nosso estudo com as opiniões contidas na vasta literatura que compendiámos e revimos, consideramos que este estudo representa um contributo, ainda que modesto, a ter em conta na organização de programas de formação continuada de educadores de infância que vão ao encontro das suas necessidades e que favoreçam o seu desenvolvimento profissional, social e pessoal, opinião que sustentamos por tudo aquilo que dimana e flui, com meridiana clarividência, das conclusões que fomos extraindo ao longo de todo o estudo e consubstanciámos na síntese conclusiva final.