Journal articles: 'Crédit documentaire Crédit documentaire' – Grafiati (2024)

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Background/Aims Mental health nursing is becoming a more transparent discipline. Increasingly, documentaries have provided the general public with insights regarding these therapeutic ward environments. The opinions of staff working in such places is important for ensuring the accuracy of the information, and the usefulness of what is publicly aired. This study explored the social media comments of nursing staff (as the experts) who viewed the Stacey Dooley: On the Psych Ward documentary. Methods Social media (Facebook and Twitter) were searched for comments on the documentary 3 weeks after the documentary was aired. In total, 4008 Facebook comments and 604 tweets were downloaded and assessed. Comments that did not relate to the documentary were excluded. A total of 31 Facebook comments and 54 tweets were used for analysis. Results Some evidence of criticism towards the presenter was found, as well as the use of an award-winning hospital as a non-representative – and unrealistic – example of psychiatric care. In general, healthcare staff felt that the documentary was useful for informing the general public, as well as students. Conclusions Documentaries such as this one that capture the realities of working on mental health wards have educational merit.

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President James A. Garfield suffered two gunshots on July 2, 1881, but did not die until 80 days later of complications from sepsis. He might have survived had his injuries not been contaminated, either by the gunshots themselves or the interventions that followed. “Yes, I shot the president,” said Charles Guiteau, Garfield's assassin, “but his physicians killed him.” The drama of Garfield's struggle to survive his injuries evoked enormous national interest, a harbinger of the medical dramas and documentaries of today. D. Willard Bliss, a former Civil War surgeon, and his handpicked consultants underwent daily scrutiny by the professional community and lay press. As the President died because of his injuries, the surgeons’ reputations suffered. A primary criticism was the supposed lack of antiseptic interventions in Garfield's care, especially when probing the wound with unwashed hands. Inserting a finger into the wound, however, was a basic part of examination of a gunshot wound at the time. Many American surgeons had not accepted Listerian antisepsis at the time of the event, and aseptic techniques, such as scrupulous handwashing and surgical gloves, had not yet been developed. In the context of surgical practice of the era, his surgeons followed the standards of care of the time.

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Abstract This paper aims to analyse the coordination and cooperation in Primary Health Care (PHC) measures adopted by the British government against the spread of the COVID-19. PHC is clearly part of the solution founded by governments across the world to fight against the spread of the virus. Data analysis was performed based on coordination, cooperation, and PHC literature crossed with documentary analysis of the situation reports released by the World Health Organisation and documents, guides, speeches and action plans on the official UK government website. The measures adopted by the United Kingdom were analysed in four periods, which helps to explain the courses of action during the pandemic: pre-first case (January 22- January 31, 2020), developing prevention measures (February 1 -February 29, 2020), first Action Plan (March 1- March 23, 2020) and lockdown (March 24-May 6, 2020). Despite the lack of consensus in essential matters such as Brexit, the nations in the United Kingdom are working together with a high level of cooperation and coordination in decision-making during the COVID-19 pandemic.

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Giorgio Fontana punta ripetutamente lo sguardo sulle trasformazioni dello spazio esterno di Milano per raccontare nei propri testi anche i mutamenti dell’identità culturale della città. A quei mutamenti presta attenzione in maniera documentaria in Babele 56. Otto fermate nella città che cambia (2008) mentre ne fa materia letteraria nel breve romanzo Per legge superiore (2011). In entrambi i testi, e nei modi richiesti dai rispettivi generi, rileva come la massiccia presenza di migranti nell’ambiente italiano spinga a rivedere non solo le coordinate identitarie dei luoghi, ma dia uno scrollo anche a paradigmi di pensiero, convincimenti, stili di vita. Il contatto con una moltitudine di persone di etnie diverse, che vivono frequentemente sotto il segno della mobilità e della precarietà, farebbe scoprire la fragilità di quanto si ritiene spesso per irremovibile in una specifica cultura: nel romanzo del 2011 è la fede stessa nella legge a richiedere nuova riflessione.

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Giorgio Fontana punta ripetutamente lo sguardo sulle trasformazioni dello spazio esterno di Milano per raccontare nei propri testi anche i mutamenti dell’identità culturale della città. A quei mutamenti presta attenzione in maniera documentaria in Babele 56. Otto fermate nella città che cambia (2008) mentre ne fa materia letteraria nel breve romanzo Per legge superiore (2011). In entrambi i testi, e nei modi richiesti dai rispettivi generi, rileva come la massiccia presenza di migranti nell’ambiente italiano spinga a rivedere non solo le coordinate identitarie dei luoghi, ma dia uno scrollo anche a paradigmi di pensiero, convincimenti, stili di vita. Il contatto con una moltitudine di persone di etnie diverse, che vivono frequentemente sotto il segno della mobilità e della precarietà, farebbe scoprire la fragilità di quanto si ritiene spesso per irremovibile in una specifica cultura: nel romanzo del 2011 è la fede stessa nella legge a richiedere nuova riflessione.

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Backgrounds: One significant problem in hospital is Health Care Associated Infection (HAI’s) and it gives many effects on patients health status.Purpose: This study was aimed to examine the incidence rate of phlebitis, the procedures of IV insertion and the factors that influence the phlebitis case in-patient department at the hospital.Methods: The main method used in this study is descriptive explorative. Started by giving training education for 15 nursing staff , medical doctor and pharmacists. Then they were obseved in doing the procedures of IV incertion, care and documentation by Using Visual Infusion Phlebitis ( VIP) scale then followed by case studies to have clear results in describing the contribution factors which influence the phlebitis incidents.Result: 35 subjects in the experimental group and 35 subjects in the control group completed The result represents that 7 from 72 patients (9,7%) were suffer from phlebitis, 25 patients (34,7%) with IV insertion were not monitored well, 5% nurses did not do the hand washing, 78% did not use the skin perlak for preventing blood to the bed linen. The mode of desinfection direction were 44% circular, 55 % from distal to proximal part, and 11% did not do the desinfectant. 100% the nurses did not documentate the IV monitoring such as the swelling, redness, the size of IV canule and any other skin symptoms of phlebitis. Some medication, insertion side of IV canule on the metacarpal area and flushing procedures were also determinant factor that lead to phlebitis cases.Conclusion: This study conclude that the treatment, care and monitoring IV insertion is a significant and important procedures to prevent phlebitis and automatically becomes an important aspect in preventing Health Care Associated Infection (HAI’s) rate in hospital.

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PurposeA well-funded, four-year integrated care programme was implemented in south London. The programme attempted to integrate care across primary, acute, community, mental health and social care. The purpose of this paper is to reduce hospital admissions and nursing home placements. Programme evaluation aimed to identify what worked well and what did not; lessons learnt; the value of integrated care investment.Design/methodology/approachQualitative data were obtained from documentary analysis, stakeholder interviews, focus groups and observational data from programme meetings. Framework analysis was applied to stakeholder interview and focus group data in order to generate themes.FindingsThe integrated care project had not delivered expected radical reductions in hospital or nursing home utilisation. In response, the scheme was reformulated to focus on feasible service integration. Other benefits emerged, particularly system transformation. Nine themes emerged: shared vision/case for change; interventions; leadership; relationships; organisational structures and governance; citizens and patients; evaluation and monitoring; macro level. Each theme was interpreted in terms of “successes”, “challenges” and “lessons learnt”.Research limitations/implicationsEvaluation was hampered by lack of a clear evaluation strategy from programme inception to conclusion, and of the evidence required to corroborate claims of benefit.Practical implicationsKey lessons learnt included: importance of strong clinical leadership, shared ownership and inbuilt evaluation.Originality/valuePrimary care was a key player in the integrated care programme. Initial resistance delayed implementation and related to concerns about vertical integration and scepticism about unrealistic goals. A focus on clinical care and shared ownership contributed to eventual system transformation.

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ObjectivesTo investigate the deployment of physician associates (PAs); the factors supporting and inhibiting their employment and their contribution and impact on patients’ experience and outcomes and the organisation of services.DesignMixed methods within a case study design, using interviews, observations, work diaries and documentary analysis.SettingSix acute care hospitals in three regions of England in 2016–2017.Participants43 PAs, 77 other health professionals, 28 managers, 28 patients and relatives.ResultsA key influencing factor supporting the employment of PAs in all settings was a shortage of doctors. PAs were found to be acceptable, appropriate and safe members of the medical/surgical teams by the majority of doctors, managers and nurses. They were mainly deployed to undertake inpatient ward work in the medical/surgical team during core weekday hours. They were reported to positively contribute to: continuity within their medical/surgical team, patient experience and flow, inducting new junior doctors, supporting the medical/surgical teams’ workload, which released doctors for more complex patients and their training. The lack of regulation and attendant lack of authority to prescribe was seen as a problem in many but not all specialties. The contribution of PAs to productivity and patient outcomes was not quantifiable separately from other members of the team and wider service organisation. Patients and relatives described PAs positively but most did not understand who and what a PA was, often mistaking them for doctors.ConclusionsThis study offers new insights concerning the deployment and contribution of PAs in medical and surgical specialties in English hospitals. PAs provided a flexible addition to the secondary care workforce without drawing from existing professions. Their utility in the hospital setting is unlikely to be completely realised without the appropriate level of regulation and authority to prescribe medicines and order ionising radiation within their scope of practice.

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This article is about paperwork: the work staff in UK integrated health and social care teams did to transform small transactions of everyday care work into big data, which in turn enabled the governance of complex service arrangements. This data-driven approach to governance, algorithmic governance, raises issues of agency and transparency. We address these issues by paying close attention to how care staff articulated their own understandings and apprehensions of the process. The article draws on a study of work roles in UK integrated health and social care teams providing support and follow up for older people and people with mental health problems. Digitised tools were used for the coordination and management of these teams. Staff described how the digitised documentation of care practices produced standardised representations of their work which poorly reflected the complexity of their everyday interactions with colleagues and clients/patients. There was a double-ness to these representations: on the one hand, they were malleable and open to negotiation, on the other they produced tangible consequences hardwired into the system of governance, transforming the work of care into an object outside of itself. In order to bring out the complexities in staff’s accounts about paperwork, the article brings the Marxist analytic of alienation into conversation with Actor Network Theory (ANT) to suggest that overstating the hegemonic power of digital technologies risks itself becoming hegemonic. We advocate a nuanced and situated analysis of what digitised documentary practices consist of and what they do in different circ*mstances.

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This article concerns an issue that has become increasingly relevant for international coalition forces participating in joint military operations abroad, viz. the duty to collect, document, record and secure evidence of serious violations of international humanitarian law (IHL) and international human rights committed in armed conflicts. The point, simple as it seems, is that respect for justice and international humanitarian law requires that perpetrators of war crimes etc. be brought to justice. Yet prosecution and trial of these crimes cannot succeed without material proof and information that meet the standards for admission into evidence in criminal trials. However, judicial experience from international criminal trials suggests that much of the evidence produced in Court fails to meet this standard – and is therefore dismissed. The article highlights the need to secure evidence of these crimes and proposes five simple basic recommendations for military personnel who come across evidence of serious violations of international humanitarian law in armed conflicts: (1) be familiar with the elements of genocide, crimes against humanity, war crimes and aggression; (2) know the rules of the game regarding collection of evidence, including the duty to respect local norms and authorities and to follow any international rules or agreements, and the duty to comply with obligations to seek authorization for investigation from domestic authorities; (3) be careful in your registration and handling of evidence material; (4) be careful not to hurt yourself or others when you search for evidence; and (5) stay critical and impartial to all material and information you receive from others. Cet article aborde un problème que les forces armées des coalitions internationales rencontrent de plus en plus souvent lorsqu’elles participent à des opérations militaires conjointes à l’étranger: l’obligation de rassembler, de documenter, d’enregistrer et de garantir des preuves de violations graves du droit international humanitaire et des droits de l’homme lors de conflits armés. Aussi simple qu’il paraisse, le principe est le suivant: le respect de la justice et du droit international humanitaire implique que les auteurs de crimes de guerre et autres soient traduits en justice. Toutefois, les poursuites judiciaires et le procès qui s’ensuit ne peuvent aboutir sans preuves matérielles et informations qui répondent aux normes d’admission de la preuve dans les procès au pénal. L’expérience judiciaire de ces procès internationaux suggère néanmoins que bon nombre des preuves présentées au tribunal ne répondent pas à ces normes et sont dès lors rejetées. L’auteur insiste sur le besoin de fournir des preuves de ces crimes et propose cinq recommandations de base pour le personnel militaire qui aurait des preuves de violations graves du droit international humanitaire dans les conflits armés: (1) informez-vous sur les différents éléments qui composent le génocide, les crimes contre l’humanité, les crimes de guerre et les agressions; (2) connaissez les règles relatives au rassemblement de preuves, y compris le devoir de respecter les normes et autorités locales, de suivre les règles et accords internationaux, et de se conformer à l’obligation d’obtenir une autoris­ation des autorités nationales pour mener une enquête; (3) soyez prudents lorsque vous enregistrez et utilisez des éléments de preuve; (4) veillez à ne pas causer de tort aux autres ni à vous-même lorsque vous cherchez des preuves; et (5) restez critique et impartial lorsque vous recevez des informations d’autres personnes. Dit artikel bespreekt een kwestie die van toenemend belang is voor internationale coalitietroepen die deelnemen aan gezamenlijke militaire operaties in het buitenland, nl. de plicht om bewijs van ernstige schendingen van het internationaal humanitair recht (IHR) en van de mensenrechten in gewapende conflicten te verzamelen, te staven, vast te leggen en veilig te stellen. Het punt, hoe eenvoudig ook, is dat het respect voor de rechtspleging en het internationaal humanitair recht vereist dat de daders van oorlogsmisdaden enz. voor het gerecht worden gebracht. Toch kunnen deze misdaden niet succesvol vervolgd en berecht worden zonder materieel bewijs en informatie die voldoen aan de normen om als bewijs in strafprocessen te worden toegelaten. De ervaring uit internationale strafprocessen leert echter dat veel van het bewijsmateriaal dat in de rechtbank wordt aangedragen, niet aan deze norm voldoet – en daarom wordt verworpen. Het artikel benadrukt de noodzaak om het bewijs van deze misdaden veilig te stellen en stelt vijf eenvoudige basisaanbevelingen voor aan militairen die in gewapende conflicten bewijzen van ernstige schendingen van het internationaal humanitair recht aantreffen: (1) wees op de hoogte van de elementen van genocide, misdaden tegen de menselijkheid, oorlogsmisdaden en agressie; (2) ken de regels van het spel met betrekking tot het verzamelen van bewijs, met inbegrip van de plicht om de lokale normen en autoriteiten te respecteren en om alle internationale regels of overeenkomsten te volgen, evenals de plicht om te voldoen aan de verplichting dat aan binnenlandse autoriteiten toestemming moet worden gevraagd om een onderzoek in te stellen; (3) let op bij het registreren en behandelen van bewijsmateriaal; (4) zorg ervoor dat je jezelf of anderen geen schade berokkent wanneer je naar bewijs zoekt; en (5) blijf kritisch en onpartijdig ten opzichte van al het materiaal en de informatie die je van anderen ontvangt. El artículo aborda un problema que con el tiempo ha adquirido una importancia relevante para las fuerzas en coalición que participan en operaciones conjuntas en el exterior, tal cual es el deber de recoger, documentar, registrar y asegurar las pruebas de crímenes graves contra el Derecho Internacional Humanitario (DIH) y contra los derechos humanos cometidos en los conflictos armados. El asunto, tan simple como parece, es que el respeto por la justicia y el Derecho Internacional Humanitario exige que en definitiva los perpetradores de crímenes de guerra sean llevados ante la justicia. Sin embargo, la acusación y el enjuiciamiento de estos crímenes no pueden prosperar sin una prueba material e información que reúna los requisitos necesarios para ser admitida como prueba de cargo en juicios penales. Al hilo de esto, la experiencia judicial en procedimientos penales internacionales demuestra que muchas de estas pruebas presentadas ante un tribunal no cumplen con estos estándares y, por consiguiente, son rechazadas. El artículo resalta la necesidad de asegurar la prueba de estos crímenes y propone cinco recomendaciones básicas para el personal militar que deba requisar estas pruebas relativas a crímenes graves contra el Derecho Internacional Humanitario en conflictos armados: (1) Familiarizarse con los elementos constitutivos del crimen de genocidio, crímenes contra la humanidad, crímenes de guerra y crimen de agresión; (2) Conocer las reglas del juego relativas a la recogida de pruebas, incluido el deber de respetar las normas y a las autoridades locales y cualquier otra regla o acuerdo internacional, y el deber de cumplir con la obligación de solicitar autorización a las autoridades locales para llevar a cabo investigaciones; (3) Ser diligente en el registro y manejo de las pruebas materiales; (4) Tener cuidado de no dañarse o dañar a otros en la búsqueda de las pruebas; y (5) tener una actitud crítica e imparcial ante las pruebas e información que se reciba de otros. Questo articolo tratta di una questione che è diventata sempre più rilevante per le forze di coalizione internazionali che partecipano ad operazioni militari congiunte all’estero, vale a dire il dovere di raccogliere, documentare, registrare e mettere al sicuro le prove di gravi violazioni al diritto internazionale umanitario (IHL) e dei diritti umani commesse nei conflitti armati. Il punto, semplice come appare, è che il rispetto della giustizia e del diritto internazionale umanitario richiedono che gli autori di crimini di guerra etc. siano assicurati alla giustizia. Però l’azione penale e il processo per tali crimini non possono avere successo senza prove materiali e informazioni che soddisfino gli standard per l’ammissione come prova nei processi penali. Tuttavia, l’esperienza giudiziaria dei tribunali penali internazionali suggerisce che molte delle prove prodotte nei tribunali non soddisfano questi standard e perciò vengono respinte. Questo articolo evidenzia la necessità di garantire prove di questi crimini e propone cinque semplice raccomandazioni di base per il personale militare che si imbatte in prove di serie violazioni al diritto internazionale umanitario nei conflitti armati: (1) Conoscere gli elementi del genocidio, dei crimini contro l’umanità, dei crimini di guerra e dell’aggressione; (2) Conoscere le regole del gioco riguardo la raccolta delle prove, compreso il dovere di rispettare le norme e autorità locali e di seguire qualsiasi regola o accordo internazionale, e il dovere di rispettare gli obblighi di chiedere l’autorizzazione alle indagini alle autorità nazionali; (3) Fare attenzione nella registrazione e gestione del materiale probatorio; (4) Fare attenzione a non fare del male a se stessi od altri nella ricerca delle prove; e (5) Rimanere critici ed imparziali nei confronti di tutto il materiale e delle informazioni ricevute da altri. Dieser Artikel behandelt eine Angelegenheit, die für die Streitkräfte internationaler Koalitionen, die sich an gemeinsamen Militäreinsätzen im Ausland beteiligen, an Relevanz gewinnt, nämlich die Pflicht, Beweismittel schwerer Verletzungen des internationalen humanitären Rechts und internationaler Menschenrechte in bewaffneten Konflikten zu sammeln, zu dokumentieren, aufzuzeichnen und sicherzustellen. Der Kernpunkt, so einfach dieser scheinen mag, besteht darin, dass Respekt vor der Justiz und dem internationalen humanitären Recht erfordert, dass Täter von Kriegsverbrechen, usw. vor Gericht gebracht werden sollen. Dennoch können die Verfolgung und Ahndung dieser Verbrechen ohne materiellen Beweis und Informationen, die den Standards zur Zulassung als Beweismittel in Strafprozessen gerecht werden, nicht gelingen. Die gerichtliche Erfahrung internationaler Strafprozesse weist allerdings darauf hin, dass manche der dem Gericht unter­breiteten Beweise diesen Standards nicht gerecht werden, und somit abgewiesen werden. Der Autor unterstreicht, dass es notwendig ist, Beweise für diese Verbrechen sicher­zustellen, und schlägt fünf einfache Grundempfehlungen für Militärangehörige vor, die auf Beweise schwerer Verletzungen des internationalen humanitären Rechts in bewaffneten Konflikten stoßen: (1) Sorgen Sie dafür, dass Sie die Elemente des Genozids, der Verbrechen gegen die Menschlichkeit, Kriegsverbrechen und Aggressionen kennen; (2) seien Sie mit den Spielregeln hinsichtlich der Sammlung von Beweisen vertraut, und dies einschließlich der Pflicht, örtliche Normen und Autoritäten zu respektieren, irgendwelche internationale Regeln oder Abkommen zu befolgen und die Verpflichtungen zu erfüllen, um die Genehmigung zur Durchführung von Ermittlungen von den Behörden des betreffenden Landes einzuholen; (3) seien Sie vorsichtig bei Ihrer Erfassung von bzw. Ihrem Umgang mit Beweismaterial; (4) sorgen Sie dafür, dass Sie sich selbst oder anderen keinen Schaden zufügen, wenn Sie nach Beweisen suchen; und (5) bleiben Sie kritisch und unvoreingenommen in Bezug auf all das Material und alle Informationen, die Sie von anderen erhalten.

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Purpose – The purpose of this paper is to report on a part of a study examining the interrelationships between personalisation and safeguarding practice. Specifically the authors aimed to examine how safeguarding practice is affected by the roll out of personalisation in adult social care, particularly when the adult at risk has a personal budget or is considering this. Design/methodology/approach – A sample of annual reports from Adult Safeguarding Boards in England was accessed for content analysis covering the period 2009-2011. One part of this sample of local authorities was selected at random; the other authorities selected had been early adopters of personalisation. The reports were analysed using a pro forma to collect salient information on personalisation that was cross-referenced to identify common themes and differences. Findings – The authors found variable mentions of personalisation as part of the macro policy context reported in the annual reviews, some examples of system or process changes at mezzo level where opportunities to discuss the interface were emerging, and some small reports of training and case accounts relevant to personalisation. Overall these two policy priorities seemed to be more closely related than had been found in earlier research on the interface between adult safeguarding and personalisation. Research limitations/implications – There was wide variation in the annual reports in terms of detail, size and content, and reports for only one year were collected. Developments may have taken place but might not have been recorded in the annual reports so these should not be relied upon as complete accounts of organisational or practice developments. Practical implications – Authors of Safeguarding Adults Board reports may benefit from learning that their reports may be read both immediately and potentially in the future. They may wish to ensure their comments on current matters will be intelligible to possible future readers and researchers. Originality/value – There does not appear to have been any other previous study of Safeguarding Adult Boards’ annual reports. Documentary analysis at local level is under-developed in safeguarding studies.

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A qualitative case study was conducted to explore the clinical decision making processes that underpinned the practice of euthanasia under the Rights of the Terminally Ill (ROTI) Act. The key informant for this research was Philip Nitschke, the general practitioner responsible for the legal cases of euthanasia. His information was supported by extensive document analysis based on the public texts created by patients in the form of letters and documentaries. Further collaborating sources were those texts generated by the media, rights groups, politicians, the coroner's court, and the literature on euthanasia and assisted suicide. A key study finding was that the ROTI legislation did not adequately provide for the specific medical situation in the Northern Territory, Australia. The medical roles, as proscribed by the legislation, carried many inherent assumptions about the health care context and the availability of appropriately qualified medical staff committed to providing euthanasia. These assumptions translated into difficulties in establishing clinical practices for the provision of euthanasia. A further finding concerned the motivations of those who requested euthanasia. This article addresses the medical roles and the motivations of those seeking euthanasia.

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Background: In the UK, improving person-centred care for people with dementia in hospitals is a policy priority. The PIE (Person, Interaction, Environment) programme comprises cycles of observation of care by staff, identification of areas for improvement and plans for practice change and evaluation. Aim: To describe and evaluate PIE implementation in three UK NHS regions. Methods: A qualitative design was adopted at 10 case study sites (wards), selected on the basis of readiness for change criteria. Following a training workshop, PIE cycles were introduced into each ward. Data collection comprised observation, interviews, documentary analysis and an events log. Normalisation process theory provided a guiding framework for analysis. Results: PIE was fully adopted in two study wards over 18 months, which resulted in sustained practice change and increased awareness of person-centredness. Partial implementation of PIE took place in a further two wards but progress stalled before significant action. The remaining six wards did not implement the programme. Factors influencing the likelihood of implementation were: relevance of PIE; collective team involvement; fit with strategic priorities; adequate resourcing; effective clinical leadership; good facilitation; and organisational stability. Conclusion: PIE has the potential to help staff improve person-centred care for people with dementia admitted to hospital wards. However, the evidence provided by this article is limited to 10 wards, of which only two fully implemented the programme. Implications for practice: A programme for improving person-centred care for people with dementia in acute hospital wards requires sustained commitment from the ward and the wider organisation Successful practice change depends on multiple factors, including effective clinical leadership and good facilitation Contextual factors at various levels of an organisation need to be considered Use of the PIE tool has the potential to enable staff to focus on person-centred care for older people with dementia in acute settings

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Purpose The purpose of this paper is to assess available human resources for neonatal care and their skills, in order to explore health providers’ perceptions of quality of neonatal care in health facilities in Ghana. Design/methodology/approach Data were gathered using qualitative interviews with health providers working in the maternity and paediatric wards and midwives; direct observation; and documentary review at a regional hospital, a municipal hospital and four health centres in a municipality in a region in Southern Ghana. Data were analysed using thematic framework through the process of coding in six phases to create and establish meaningful patterns. Findings The study revealed that health providers were concerned about the number of staff available, their competence and also equipment available for them to work more efficiently. Some essential equipment for neonatal care was either not available or was non-functional where it was available, while aseptic procedures were not adhered to. Moreover, personal protective equipment such as facemask, caps, aprons were not used except in the labour wards where staff had to change their footwear before entering. Research limitations/implications Limited number of health providers and facilities used, lack of exploration of parents of neonates’ perspective of quality of neonatal care in this study and other settings, including the teaching hospitals. The authors did not examine issues related to the ineffective use of IV cannulation for neonates by nurses as well as referral of neonates. Additionally, the authors did not explore the perspectives of management of the municipal and regional health directorates or policy makers of the Ministry of Health and Ghana Health Service regarding the shortage of staff, inadequate provision of medical equipment and infrastructure. Practical implications This paper suggests the need for policy makers to redirect their attention to the issues that would improve the quality of neonatal health care in health facilities in Ghana and in countries with similar challenges. Social implications The study found that the majority of nursing staff catering for sick newborns were not trained in neonatal nursing. Babies were found sleeping in separate cots but were mixed with older children. The study suggests that babies should be provided with a separate room and not mixed with older babies. Originality/value There seemed to be no defined policy framework for management of neonatal care in the country’s health care facilities. The study recommends the adoption of paediatric and neonatal care nursing as a specialty in the curricula of health training institutions. In-service trainings should encompass issues related to management of sick babies, care of preterm babies, neonatal resuscitation and intravenouscannulation, among others.

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11002 Background: Caring for transgender patients requires specific knowledge and skills. Medical schools spend less than 5 hours on average training for treatment of LGBT patients (Obedin-Maliver, JAMA, 306 (9), 971). This paper assesses the knowledge on the topic and skills of postgraduate Oncology students from Universidad del Salvador at the Observational Standard Clinical Examination (OSCE) 2019 (JCO 34 (15), Abstract e18150, 2017). Methods: At one of the stations of OSCE 2019, students had thirty minutes to complete a clinical record of a simulated transman patient with ovarian cancer stage IIIC. Based on the real case of Robert Eads, actors were trained with the documentary on his life “Southern Comfort”. Students were assessed on: A) knowledge of the transman condition, B) use of preferred gender pronoun by the patient, C) discontinuation of testosterone treatment, D) recommendation of genetic study, E) treatment of ovarian cancer according to NCCN guidelines, F) moral discomfort with LGBT patient care. All interviews were filmed or recorded by an observer. All films, recordings and clinical records were reviewed to rate the students' performance. Results: A total of 25 postgraduate Oncology students took the OSCE 2019. Assessment: A) 5/25 (20%) lacked knowledge of the transman condition, B) 3/25 (12%) did not use the patient's preferred gender pronoun, C) 17/25 (68%) discontinued testosterone, D) 23/25 (92%) requested genetic study, E) all students treated ovarian cancer according to NCCN guidelines, F) none expressed moral discomfort with LGBT patient care. Conclusions: 1) It is feasible to assess the knowledge and skills required for treatment of transgender patients in Oncology. 2) We found shortcomings of student's medical training regarding transgender patients: one in five did not understand the patient's condition, three did not use the patient´s preferred gender pronoun during the interview and more than half suspended the necessary hormone therapy for their condition. 3) This emphasizes the need to deepen our medical and communication skills in order to assist the transgender population and should be included in future ASCO-ASH milestones for specialty accreditation.

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Objetivo: o estudo buscou identificar as atividades desenvolvidas pelo enfermeiro durante a internação domiciliar de pacientes com assistência de Enfermagem 24 horas por dia. Metodologia: a pesquisa é documental e retrospectiva e foi realizada em uma empresa de assistência domiciliar do município de São Paulo. A coleta de dados foi realizada em 25 prontuários de pacientes, que foram classificadas e analisadas de acordo com a Resolução Nº 267/2001. Resultados: evidencia-se a importância do enfermeiro frente à assistência domiciliar nas funções assistencial, administrativa e educacional. Conclusão: o enfermeiro vem ocupando, crescentemente o protagonismo do gerenciamento do cuidado domiciliar por meio de ações integradas e planejadas.Descritores: Cuidados de enfermagem, Serviços de assistência domiciliar, Papel do profissional de enfermagem.The nurse’s importance in home care assistanceObjective: The study aim to identify the activities performed by nurses during home care of patients with nursing care 24 hours a day. Method: documentary research retrospective, held in a home care company in São Paulo. Data were collected in 25 charts of patients, which were classified and analyzed according to Resolution No. 267/2001. Results: highlights the importance of nurses in front of home care assistance, administrative and educational functions. Conclusion: the nurse occupies, increasingly, the protagonist in different spaces, e care, by means of systematic and integrated action to team in the execution and planning of the therapeutic process.Descriptors: Nursing care, Home care services, Nurse’s role.El papel del enfermero en los servicios de atención domiciliaria – Home CareObjetivo: el estudio trata de identificar las actividades realizadas por las enfermeras en la atención domiciliaria de los pacientes con la atención de enfermería las 24 horas del día. Método: investigación documental y retrospectivo, realizado en una empresa de atención domiciliaria en São Paulo. Los datos fueron obtenidos a en25 expedientes de pacientes, que fueran clasificadas y analizadas de acuerdo con la Resolución N ° 267/2001. Resultados: se destaca la importancia de las enfermeras frente a la asistencia de atención domiciliaria, administrativa y funciones educativas. Conclusión: la enfermera ocupa, cada vez más, el protagonista en diferentes espacios, especialmente en los cuidados en el hogar, a través de actividades integrado y planificación.Descriptores: Atención de Enfermería, Servicios de Atención de Salud a Domicilio, Rol de la Enfermera.

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Purpose. This study aimed to evaluate reports of patents for oral care formulations, based on Camellia sinensis (C. sinensis), deposited and granted in intellectual property banks. Methods. A survey was conducted through collection, treatment, and analysis of extracted information from patent reports selected. The documentary research was conducted in January 2021 on formulations with C. sinensis for dental applications, including since the first patent deposits until the current time. The risk of bias of clinical trials with these formulations was analyzed to verify the scientific evidence. The data extracted represent the distribution of the number of patents by banks, annual evolution of patent deposits, applicant of patents by country, distribution of patents according to International Patent Classification codes, and the types of patented products. Results. Data and information from 20 selected patents were extracted. The United States Patent and Trademark Office (USPTO) and World Intellectual Property Organization (WIPO) were the banks with the largest number of patents for products/formulations with C. sinensis for oral care applications with 7 (35%) and 6 (30%) patent registrations, respectively. Other banks did not provide patents related to the search. Patents of compositions were the largest with 14 filings, and the remainder of formulations are represented specially by mouthwashes and toothpastes. As for clinical application, 18 patents were filed as products with antimicrobial and antibiofilm action, while 2 patents are directed to the treatment of xerostomia. In general, the aspects of the studies of clinical efficacy pointed to a low risk of bias. Conclusion. The study pointed out a small number of products protected by patents for Camellia sinensis for oral care indication, highlighting mainly mouthwash compositions and formulations. In the methodological parameters of clinical trials carried out with the formulations, the majority pointed out a low risk of bias.

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Aims/Objectives/BackgroundEmergency airway management outside a controlled theatre environment has been previously associated with a high rate of adverse events. Several initiatives to improve safety (such as video laryngoscopy, checklists, simulation training etc..) have been studied in isolation.It remains unclear as to whether these interventions have been embedded in the Emergency Department (ED) and whether they offer cumulative marginal gains in safety.Methods/DesignA prospective 3-year service evaluation delivered at a major trauma and neurosciences centre between 2016 and 2019. We designed a rolling quality improvement program to mitigate procedural airway risk through collaborative multidisciplinary team (MDT) working, education and transparent metrics.PDSA cycles included documentary guidance (including flowcharts and checklists), high fidelity simulation training, equipment redesign, prefilled medications and mandatory reporting items (figure 1).Abstract 292 Figure 1Abstract 292 Figure 2Primary induction agents selected throughout the study periodAbstract 292 Figure 3Results/ConclusionsWe analysed prospectively collected data on 1181 intubation episodes outside a theatre environment over a 39 month period, of which 575 (48.7%) were performed out of hours and 635 (53.8%) were performed in the ED.Bedside consultant presence and periprocedural checklist use both showed a sustained increase during the study period. Use of ketamine and thiopentone as primary induction agents increased and decreased, respectively (figure 2). Cricoid pressure and video laryngoscopy (VL) utilisation rates remained relatively static throughout, as did a first pass success (FPS) rate of between 83.0 to 93.5%.Composite major complications (including sustained hypotension and/or critical hypoxia) were significantly reduced during the study period, as demonstrated via statistical process chart (SPC) mapping (figure 3).In conclusion, we found a quality improvement program to be associated with a sustained reduction in the risk of major complications following emergency airway management. This improvement was not explained by simple direct changes in procedural care, such as the use of VL or technique changes resulting in improved FPS, but may have been influenced by unknown confounding variables.

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The article deals with the problems of social adaptation of disabled veterans of the Great Patriotic War in the Tatar Autonomous Soviet Socialist Republic after their return to peaceful life. Based on the documentary materials extracted from the funds of the federal and Tatarstan archives The author characterizes forms of state support for war-maimed people, resolution of their production training and employment, appointment of pensions, opening of boarding houses, organization of health care services, etc. It is noted that for the majority of disabled people this targeted support was often a determining factor in ensuring their livelihoods. The employment of disabled veterans of the Patriotic War made it possible to solve a two-fold problem: in the conditions of an acute shortage of workers, a new personnel reserve was created for the economy and at the same time social protection of veterans returned after treatment in hospitals was provided. Many disabled veterans of the Great Patriotic War showed themselves well in the workplace, became leaders and were nominated for leadership positions. But there were those who led an immoral lifestyle, begging. The authorities, called to solve the issues of social rehabilitation of disabled people, did not always cope with the tasks assigned to them. Evidence of this is the facts of the soullessly-bureaucratic attitude of certain officials to the needs and requests of disabled people, cases of appropriation of funds and squandering of state funds.

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Den historiske utviklingen til pedagogikkfa*get i norsk lærerutdanning kan studeres på mange måter. Gjennom dokumentanalyse av de nasjonale planene fra 1837 til de differensierte utdanningene i 2010, forsøker denne studien å forklare fa*gets opplevde mangel på relevans for lærerprofesjonen. Resultatene viser at det ikke er noen konsistent bruk av begreper i fa*get, og begrep som anvendes på didaktiske kategorier i klasserommet har variert. Ulike disipliner har dominert til ulike tider, selv om psykologien totalt sett har vært mest fremtredende. Pedagogikkens rolle har variert fra å være utdanningens viktigste fa*g til å være et refleksjonsfa*g og, fra å være et redskapsfa*g til å ha danning og personlighetsutvikling av lærerstudenten som hovedmål. På bakgrunn av dokumentanalysen og tidligere studier foreslås en lærerutdanningspedagogikk der grunnleggende begreper hentet fra sentrale aktiviteter i klasserommet utgjør fundamentet og rammeverket. På denne måten re-introdu­seres metodikken i pedagogikkfa*get, og undervisningshåndverket får en sentral plass. Overbygningen dannes i kombinasjon med pedagogikken som vitenskap, og slik skapes et område der pedagogikkfa*get i lærerutdanningen kan konstituere seg. Ved at undervisnings­læren og metodikken får tilbake sin sentrale plass, kan profesjonsnærheten sikres. Da er vi tilbake til den egentlige pedagogikken i lærerutdanningen, pedagogikken fra de nasjonale planene i perioden 1837–1939.Nøkkelord: lærerstudenter, pedagogikk, metodikk, læreplan, refleksjon, lærerutdannings­pedagogikkAbstractOne way to study the historical development of pedagogical studies in Norwegian teacher education is to examine the national curricula. Through documentary analyses of the national curricula for general teacher education from 1837 until the arrival of the differentiated programmes in 2010, this study tries to explain the pedagogical studies’ perceived lack of relevance to the profession. The findings show an inconsistent use of concepts in pedagogical studies and varying concepts describing didactic categories of classroom activities and prac­tices, if they are present. The role of pedagogy in teacher education has varied, from being the main subject to a subject of reflection, and from a base for knowledge and tools to a base for reflection and formation. This article suggests that pedagogical studies must primarily include basic concepts concerning central activities or practices of the teaching profession as a way to reintroduce methodology and bring teacher education closer to the profession. With classroom activities as the foundation and framework, combined with the science of education, a pedagogy of teacher education can constitute itself. This approach also brings pedagogical studies back to the curricula covering the 1837–1939 period with teaching as their core content, and teaching methodology and didactics as the real pedagogy of teacher education.Keywords: student teachers, pedagogical studies, methodology, national curricula, reflection, pedagogy of teacher education

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BackgroundThe Health and Social Care Act 2012 (Great Britain.Health and Social Care Act 2012. London: The Stationery Office; 2012) has mandated research use as a core consideration of health service commissioning arrangements. We evaluated whether or not access to a demand-led evidence briefing service improved the use of research evidence by commissioners, compared with less intensive and less targeted alternatives.DesignControlled before-and-after study.SettingClinical Commissioning Groups (CCGs) in the north of England.Main outcome measuresChange at 12 months from baseline of a CCG’s ability to acquire, assess, adapt and apply research evidence to support decision-making. Secondary outcomes measured individual clinical leads’ and managers’ intentions to use research evidence in decision-making.MethodsNine CCGs received one of three interventions: (1) access to an evidence briefing service; (2) contact plus an unsolicited push of non-tailored evidence; or (3) an unsolicited push of non-tailored evidence. Data for the primary outcome measure were collected at baseline and 12 months post intervention, using a survey instrument devised to assess an organisation’s ability to acquire, assess, adapt and apply research evidence to support decision-making. In addition, documentary and observational evidence of the use of the outputs of the service was sought and interviews with CCG participants were undertaken.ResultsMost of the requests were conceptual; they were not directly linked to discrete decisions or actions but were intended to provide knowledge about possible options for future actions. Symbolic use to justify existing decisions and actions were less frequent and included a decision to close a walk-in centre and to lend weight to a major initiative to promote self-care already under way. The opportunity to impact directly on decision-making processes was limited to work to establish disinvestment policies. In terms of impact overall, the evidence briefing service was not associated with increases in CCGs’ capacity to acquire, assess, adapt and apply research evidence to support decision-making, individual intentions to use research findings or perceptions of CCGs’ relationships with researchers. Regardless of the intervention received, at baseline participating CCGs indicated that they felt that they were inconsistent in their research-seeking behaviours and their capacity to acquire research remained so at follow-up. The informal nature of decision-making processes meant that there was little or no traceability of the use of evidence.LimitationsLow baseline and follow-up response rates (of 68% and 44%, respectively) and missing data limit the reliability of these findings.ConclusionsAccess to a demand-led evidence briefing service did not improve the uptake and use of research evidence by NHS commissioners compared with less intensive and less targeted alternatives. Commissioners appear to be well intentioned but ad hoc users of research.Future workFurther research is required on the effects of interventions and strategies to build individual and organisational capacity to use research. Resource-intensive approaches to providing evidence may best be employed to support instrumental decision-making. Comparative evaluation of the impact of less intensive but targeted strategies on the uptake and use of research by commissioners is warranted.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Background The ‘Productive Ward: Releasing Time to Care’™ programme (Productive Ward; PW) was introduced in English NHS acute hospitals in 2007 to give ward staff the tools, skills and time needed to implement local improvements to (1) increase the time nurses spend on direct patient care, (2) improve the safety and reliability of care, (3) improve staff and patient experience and (4) make structural changes on wards to improve efficiency. Evidence of whether or not these goals were met and sustained is very limited. Objective To explore if PW had a sustained impact over the past decade. Design Multiple methods, comprising two online national surveys, six acute trust case studies (including a secondary analysis of local audit data) and telephone interviews. Data sources Surveys of 56 directors of nursing and 35 current PW leads; 88 staff and patient and public involvement representative interviews; 10 ward manager questionnaires; structured observations of 12 randomly selected wards and documentary analysis in case studies; and 14 telephone interviews with former PW leads. Results Trusts typically adopted PW in 2008–9 on their wards using a phased implementation approach. The average length of PW use was 3 years (range < 1 to 7 years). Financial and management support for PW has disappeared in the majority of trusts. The most commonly cited reason for PW’s cessation was a change in quality improvement (QI) approach. Nonetheless, PW has influenced wider QI strategies in around half of the trusts. Around one-third of trusts had impact data relating specifically to PW; the same proportion did not. Early adopters of PW had access to more resources for supporting implementation. Some elements of local implementation strategies were common. However, there were variations that had consequences for the assimilation of PW into routine practice and, subsequently, for the legacies and sustainability of the programme. In all case study sites, material legacies (e.g. display of metrics data; storage systems) remained, as did some processes (e.g. protected mealtimes). Only one case study site had sufficiently robust data collection systems to allow an objective assessment of PW’s impact; in that site, care processes had improved initially (in terms of patient observations and direct care time). Experience of leading PW had benefited the careers of the majority of interviewees. Starting with little or no QI experience, many went on to work on other initiatives within their trusts, or to work in QI at regional or national level within the NHS or in the private sector. Limitations The research draws on participant recall over a lengthy period characterised by evolving QI approaches and system-level change. Conclusions Little robust evidence remains of PW leading to a sustained increase in the time nurses spend on direct patient care or improvements in the experiences of staff and/or patients. PW has had a lasting impact on some ward practices. As an ongoing QI approach continually used to make ongoing improvements, PW has not been sustained, but it has informed current organisational QI practices and strategies in many trusts. The design and delivery of future large-scale QI programmes could usefully draw on the lessons learnt from this study of the PW in England over the period 2008–18. Funding This National Institute for Health Research Health Services and Delivery Research programme.

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Background and context: In Senegal, pediatric oncology patients arrive at the hospital at advanced stages of disease. Their large tumors, as well as the side effects of chemotherapy make children experience intense pain. In this low-resource setting, morphine supply was quite irregular. Doctors don´t prescribe morphine due to shortages; but few prescriptions also lead to limited orders. A vicious circle with only 1 victim: the patient. Hearing children in pain was agonizing for everyone: patients, caregivers and healthcare practitioners. Aim: This advocacy narrative illustrates how the fight for access to morphine in pediatric oncology has led to both positive and negative externalities. We will highlight ways in which this fight for morphine has provoked political tensions moving the issue forward, but has also affected the careers of health workers involved. Strategy/Tactics: Morphine is a cheap drug, yet it is extremely regulated by international laws. It takes political will to influence national morphine orders. This advocacy strategy was built on raising awareness and setting morphine shortage on the political agenda. Not providing morphine in oncology goes against international standards of care. But most importantly, letting patients suffer without “existing” relief is a breach of basic human right to live - and also die - in dignity. Program/Policy process: Conversations began within the pediatric oncology department. Focus groups highlighted caregivers' feelings of powerlessness before their suffering child. Interviews with key informants (doctor and nurses) were instrumental to a widely diffused Human Rights Watch report exploring the medical and political causes to morphine supply shortages, as well as its psychological repercussions on patient care. A BBC documentary was broadcasted soon after. Subsequently, meetings were held between the Ministry of Health, the National Supply Pharmacy and leading local oncologists. Outcomes: Morphine orders were multiplied by 10, leading to much improved pain management for patients. However, Senegal was portrayed negatively on the international scenes, much to the Health Minister´s dismay. The consequences were incurred by the health workers who contributed to the international publications/reports. What was learned: Health practices can inform policy just like policy can inform health practices. It is a cyclical process. Creating advocacy coalitions and rallying the help of the international community are effective strategies. However, in the political arena, health workers need more than commitment to human rights and quality care. Even in democratic republics, systems can penalise outspoken activists. We have learned that health care practitioners (especially working in public settings) who wish improvement for their patients must learn to be tactical and diplomatic. International partners will return to their home countries, but local actors will pay the high cost of advocacy.

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In spring 1986, Lindsay Anderson appeared in a television programme on British cinema. This was part of a series of three under the heading British Cinema: Personal View, produced by Thames Television. Anderson's contribution, Free Cinema 1956–? An Essay on Film by Lindsay Anderson, was written and directed by him. He was also the star of the programme, providing a lecture on the history of British cinema with himself at the very core, although, at the time of the production, Anderson's career was in decline and he was not involved in any film projects. Drawing on press materials, the programme itself and Anderson's personal papers in the University of Stirling library, this article analyses Anderson's personal conception of Free Cinema – according to his understanding, a short-lived documentary movement in the 1950s which eventually transformed itself into a series of feature films in the ensuing decades, particularly his own trilogy If…. (1968), O Lucky Man! (1973) and Britannia Hospital (1982). The polemic in the programme was particularly aimed at the general idea of the British Film Year of 1985 and at the successful film producer David Puttnam, at the time well known for his contribution to what was sometimes called the ‘New British Cinema’ of the 1980s. Anderson, however, dismissed Puttnam as a film-maker concerned only with Oscars and economic success, and instead lauded the qualities of ‘Free Cinema’, a realist, non-conformist and radical aesthetic, as the most artistically rewarding tradition in British cinema. The programme was highly entertaining and was generally well received by the British press, but did not really strengthen Anderson's position within the British film industry, which might, or might not, have been Anderson's intention.

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Background High-quality nursing care is crucial for patients with complex conditions and comorbidities living at home, but such care is largely invisible to health planners and managers. Nursing care quality in acute settings is typically measured using a range of different quality measures; however, little is known about how service quality is measured in community nursing. Objective To establish which quality indicators (QIs) are selected for community nursing; how these are selected and applied; and their usefulness to service users (patients and/or carers), commissioners and provider staff. Design A mixed-methods study comprising three phases. (1) A national survey was undertaken of ‘Commissioning for Quality and Innovation’ indicators applied to community nursing care in 2014/15. The data were analysed descriptively using IBM SPSS Statistics 20.0 (IBM Corporation, Armonk, NY, USA). (2) An in-depth case study was conducted in five sites. Qualitative data were collected through observations, interviews, focus groups and documents. A thematic analysis was conducted using QSR NVivo 10 (QSR International, Warrington, UK). The findings from the first two phases were synthesised using a theoretical framework to examine how local and distal contexts affecting care provision impacted on the selection and application of QIs for community nursing. (3) Validity testing the findings and associated draft good practice guidance through a series of stakeholder engagement events held in venues across England. Setting The national survey was conducted by telephone and e-mail. Each case study site comprised a Clinical Commissioning Group (CCG) and its associated provider of community nursing services. Participants Survey – 145 (68.7%) CCGs across England. Case study NHS England national and regional quality leads (n = 5), commissioners (n = 19), provider managers (n = 32), registered community nurses (n = 45); and adult patients (n = 14) receiving care in their own homes and/or carers (n = 7). Findings A wide range of indicators was used nationally, with a major focus on organisational processes. Lack of nurse and service user involvement in indicator selection processes had a negative impact on their application and perceived usefulness. Indicator data collection was hampered by problematic information technology (IT) software and connectivity and interorganisational system incompatibility. Front-line staff considered indicators designed for acute settings inappropriate for use in community settings. Indicators did not reflect aspects of care, such as time spent, kindness and respect, that were highly valued by front-line staff and service user participants. Workshop delegates (commissioners, provider managers, front-line staff and service users, n = 242) endorsed the findings and drafted good practice guidance. Limitations Ongoing service reorganisation during the study period affected access to participants in some sites. The limited available data precluded an in-depth documentary analysis. Conclusions The current QIs for community nursing are of limited use. Indicators will be enhanced by involving service users and front-line staff in identification of suitable measures. Resolution of connectivity and compatibility challenges should assist implementation of new IT packages into practice. Modifications are likely to be required to ensure that indicators developed for acute settings are suitable for community. A mix of qualitative and quantitative methods will better represent community nursing service quality. Future work Future research should investigate the appropriate modifications and associated costs of administering QI schemes in integrated care settings. Funding The National Institute for Health Research Health Services and Delivery Research programme.

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BackgroundChildren’s community nursing (CCN) services support children with acute, chronic, complex and end-of-life care needs in the community.ObjectivesThis research examined the impact of introducing and expanding CCN services on quality, acute care and costs.MethodsA longitudinal, mixed-methods, case study design in three parts. The case studies were in five localities introducing or expanding services. Part 1: an interrupted time series (ITS) analysis of Hospital Episode Statistics on acute hospital admission for common childhood illness, and bed-days and length of stay for all conditions, including a subset for complex conditions. The ITS used between 60 and 84 time points (monthly data) depending on the case site. Part 2: a cost–consequence analysis using activity data from CCN services and resource-use data from a subset of families (n = 32). Part 3: in-depth interviews with 31 parents of children with complex conditions using services in the case sites and a process evaluation of service change with 41 NHS commissioners, managers and practitioners, using longitudinal in-depth interviews, focus groups and documentary data.FindingsPart 1: the ITS analysis showed a mixed pattern of impact on acute activity, with the greatest reductions in areas that had rates above the national average before CCN services were introduced and significant reductions in some teams in acute activity for children with complex conditions. Some models of CCN appear to have more potential for impact than others. Part 2: the cost–consequence analysis covered only part of the CCN teams’ activity. It showed some potential savings from reduced admissions and bed-days, but none that was greater than the total cost of the services. Part 3: three localities implemented services as planned, one achieved partial service change and one was not able to achieve any service change. Organisational stability, finance, medical stakeholder support, competition, integration with primary care and visibility influenced the planning and implementation of new and expanded CCN services. Feeling supported to manage their ill child at home was a key outcome of using services for parents. Various service features contributed to this and were important in different ways at different times. Other outcomes included being able to avoid hospital care, enabling the child to stay in school, and getting respite. Although parents judged that care was of high quality when teams enabled them to feel supported, reassured and secure in managing their ill child at home, this did not depend on a constant level of contact from teams.LimitationsDelays in service reconfigurations required adaptation of research activity across sites. Use of administrative data, such as Hospital Episode Statistics, for research purposes is technically difficult and imposed some limitations on both the ITS and the cost–consequence analyses.ConclusionsLarge, generic CCN teams that integrate acute admission avoidance for all children with support for children with complex conditions and highly targeted teams for children with complex conditions offer the possibility of supporting children more appropriately at home while also making some difference to acute activity. This possibility remains to be tested further.Future workFurther work should refine the evidence on outcomes of services by looking at outcomes in promising models, value for money and measuring quality-based outcomes.FundingThe National Institute for Health Research Health Services and Delivery Research Programme.

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ABSTRACT Objective: to characterize a profile of gynecoobstetric and to identify the main quality indicators of prenatal pregnant women saw in the Unidade Básica de Saúde da Família (UBASF). Methods: it’s a documentary study, retrospective and quantitative study of 38 pregnant women. A questionnaire was used with aspects of characterization and of the indicators of the Programa de Humanização no Pré-Natal e Nascimento-PHPN. Data was analyzed accord to pertinent literature. The research project has been approved by the Ethics Committee of the UNIFOR (protocol number 039/2009). Results: the majority consisted of pregnant women between the ages of 15 and 35 years old, with basic education, one partner, multiple gestations, of low weight and a vagin*l childbirth. It was observed that 63.2% of the women had not initiated prenatal care until 14th week of gestation; 52.6% did not attend six or more consultation; 94.7% were immunized against tetanus; 65.8% participated in educational activities on self breast examination and 68.4% received training on breastfeeding. The majority of the pregnant did not obtain tests for hepatitis B, toxoplasmosis, HIV. Only one woman (2.6%) obtained a uterine cytopathology examination during her pregnancy period. Conclusion: there was an inadequate prenatal care, because the minimum criteria of PHPN was not fulfilled. Descriptors: maternal and child health; prenatal care; quality of health care; primary health care; quality indicators, health care. RESUMOObjetivo: caracterizar o perfil gineco-obstétrico e identificar os principais indicadores de qualidade do pré-natal de gestantes acompanhadas em uma Unidade Básica de Saúde da Família (UBASF). Métodos: estudo documental, retrospectivo e quantitativo, com amostra de 38 gestantes. Utilizou-se um formulário abordando aspectos de caracterização da amostra e dos indicadores do Programa de Humanização no Pré-Natal e Nascimento (PHPN). O projeto de estudo foi aprovado pelo Comitê de Etica em Pesquisa da UNIFOR (número de protocolo 039/2009). Resultados: predominaram no estudo gestantes com idades entre 15 e 35 anos, Ensino Fundamental, com companheiro fixo, multigestas, com baixo peso e que tiveram parto vagin*l. Em relação ao PHPN, observou-se que 63,2% das grávidas não iniciaram o pré-natal até a 14ª semana de gestação; 52,6% não realizaram seis ou mais consultas; 94,7% realizaram a imunização contra o tétano; 65,8% participaram de atividades educativas sobre o exame das mamas e 68,4% receberam orientações sobre aleitamento materno. A maioria das gestantes não realizou sorologias para hepatite B, toxoplasmose e HIV. Apenas uma mulher (2,6%) realizou o exame citopatológico de colo uterino no período gravídico. Conclusão: constatou-se uma assistência pré-natal inadequada, pois não foram cumpridos os critérios mínimos preconizados pelo PHPN. Descritores: saúde materno-infantil; cuidado pré-natal; qualidade da assistência à saúde; atenção primária à saúde; indicadores de qualidade em assistência à saúde. RESUMEN Objetivo: caracterizar el perfil gineco-obstétrico y determinar los principales indicadores de la calidad de la atención prenatal de mujeres embarazadas atendidas en una Unidad Básica de Salud de la Familia (UBASF). Métodos: estudio documental, retrospectivo y cuantitativo, con muestras de 38 mujeres. Utiliza un instrumento sobre características y indicadores del Programa de Humanización del Prenatal y Nacimiento (PHPN). Se analizaron datos como la documentación pertinente. El estudio fue aprobó por parte del Comité de Ética de la UNIFOR (número de registro 039/2009). Resultados: Predominaron en este estudio mujeres de 15 a 35 años, con educación primaria, compañero fijo, multigravidas, bajo peso y tenían parto vagin*l. Mostró que 63,2% de las mujeres embarazadas no han iniciado la atención prenatal hasta la 14ª semana de gestación; 52,6% no tenían seis o más consultas; 94,7% se sometió a la inmunización contra el tétanos; 65,8% participaron de actividades educativas sobre examen de los senos y 68,4% recibieron orientación sobre la lactancia materna. La mayoría de las mujeres no realizaron la serología para hepatitis B, toxoplasmosis y VIH. Sólo una mujer (2,6%) realizó el examen cytopathologic del cuello del útero durante el embarazo. Conclusión: Existe una inadecuada atención prenatal, ya que no han alcanzado los criterios mínimos recomendados por el PHPN. Descriptores: salud materno-infantil; atención prenatal; calidad de la atención de salud; atención primaria de salud; indicadores de calidad de la atención de salud.

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On 27-28 March 2006, Pennsylvania State University hosted an internationalconference on “Islam and Bioethics: Concerns, Challenges, and Responses.”Cosponsored by several academic units in the College of Liberal Arts, theconference brought in historians, health care professionals, theologians, and social scientists from ten different countries. Twenty-four papers were presented,along with Maren Grainger-Monsen’s documentary about an Afghaniimmigrant seeking cancer treatment in California.After opening remarks by Susan Welch (dean, College of Liberal Arts)and Nancy Tuana (director, Rock Ethics Institute), panelists analyzed“Critical Perspectives on Islamic Medical Ethics.” Hamada Hamid’s (NewYork University Medical School) “Negotiating Autonomy and Religion inthe Clinical Setting: Case Studies of American Muslim Doctors andPatients,” showed that few doctors explore the role of religion in a patient’sdecision-making process. She suggested that they rethink this practice.Hassan Bella (College of Medicine, King Faisal University, Dammam)spoke on “Islamic Medical Ethics: What and How to Teach.” His survey, conductedin Saudi Arabia among medical practitioners, revealed that most practitionersapproved of courses on Islamic ethics but did not know if suchcourses would improve the doctor-patient relationship. Sherine Hamdy’s(Brown University) “Bodies That Belong to God: Organ Transplants andMuslim Ethics in Egypt” maintained that one cannot easily classify transplantpatients’ arguments as “religious” or “secular,” for religious values are fusedtogether with a patient’s social, political, and/or economic concerns.The second panel, “Ethical Decision-Making in Local and InternationalContexts,” provoked a great deal of discussion. Susi Krehbiel (Brown University)led off with “‘Women Do What They Want’: Islam and FamilyPlanning in Tanzania.” This ethnographic study was followed by Abul FadlMohsin Ebrahim’s (KwaZulu University, Durban) “Human Rights andRights of the Unborn.” Although Islamic law is commonly perceived asantagonistic to the UN’s charter on human rights, Ebrahim argues that bothmay be used to protect those who can and cannot fight for their right to dignity,including the foetus. Thomas Eich (Bochum University) asserted in“The Process of Decision Making among Contemporary Muslim ReligiousScholars in the Case of ‘Surplus’ Embryos” that decisions reached by internationalMuslim councils were heavily influenced by local politics and contentiousdecisions in such countries as Germany and Australia.The afternoon panel, “The Fetus and the Value of Fetal Life,” focusedon specific issues raised by artificial reproductive technologies (ARTs).Vardit Rispler-Chaim (Haifa University) presented “Contemporary Muftisbetween Bioethics and Social Reality: Pre-Selection of the Sex of a Fetus asParadigm.” After summarizing social customs and religious literature fromaround the world, she claimed that muftis generally favor pre-selection techniquesand suggested that their reasoning is guided by a general social ...

Abstract:

BackgroundMeasuring, understanding and improving patients’ experiences is of central importance to health care systems, but there is debate about the best methods for gathering and understanding patient experiences and how to then use them to improve care. Experience-based co-design (EBCD) has been evaluated as a successful approach to quality improvement in health care, drawing on video narrative interviews with local patients and involving them as equal partners in co-designing quality improvements. However, the time and cost involved have been reported as a barrier to adoption. The Health Experiences Research Group at the University of Oxford collects and analyses video and audio-recorded interviews with people about their experiences of illness. It now has a national archive of around 3000 interviews, covering around 75 different conditions or topics. Selected extracts from these interviews are disseminated for a lay audience onwww.healthtalkonline.org. In this study, we set out to investigate whether or not this archive of interviews could replace the need for discovery interviews with local patients.ObjectivesTo use a national video and audio archive of patient experience narratives to develop, test and evaluate a rapid patient-centred service improvement approach (‘accelerated experience-based co-design’ or AEBCD). By using national rather than local patient interviews, we aimed to halve the overall cycle from 12 to 6 months, allowing for EBCD to be conducted in two clinical pathways rather than one. We observed how this affected the process and outcomes of the intervention.DesignThe intervention was an adapted form of EBCD, a participatory action research approach in which patients and staff work together to identify and implement quality improvements. The intervention retained all six components of EBCD, but used national trigger films, shortened the time frame and employed local service improvement facilitators. An ethnographic process evaluation was conducted, including observations, interviews, questionnaires, cost and documentary analysis including previous EBCD evaluation reports.SettingIntensive care and lung cancer services in two English NHS hospital trusts (Royal Berkshire and Royal Brompton and Harefield).ParticipantsNinety-six clinical staff (primarily nursing and medical) and 63 patients and family members.InterventionFor this accelerated intervention, the trigger film was derived from pre-existing national patient experience interviews. Local facilitators conducted staff discovery interviews. Thereafter, the process followed the usual EBCD pattern: the film was shown to local patients in a workshop meeting, and staff had a separate meeting to discuss the results of their feedback. Staff and patients then came together in a further workshop to view the film, agree priorities for improvement and set up co-design working groups to take these priorities forward.ResultsThe accelerated approach proved readily acceptable to staff and patients; using films of national rather than local narratives did not adversely affect local NHS staff engagement, and may in some cases have made the process less threatening or challenging. Local patients felt that the national films generally reflected important themes, although a minority felt that they were more negative than their own personal experience. However, they served their purpose as a ‘trigger’ to discussion, and the resulting 48 co-design activities across the four pathways were similar in nature to those in EBCD but achieved at reduced cost. AEBCD was nearly half the cost of EBCD. However, where a trigger film already exists, pathways can be implemented for as little as 40% of the cost of traditional EBCD. It was not necessary to do additional work locally to supplement the national interviews. The intervention carried a ‘cost’ in terms of heavy workload and intensive activity for the local facilitators, but also brought benefits in terms of staff development/capacity-building. Furthermore, as in previous EBCDs, the approach was subsequently adopted in other clinical pathways in the trusts.ConclusionsAccelerated experience-based co-design delivered an accelerated version of EBCD, generating a comparable set of improvement activities. The national film acted as an effective trigger to the co-design process. Based on the results of the evaluation, AEBCD offers a rigorous and effective patient-centred quality improvement approach. We aim to develop further trigger films from the archived material as resources permit, and to investigate different ways of conducting the analysis (e.g. involving patients in doing the analysis).FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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A asfixia perinatal, causada pela Síndrome de Aspiração Meconial, é uma das principais causas de mortalidade neonatal precoce em recém-nascidos de baixo risco e sem anomalias congênitas. O objetivo da pesquisa foi definir o perfil e a ocorrência de reanimação neonatal de recém-nascidos em Líquido Amniótico Meconial de uma maternidade de referência materno infantil. Estudo quantitativo, retrospectivo documental realizado com 47 prontuários de recém-nascido selecionados mediante a presença de Líquido Amniótico Meconial ao nascimento. Na amostra: 55,3% a termo; 51,5% do sexo masculino; 55,3% via parto cesáreo; 48,9% com peso adequado para a idade gestacional; 78,7% não precisou de Aspiração sob Visualização Direta da Traqueia. Índice de Apgar menor que 7 pontos no primeiro minuto de vida foram 93,6 %, mas com melhora no quinto minuto de vida. Observa-se a importância de conhecer o perfil destes neonatos para proporcionar um atendimento qualificado.Descritores: Líquido Amniótico, Mecônio, Recém-Nascido. Neonates born through meconium stained amniotic fluid: variables and interventionsAbstract: Perinatal asphyxia, caused by Meconium Aspiration Syndrome (MAS), is one of the main causes of early neonatal mortality in low risk newborns and without congenital abnomalities. The goal of this research was to define the profile and the occurrence of neonatal resuscitation of neonates born on Meconium Stained Amniotic Fluid (MSAF) in a maternal hospital child care reference. This is a quantitative, retrospective documentary study performed based in 47 medical records of newborns selected through the presence of Meconium Stained Amniotic Fluid (MSAF) at the birth. In the specimen it was found that: 55.3% were born at term; 51.5% were male; 55.3% by way of cesarean; 48.9% with adequate weight for gestational age (AGA); 78.7% did not need aspiration under Direct Tracheal Visualization. It was identified that 93.6% had an Apgar score less than 7 points in the first minute of life, but with improvement in the fifth minute of life. It is noted the importance of knowing the profile of these newborns to provide qualified care.Descriptors: Amniotic Fluid, Meconium, Newborn. Recién nacido en líquido amniotico meconial: variables e intervencionesResumen: La asfixia perinatal, causada por el Síndrome de Aspiración Meconial, es una de las principales causas de mortalidad neonatal temprana en recién nacidos de bajo riesgo y sin anomalías congénitas. El objetivo de la investigación fue definir el perfil y la ocurrencia de la reanimación neonatal de recién nacidos en líquido amniótico meconial en un hospital de maternidad de referencia materno-infantil. Estudio cuantitativo, retrospectivo documental realizado con 47 registros médicos de recién nacidos seleccionados mediante la presencia de líquido amniótico meconial al nacer. En la muestra: 55,3% a término; 51.5% eran de género masculino; 55.3% por cesárea; 48,9% con peso adecuado para la edad gestacional; 78.7% no necesitaron aspiración mediante visualización directa de las traqueas. 93,6% presentaron puntuación de Apgar inferior a 7 puntos en el primer minuto de vida, pero con una mejora en el quinto minuto de vida. Se destaca la importancia de conocer el perfil de estos recién nacidos para proporcionar atención calificada.Descriptores: Líquido amniótico, Meconio, Recién Nacido.

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Descrever as variáveis neonatais, condições clínicas e nutricionais de recém-nascidos portadores de Atresia Esofágica submetidos a correção cirúrgica. Estudo documental, retrospectivo e quantitativo em 50 prontuários de neonatos portadores de atresia de esôfa*go, internados em um hospital de referência. Na amostra: 96% das genitoras realizaram o pré-natal, com 64% nascidos de parto cesáreo, sendo 62% do sexo feminino e 60% dos neonatos nasceram com peso normal. Sobre a classificação da Atresia Esogágica, 84% tipo C. A média da amostra foi de 10 dias de vida a submissão da cirurgia de correção e 20 dias de vida para introdução da dieta. A idade média no alcance da dieta plena foi de 30 dias, sendo em torno do 21º dia de pós-operatório. A amamentação foi informada em 44% da amostra. Predominou consonâncias entre as variáreis do estudo comparadas com publicações nacionais e internacionais sobre o tema.Descritores: Atresia Esofágica, Anormalidades Congênitas, Enfermagem Pediátrica. Therapeutic and nutritional aspects of neonates submitted to esophageal atresia correctionAbstract: To describe the neonatal variables, clinical and nutritional conditions of newborns with esophageal atresia who underwent surgical correction. This is a documentary, retrospective and quantitative study of 50 medical records of neonates with Esophageal Atresia, admitted in a reference hospital. In the sample: 96% of mothers received prenatal care, with 64% of infants born by cesarean delivery, 62% of whom were female and 60% of neonates were born with normal weight. Regarding the classification of Esophageal Atresia, 84% were classified as type C. The sample mean was being 10 days old until the moment that the newborn underwent correction surgery and 20 days old to introduce the diet. The average age to tolerate the full diet was 30 days, being around the 21st postoperative day. Breastfeeding was reported in 44% of the sample. There was a consonance between the study variables compared to national and international publications on the subject.Descriptors: Esophageal Atresia, Congenital Abnormalities, Pediatric Nursing. Aspectos terapéuticos y nutricionales de los neonatos sujetos a la corrección de la atresia esofágicaResumen: Describir las variables neonatales, las condiciones clínicas y nutricionales de los recién nacidos con atresia esofágica sometidos a corrección quirúrgica. Estudio documental, retrospectivo y cuantitativo de 50 registros médicos de recién nacidos con atresia esofágica, internados en un hospital de referencia. En la muestra: 96% de las madres realizaron atención prenatal, 64% nacieron por cesárea, 62% de las cuales eran del sexo feminino y 60% de los recién nacidos teníam peso normal. Con respecto a la clasificación de la Atresia de Esófa*go, 84% eran del tipo C. La media de la muestra fue de 10 días hasta el momento de la realización de la cirugía de corrección y de 20 días para introducir la dieta. La media de edad para alcanzar la dieta completa fue de 30 días, alrededor del día 21 de postoperatorio. La lactancia materna se informó en 44% de la muestra. Hubo una consonancia entre las variables de estudio en comparación con las publicaciones nacionales e internacionales sobre el tema.Descriptores: Atresia Esofágica, Anomalías Congénitas, Enfermería Pediátrica.

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RESUMO Objetivo: analisar a adesão à identificação do paciente por pulseira pela equipe de saúde e pelos pacientes. Método: trata-se de estudo quantitativo, descritivo e documental. Constituiu-se a amostra por 137 pacientes internados em uma unidade cardiointensiva de um hospital universitário. Coletaram-se os dados, mediante o preenchimento de um formulário estruturado, em seguida, organizados e analisados utilizando-se a estatística descritiva simples. Resultados: observou-se a presença da pulseira de identificação em 100% dos pacientes. Destes, 26% apresentavam não conformidades. Ansalisou-se, a partir dos relatos dos pacientes, que 61% dos profissionais não utilizaram a pulseira para identificá-los no momento dos procedimentos e 90% dos pacientes não foram orientados quanto ao motivo e importância da utilização da pulseira. Conclusão: observou-se de forma unânime a identificação dos pacientes, no entanto, necessita-se, na prática, de maior sensibilização e treinamento da equipe multiprofissional para a adequação conforme se preconiza na Meta 1 de Segurança do Paciente. Descritores: Segurança do Paciente; Sistemas de Identificação de Pacientes; Qualidade da Assistência à Saúde; Gestão de Risco; Hospitalização; Hospitais Universitários.ABSTRACT Objective: to analyze the adherence to the identification of the patient by hospital wristband by the health team and by the patients. Method: this is a quantitative, descriptive and documentary study. The sample consisted of 137 patients hospitalized in a cardio-intensive unit of a university hospital. Data was collected by completing a structured form, then organized and analyzed using simple descriptive statistics. Results: the presence of the identification wristband was observed in 100% of the patients. Of these, 26% had nonconformities. From the patients' reports, 61% of the professionals did not use the wristband to identify them at the time of the procedures and 90% of the patients were not guided as to the reason and importance of the use of the wristband. Conclusion: the identification of patients was unanimously observed, however, it is necessary, in practice, to increase awareness and training of the multi-professional team for the adequacy as recommended in Goal 1 of Patient Safety. Descriptors: Patient Safety; Patient Identification Systems; Quality of Health Care; Risk Management; Hospitalization; Hospitals, University.RESUMENObjetivo: analizar la adhesión a la identificación del paciente por pulsera por el equipo de salud y por los pacientes. Método: se trata de un estudio cuantitativo, descriptivo y documental. Se constituyó la muestra por 137 pacientes internados en una unidad cardiointensiva de un hospital universitario. Se recogen los datos, mediante el llenado de un formulario estructurado, a continuación, organizado y analizado utilizando la estadística descriptiva simple. Resultados: se observó la presencia de la pulsera de identificación en el 100% de los pacientes. De ellos, el 26% presentaba no conformidades. Se analizó, a partir de los relatos de los pacientes, que el 61% de los profesionales no utilizaron la pulsera para identificarlos en el momento de los procedimientos y el 90% de los pacientes no fueron orientados en cuanto al motivo e importancia del uso de la pulsera. Conclusión: se observó de forma unánime la identificación de los pacientes, sin embargo, se necesita, en la práctica, de mayor sensibilización y entrenamiento del equipo multiprofesional para la adecuación conforme se preconiza en la Meta 1 de Seguridad del Paciente. Descriptores: Seguridad del Paciente; Sistemas de Identificación de Pacientes; Calidad de la Atención de Salud; Gestión de Riesgos; Hospitalización; Hospitales Universitarios.

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Resumo: O objetivo deste artigo foi analisar os resumos presentes nos Anais da Mostra Parceria Ensino-Serviço-Comunidade (MOPESCO) desenvolvidos por alunos, professores e servidores da Universidade Federal de Goiás (UFG) e por participantes do Programa de Educação pelo Trabalho para a Saúde (PET-Saúde), nas cinco edições do evento. Realizou-se uma análise documental dos 551 resumos produzidos pela parceria entre a UFG e os serviços de saúde publicados nos anais do evento de 2007 a 2015. Os resumos foram categorizados nos seguintes eixos: atenção básica (262), reorientação da formação e educação permanente (109), extensão universitária (92), atenção à média e alta complexidade (59), mobilização e participação comunitária (14), gestão setorial (10) e gestão pública (05). A parceria ensino-serviço produziu 50,8% das experiências. O público-alvo predominante foi os usuários em unidades de saúde; e a roda de conversa e oficinas foram a estratégia educativa mais utilizada. Percebeu-se forte parceria entre ensino-serviço, porém a comunidade pouco participou da elaboração das experiências. Diversidade de público-alvo e estratégias educativas apontam esforços dos autores dos trabalhos para alcançar maior número de pessoas nas ações. O evento se firmou como espaço de diálogo entre o mundo do ensino e do trabalho, e houve crescente empenho para fortalecer e qualificar a formação dos profissionais de saúde. Palavras-chave: Integração Ensino-Serviço, Formação de Recursos Humanos, Educação Continuada, Ensino na Saúde Integrating teaching, service, and the community: getting (re)acquainted with teaching-service-community outreach partnership (MOPESCO) held by the Universidade Federal de Goiás Abstract: The objective of the article was to analyze the summaries present in the Annals of Teaching-Service-Community Partnership - Mostra Parceria Ensino-Serviço-Comunidade (MOPESCO) - developed by students, professors and employees of the Federal University of Goiás (UFG, Goiás State, Brazil) and by participants in the Education through Work for Health Program (“Programa de Educação pelo Trabalho para a Saúde” - PET-Saúde), in the five editions of the event. Documentary analysis of the 551 abstracts produced by the partnership between UFG and health services published in the annals of the event from 2007 to 2015 was carried out. The abstracts were categorized in the following axes: primary health care (262), reorientation of training and permanent education (109), university extension (92), attention to medium and high complexity (59), community mobilization and participation (14), sector management (10) and public management (05). The teaching-service partnership produced 50.8% of the experiences; the predominant target audience was the users in health units, and conversation circles and educational workshops were the most used educational strategy. A strong teaching-service partnership was perceived, but the community did not participate in the elaboration of the experiences. The diversity of the target audience and educational strategies indicate the efforts of the authors to reach a higher number of people in the activities. The event was established as a space for dialogue between the world of teaching and work, and there was a growing commitment to strengthen and qualify the training of health professionals. Keywords: Service learning, Human Resources Training, Continuing Education, Health Teaching Integración enseñanza servicio y comunidad: (re) conociendo la exposición asociación enseñanza-servicio-comunidad (MOPESCO) realizada por la Universidad Federal de Goiás Resumen: El objetivo de este artículo fue analizar los resúmenes presentes en los Anales de la Exposición Asociación Enseñanza-Servicio-Comunidad (MOPESCO) desarrollados por alumnos, profesores y servidores de la Universidad Federal de Goiás (UFG, estado de Goiás, Brasil) y por participantes del Programa Educación por el Trabajo para la Salud (PET-Salud), en las cinco ediciones del evento. Se realizó un análisis documentado de los 551 resúmenes producidos por la asociación entre la UFG y los servicios de salud publicados en los anales de 2007 a 2015. Se categorizaron los resúmenes en los siguientes ejes: atención básica (262), reorientación de la formación y educación permanente (109), extensión universitaria (92), atención a la media y alta complejidad (59), movilización y participación comunitaria (14), gestión sectorial (10) e gestión pública (05). La asociación enseñanza-servicio produjo 50,8% de las experiencias. El público alcanzado fueron en su mayoría los usuarios en unidades de salud; y la rueda de conversación y talleres fueron la estrategia educativa más utilizada. Se notó una fuerte asociación entre enseñanza-servicio, sin embargo la comunidad participó poco de la elaboración de las experiencias. Diversos públicos y estrategias educativas muestran esfuerzos de los autores de los trabajos para alcanzar el mayor número de personas en la acciones. El evento se transformó en un espacio de diálogo entre el mundo de la enseñanza y el trabajo, hubo el aumento del empeño para fortalecer calificar la formación de los profesionales de la salud. Palabras-clave: Integración Enseñanza-Servicio, Formación de Recursos Humanos, Educación Continua, Enseñanza en la Salud

Abstract:

Настоящая работа является первым общим описанием на русском языке двух некрополей Кампокиаро (Кампобассо, Италия) – Виченне и Морионе, датируемых последней третью VII в. – началом VIII в. Культурное содержание некрополей показывает прочные связи с населением центральноазиатского происхождения. Важнейшим признаком некрополей являются захоронения с конем, соответствующие евразийскому кочевому погребальному обряду. Автор поддержал выводы европейских исследователей о том, что с большой долей вероятности некрополи оставлены булгарами дукса–гаштальда Алзеко, зафиксированными Павлом Диаконом в VIII в. на территориях Бояно, Сепино и Изернии. Аналогии некрополей Кампокиаро с погребениями Аварского каганата показывают присутствие в аварском обществе булгар со схожим погребальным обрядом. Из тысяч погребений с конем, оставленных аварским населением, булгарам могла принадлежать большая часть. Авары и булгары составляли основу и правящую верхушку каганата. Народ Алзеко являлся той частью булгар, которая в 631 г. боролась за каганский престол, что указывает на высокое положение булгар и их большое количество. После поражения эта группа булгар мигрировала последовательно в Баварию, Карантанию и Италию. Несколько десятков лет проживания в венедской, а затем в лангобардской и романской среде привели к гетерогенности погребального инвентаря, но не изменили сам обряд. Булгары лангобардского королевства составляли новый военный слой, который представлял из себя профессиональную кавалерию, получивший землю. Эта конная дружина является ранним примером европейского феодального воинского и социального сословия, которое станет называться рыцарством. Библиографические ссылки Акимова М.С. Материалы к антропологии ранних болгар // Генинг В.Ф., Халиков А.Х. Ранние болгары на Волге (Больше–Тарханский могильник). М.: Наука, 1964. С. 177–191. Амброз А.К. Кинжалы VI – VIII вв, с двумя выступами на ножнах // СА. 1986. № 4. С. 53–73. Безуглов С.И., Ильюков Л.С. Памятник позднегуннской эпохи в устье Дона // Средневековые древности Дона / Ред. Ю.К. Гугуев. М.–Иерусалим: Мосты и культуры, 2007. C. 25–48. Бешевлиев В. Пръвобългарите. История, бит и култура. Пловдив: Фондация «Българско историческо наследство», 2008. 505 с. Гавритухин И.О., Иванов А.Г. Погребение 552 Варнинского могильника и некоторые вопросы изучения раннесредневековых культур Поволжья // Пермский мир в раннем средневековье / Отв. ред. А.Г. Иванов. Ижевск: УИИЯЛ УрО РАН, 1999. С. 99–159. Добиаш–Рождественская О.А. Ранний фриульский минускул и одна из проблем жизни и творчества лангобардского историка VIII в. // Вспомогательные исторические дисциплины / Под ред. А. С. Орлова. М.; Л.: Изд–во АН СССР, 1937. С. 109–140. Засецкая И.П. Культура кочевников южнорусских степей в гуннскую эпоху (конец IV–V вв.). СПб.: АО "Эллипс", 1994. 221 с. Казанский М.М. Оногуры в постгуннское время на Дону // Дивногорский сборник / Труды музея-заповедника «Дивногорье». Вып. 6. / под ред. А. З. Винникова. Воронеж: Изд.– полигр. центр «Научная книга», 2016. С. 96–111. Казанский М.М. Хронологические индикаторы степных древностей постгуннского времени в Восточной Европе // НАВ. 2019. Т. 18 (2). С. 109–124. Кардини Ф. Истоки средневекового рыцарства // Пер. с ит. В.П. Гайдук / Общ. ред. В.И. Уколова, Л.А. Котельникова. М.: Прогресс, 1987. 384 с. Комар А.В., Кубышев А.И., Орлов Р.С. Погребения кочевников VI–VII вв. из Северо–Западного Приазовья // Степи Европы в эпоху средневековья. Т. 5. Хазарское время / Гл.ред. А.В.Евглевский Донецк: ДонНУ, 2006. С. 245–376. Кондукторова Т.С. Антропологическая характеристика черепов из Верхнего Чир–Юртовского могильника в Дагестане // ВА. 1967. Вып. 25. С. 117–129. Красильников К.И. Могильник древних болгар у с. Желтое на Северском Донце // Проблеми на прабългарската история и култура. София: БАН, Нац. Археол. институт с музей филиал Шумен, Аргес, 1991. Т. 2. С. 62–81. Красильников К.И., Красильникова Л.И. Могильник у с. Лысогоровка – новый источник по этноистории степей Подонцовья раннего средневековья // Степи Европы в эпоху средневековья. Т 4. Хазарское время / Гл.ред. А.В. Евглевский. Донецк: ДонНУ, 2005. С. 187–244. Красильников К.И., Руженко А.А. Погребение хирурга на древнеболгарском могильнике у с. Желтое // СА. 1981. № 2. С. 282–289. Кузнецова Т.И. Павел Диакон. Из «Истории лангобардов» // Памятники средневековой латинской литературы IV–IX веков / Отв. ред. М. Е. Грабарь-Пассек и М. Л. Гаспаров. М.: Наука, 1970. С. 243–257. Медникова М.Б. Трепанации у древних народов Евразии. М.: Научный мир, 2001. 304 с. Мингазов Ш.Р. Болгары Алзеко в Баварии, Карантании и Италии как пример автономной части этнокультурной общности // Восточная Европа в древности и средневековье. Античные и средневековые общности: XXIX Чтения памяти члена-корреспондента АН СССР В.Т. Пашуто. Москва, 19–21 апреля 2017 / Отв. Ред. Е. А. Мельникова. М: Институт всеобщей истории РАН, 2017. С. 160–164. Мингазов Ш.Р. Следы взаимовлияния европейской и азиатской социокультурных моделей: булгары в Италии (VI–VIII вв.) // Восточная Европа в древности и средневековье. Сравнительные исследования социокультурных практик: XXXII Чтения памяти члена корреспондента АН СССР В.Т. Пашуто. Москва, 15–17 апреля 2020 / Отв. Ред. Е. А. Мельникова. М.: Институт всеобщей истории РАН, 2020. С. 162–166. Нестеров С.П. Конь в культах тюркоязычных племен Центральной Азии в эпоху средневековья. Новосибирск: Наука. Сиб. отд–ие АН СССР, 1990. 143 с. Павел Диакон. История лангобардов / Пер. с лат., ст. Ю.Б. Циркина. СПб.: Азбука–классика, 2008. 318 с. Решетова И.К. Население донецко–донского междуречья в раннем средневековье: Палеоантропологическое исследование. СПб.: Нестор–История, 2015. 132 с. Решетова И.К. Описание индивидов с трепанированными черепами среди носителей Салтово–маяцкой культуры: медицинская практика или культ? // Этнографическое обозрение. 2012. № 5. С. 151–157. Ронин В.К. «История лангобардов» Павла Диакона // Свод древнейших письменных известий о славянах / Отв. ред. Л. А. Гиндин, Г. Г. Литаврин. М.: Издательская фирма «Восточная литература» РАН, 1995. Т. II. С. 480–501. Ронин В.К. Так называемая Хроника Фредегара // Свод древнейших письменных известий о славянах / Отв. ред. Л. А. Гиндин, Г. Г. Литаврин. М.: Издательская фирма «Восточная литература» РАН, 1995. Т. II. С. 364–397. Трифонов Ю.И. Об этнической принадлежности погребений с конем древнетюркского времени (в связи с вопросом о структуре погребального обряда тюрков–тугю // Тюркологический сборник 1972. / Отв. ред. А.Н. Кононов. М.: Наука, 1973. С. 351–374. Храпунов И.Н., Казанский М.М. Погребение № 114 на могильнике Нейзац (предгорный Крым) и древности кочевников Северного Причерноморья второй половины V — первой половины VI в. // КСИА. Вып. 238. М.: ИА РАН, 2015. С. 170–194. Шишманов И. Българите в “Orlando furioso” и въ по–старата френска драма // Български преглед. VI. Кн. 8. София: Придворна печатница, 1900. Година С. 67–84. Ceglia V. Campochiaro. La necropoli di Vicenne // L’oro degli Avari: popolo delle steppe in Europa. Milano: Inform, 2000. P. 212–221. Ceglia V. Campochiaro: la necropoli altomedievale di Vicenne (CB) // V Settimana beni culturali. Tutela. Catalogo della mostra. Matrice: Soprintendenza archeologica e per i beni ambientali, architettonici, artistici e storici del Molise, 1989. P. 63–67. Ceglia V. Interventi di recupero dei siti sparsi e necropolis // Conoscenze. Campobasso: Soprintendenza archeologica e per i beni ambientali, architettonici, artistici e storici del Molise, 1994. Vol. 7. P. 17–20. Ceglia V. La Necropoli altomedioevale di Vicenne nel Comune di Campochiaro // Almanacco del Molise. Campobasso: Habacus Edithore,1989. Ed. 21, vol. II. P. 153–158. Ceglia V. La necropoli di Campochiaro (Italia) // Roma e i Barbari. La nascita di un nuovo mondo. Catalogo della Mostra (Venezia, 26 gennaio –20 luglio 2008) / A cura di J.J. Aillagon. Milano: Skira, 2008. P. 469–475. Ceglia V. Lo scavo della necropoli di Vicenne // Conoscenze. Campobasso: Soprintendenza archeologica e per i beni ambientali, architettonici, artistici e storici del Molise, 1988. Vol. 4. P. 31–48. Ceglia V. Necropoli di Vicenne // Studi sull’Italia dei Sanniti. Milano: Electa, 2000. P. 298–302. Ceglia V. Presenze funerarie di eta altomedievale in Molise. Le necropoli di Campochiaro e la tomba del cavaliere // I Longobardi del Sud. Roma: Giorgio Bretschneider Editore, 2010. P. 241–255. Ceglia V. Tomba bisoma 88 della necropoli di Campochiaro, localita Morrione // Il futuro dei longobardi. L 'Italia e la costruzione dell' Europa di Carlo Magno / A cura di С. Bertelli, G.P. Brogiolo. Milano: Skira, 2000. P. 80–81. Ceglia V. Varietа di infl ussi culturali nelle necropoli di Campochiaro. Considerazioni preliminari / I beni culturali nel Molise. Il Medioevo / A cura di De Benedittis G. Campobasso: Istituto regionale per gli studi storici del Molise “V. Cuoco”, 2004. P. 79–86. Ceglia V., Genito B. La necropoli altomedievale di Vicenne a Campochiaro // Samnium: Archeologia del Molisе. Roma: Quasar, 1991. P. 329–334. Ceglia V., Marchetta I. Nuovi dati dalla necropoli di Vicenne a Campochiaro // La trasformazione del mondo romano e le grandi migrazioni. Nuovi popoli dall'Europa settentrionale e centro–orientale alle coste del Mediterraneo / A cura di C. Ebanista, M. Rotili. Napoli: Tavolario Edizioni, 2012. P. 217–238. Chronicarum quae dic*ntur Fredegarii Scholastici libri IV // MGH, Scriptores Rerum Merovingicarum / Ed. B. Krusch. Hannoverae: Impensis bibliopolii hahniani, 1888. T. 2. P. 1-193. Constitutiones et Acta Publica Imperatorum et Regum // MGH, Rerum Germanicarum Medii Aevi / Ed. L. Weiland. Hannoverae, Impensis bibliopolii hahniani, 1893. T. I, №. 333. P. 472–477. Curta F. Ethnicity in the Steppe Lands of the Northern Black Sea Region During The Early Byzantine Times // Archaeologia Bulgarica. 2019. T. ХХIII. P. 33–70. De Benedittis G. Di alcuni materiali altomedievali provenienti dal Molise centrale ed il problema topografi co della necropoli di Vicenne // Conoscenze. Campobasso: Soprintendenza archeologica e per i beni ambientali, architettonici, artistici e storici del Molise, 1988. Vol. 4. P. 103–108. De Benedittis G. Introduzione // Samnium: Archeologia del Molisе. Roma: Quasar, 1991. P. 325–328. De Marchi P.M. Modelli insediativi "militarizzati" d'eta longobarda in Lombardia // Citta, castelli, campagne nel territori di frontiera (secoli 6–7). Mantova: SAP Societa Archeologica S.r.l., 1995. P. 33–85. De Vingo P. Avari e slavi nel Friuli altomedievale secondo l’Historia Langobardorum di Paolo Diacono // Paolo Diacono e il Friuli alto medievale (secc. VI– X). Spoleto: Centro Italiano di studi sull’alto medioevo, 2001. P. 807–815. Ditten H. Protobulgaren und Germanen im 5.–7. Jahrhundert (vor der Grundung des ersten bulgarischen Reiches) // Bulgarian Historical Review. София: Институт за исторически изследвания, 1980. Vol. VIII, 3. P. 51–77. Donceva–Petkova L. Zur ethnischen Zugehörigkeit einiger Nekropolen des 11. Jahrhunderts in Bulgarien // Post–Roman Towns, Trade and Settlement in Europe and Byzantium / Ed. J. Henning. Berlin–New York: Walter de Gruyter, 2007. Vol. 2. S. 643–660. Ebanista C. Gli usi funerari nel ducato di Benevento: alcune considerazioni sulle necropoli campane e molisane di VI–VIII secolo // Archeologia e storia delle migrazioni: Europa, Italia, Mediterraneo fra tarda eta romana e alto medioevo (Giornate sulla tarda antichita e il medioevo, 3). Cimitile: Tavolario Edizioni, 2011. P. 337–364. Ebanista С. Tradizioni funerarie nel ducato di Benevento: l’apporto delle popolazioni alloctone // Nekropoli Longobarde in Italia. Atti del Convegno Internazionale 26–28.09.2011. Trento: Castello del Buonconsiglio, monumenti e collezioni provinciali, 2014. P. 445–471. Fedele A. La deposizione del cavallo nei cimiteri longobardi: dati e prime osservazioni // Archeologia dei Longobardi: dati e metodi per nuovi percorsi di analisi (Archeologia Barbarica, 1). Mantova: SAP Societa Archeologica s.r.l., 2017. P. 59–82. Fedele A., Marchetta I., Colombo D. Ritualita e rappresentazione funeraria nelle tombe di Vicenne (Campochiaro, CB). Una sintesi // Prima e dopo Alboino sulle trace dei Longobardi. Atti del Convegno internazionale di studi Cimitile–Nola–Santa Maria Capua Vetere. Cimitile: Guida, 2019. P. 295–314. Genito B. Archaeology of the Early medieval nomads in Italy: the horse–burials in Molise (7th century) south–central Italy // Kontakte zwischen Iran, Byzanz und der Steppe in 6.–7. Jh. / Hrsg. C. Balint (Varia Archaeologica Hungarica, IX). Budapest: Archaologisches Institut der UAW, 2000. P. 229–247. Genito B. Il Molise nell’altomedioevo: tra Mediterraneo ed Eurasia. Un’occasione perduta? // Miti e popoli del Mediterraneo antico. Scritti in onore di Gabriella d'Henry. Salerno: Tipografi a Fusco, 2014. P. 279–292. Genito B. Materiali e problemi // Conoscenze. Campobasso: Soprintendenza archeologica e per i beni ambientali, architettonici, artistici e storici del Molise, 1988. Vol. 4. P. 49–67. Genito B. Sepolture con cavallo da Vicenne (CB): un rituale nomadico di origine centroasiatica // I Congresso Nazionale di Archeologia Medievale (Pisa 29–31 maggio 1997) / A cura di S. Gelichi. Firenze: All'Insegna del Giglio, 1997. P. 286–289. Genito B. Tombe con cavallo a Vicenne // Samnium: Archeologia del Molisе. Roma: Quasar, 1991. P. 335–338. Giostra C. Il ducato longobardo di Ivrea: la grande necropoli di Borgomasino // Per il Museo di Ivrea. Lasezione archeologica del Museo Civico P.A. Garda / A cura di A. Gabucci, L. Pejrani Baricco, S. Ratto. Firenze: All’Insegna Giglio, 2014. P. 155–176. Hersak E. Vulgarum dux Alzeco // Casopis za zgodovino in narodopisje. Maribor: Izdajata univerza v Mariboru in Zgodovinsko drustvo v Mariboru, 2001. Let. 72 (37), 1–2. S. 269–278. Hodgkin T. Italy and her Invaders. Oxford: Clarendon Press, 1895. Vol. VI. 636 p. Jozsa L., Fothi E. Trepanalt koponyak a Karpat–medenceben (a leletek szambavetele, megoszlasa es lelohelyei) // Folia Anthropologica. Szombathely: Balogh es Tarsa Kft, 2007. T. 6. O. 5–18. Koch A. Uberlegungen zum Transfer von Schwerttrag– und –kampfesweise im fruhen Mittelalter am Beispiel chinesischer Schwerter mit p–förmigen Tragriemenhaltern aus dem 6.–8. Jahrhundert n. Chr. // Jahrbucher des Romisch–Germanischen Zentralmuseums. Mainz: RGZM, 1998. Bd. 45. S. 571–598. Kruger K.–H. Zur «beneventanischen» Konzeption der Langobardengeschichte des Paulus Diakonus // Fruhmittelalterliche studien. Berlin–New York: Walter de Gruyter, 1981. Bd. 15. P. 18–35. La Rocca C. Tombe con corredi, etnicita e prestigio sociale: l’Italia longobarda del VII secolo attraverso l’interpretazione archeologica // Archeologia e storia dei Longobardi in Trentino. Mezzolombardo: Comune di Mezzolombardo, 2009. P. 55–76. La Salvia V. La diffusione della staffa nell’area merovingia orientale alla luce delle fonti archeologiche // Temporis Signa. Spoleto: Fondazione Centro Italiano di studi sull’alto Medioevo, 2007. Vol. 2. P. 155–171. Laszlo O. Detailed Analysis of a Trepanation from the Late Avar Period (Turn of the 7th–8th Centuries—811) and Its Signifi cance in the Anthropological Material of the Carpathian Basin // International Journal of Osteoarchaeology. Published online in Wiley Online Library, 2016. Vol. 26–2. P. 359–365. Marchetta I. Ceramica ed Ethnos nelle tombe di Vicenne (Campochiaro, CB): il ritual funerario attraverso l’analisi del corredo vascolare // Le forme della crisi. Produzioni ceramiche e commerce nell’Italia centrale tra Romani e Longobardi (III–VIII sec. d.C.) / A cura di E. Cirelli, F. Diosono, H. Patterson. Bologna: Ante Quem, 2015. P. 663–671. Marchetta I. Il carattere composito del regno: le necropoli di Campochiaro (Campobasso) (cat. II.36–40) // Longobardi. Un popolo che cambia la storia. Schede mostra / A cura di G.P. Brogiolo, F. Marazzi, C. Giostra. Milano, Skira, 2017. P. 54–58. Mednikova M.B. Prehistoric Trepanations in Russia: Ritual or Surgical? // Trepanation: History, Discovery, Theory / Eds. R. Arnott, S. Finger, S. Smith C. Lisse: Swets & Zeitlinger, 2003. P. 163–174. Muratori L.A. Antiquitates Italicae medii Aevi, sive Dissertationes. Mediolani: Ex Typographia societatis Palatinae, 1740. T. III. 1242 coll.Pasqui U. Documenti per la storia della citta di Arezzo nel medio evo. Arezzo: G.P. Vieusseux, 1899. Vol. I. 576 p. Pauli historia Langohardorum // MGH. Scriptores rerum Langobardicarum et Italicarum saec. VI–IX / Ed. G. Waitz. Hannoverae: Impensis bibliopolii hahniani, 1878. Bd. I. P. 12–187. Pieri S. Toponomastica della Toscana meridionale (valli della Fiora, dell ‘Ombrone, della Cecina e fi umi minori) e dell‘Arcipelago Toscano. Siena: Accademia senese degli intronati, 1969. 472 p. Pohl W. Die Awaren. Ein Steppenvolk im Mittelalter. 567–822. Munchen: Verlag C.H. Beck, 1988. 529 p. Polverari A. Una Bulgaria nella Pentapoli. Longobardi, Bulgari e Sclavini a Senigallia. Senigallia: Pierfederici, 1969. 41 p. Premuzic Z., Rajic Sikanjic P., Rapan Papesa A. A case of Avar period trepanation from Croatia // Anthropological Review. Published online by De Gruyter, 2016. Vol. 79 (4). P. 471–482. Provesi C. Cavalli e cavalieri in Italia nell'Alto Medioevo (secc. V–X): studio della simbologia equestre attraverso fonti narrative, documentarie e archeologiche. Tesi di Dottorato. Venezia, 2013. Provesi C. I cavalieri e le loro donne, uno studio dei corredi funerari di VI–VII secolo // Univ. Degli studi di Verona. Verona, 2013. Доступно по URL: https://www.yumpu.com/it/document/view/16247410/chiara–provesi–scuola–superiore–di–studi–storici–geografi ci–(Дата обращения 04.12.2020) Provesi C. Uomini e cavalli in Italia meridionale da Cassiodoro ad Alzecone // Ipsam Nolam barbari vastaverunt: l’Italia e il Mediterraneo occidentale tra il V secolo e la metа del VI. Cimitile: Tavolario Edizioni, 2010. P. 97–111. Repetti E. Dizionario geografi co fi sico storico della Toscana. Firenze: Presso L’autore e editore, 1833. Vol. 1. 846 p. Rotili M. I Longobardi migrazioni, etnogenesi, insediamento // I Longobardi del Sud. Roma: Giorgio Bretschneider Editore, 2010. P. 1–77. Rubini M, Zaio P. Warriors from the East. Skeletal evidence of warfare from a Lombard–Avar cemetery in Central Italy (Campochiaro, Molise, 6th–8th Century AD) // Journal of Archaeological Science. Published online by Elsevier, 2011. Vol. 38. Issue 7. P. 1551–1559. Rubini M. Gli Avari in Molise. La necropoli di Campochiaro Morrione // ArcheoMolise. Associazione culturale ArcheoIdea. Isernia: Associazione culturale ArcheoIdea, 2009. T. II (apr.–giu. 2009). Р. 17–25. Rubini M. Il popolamento del Molise durante l’alto medioevo // I beni culturali nel Molise. Il Medioevo / A cura di De Benedittis G. Campobasso: Istituto regionale per gli studi storici del Molise “V. Cuoco”, 2004. P. 151–162. Sabatini F. Rifl essi linguistici della dominazione longobarda nell’Italia mediana e meridionale // Aristocrazie e societa fra transizione romano–germanica e alto medioevo. San Vitaliano: Tavolario Edizioni, 2015. P. 353–441. Sarno E. Campobasso da castrum a citta murattiana. Roma: Aracne, 2012. 324 p. Schneider F. Regestum Volaterranum. Regesten der Urkunden von Volterra (778–1303). Roma: Ermanno Loescher, 1907. 448 p. Staffa A.R. Una terra di frontiera: Abruzzo e Molise fra VI e VII Secolo // Citta, castelli, campagne nei territori di frontiera (secoli VI–VII) / A cura di G.P. Brogiolo. Мantova: Padus, 1995. P. 187–238. Staffa A.R. Bizantini e Longobardi fra Abruzzo e Molise (secc. VI–VII) / I beni culturali nel Molise. Il Medioevo / A cura di De Benedittis G. Campobasso: Istituto regionale per gli studi storici del Molise “V. Cuoco”, 2004. P. 215–248. Tomka P. Die Bestattungsformen der Awaren // Hunnen und Awaren. Reitervolker aus dem Osten. Burgenlandische Landesausstellung 1996 Schloss Halbturn vom 26. April bis 31. Oktober 1996. Begleitbuch und Katalog / Ed. F. Daim. Eisenstadt: Burgenland, Landesregierung, 1996. S. 384–387. Tornesi M. Presenze alloctone nell’Italia centrale: tempi, modalita e forme dell’organizzazione territorial nell’Abruzzo altomediale. Tesi di Dottorato. Roma: Sapienza universita’ di Roma, 2012. 275 p. Valenti M. Villaggi nell’eta delle migrazioni // I Longobardi. Dalla caduta dell’Impero all’alba dell’Italia / A cura di G.P. Brogiolo, A. Chavarria Arnau. Catalogo della mostra (Torino 28 settembre 2007–6 gennaio 2008). Milano: Silvana Editoriale, 2007. P. 151–158. Villa L. Il Friuli longobardo е gli Avari // L'oro degli Avari. Popolo delle steppe in Europa. Milano: Inform, 2000. P. 187–189. Wattenbach W. Deutschlands Geschichtsquellen im Mittelalter. Berlin: Verlag von Wilhelm Hertz, 1858. Vol. I. 478 p. Wattenbach W., Levison W., Lowe H. Deutschlands Geschichtsquellen im Mittelalter. Vorzeit und Karolinger. Weimar: Hermann Bohlaus nachfolger, 1953, Heft II. P. 157–290.

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RIASSUNTONonostante la situazione documentaria favorevole, da più di cento anni l’attenzione della ricerca si è rivolta solo raramente alla storia commerciale tra i territori tedeschi e veneziani nell’epoca moderna. Uno dei motivi ne è la distruzione di un importante fondo documentario della cosiddetta Nazione Alemana, ovvero il gruppo dei commercianti tedeschi a Venezia, avvenuta durante la seconda guerra mondiale per la coincidenza di molteplici tragiche circostanze. I capitolari del Fondaco dei Tedeschi, che erano stati portati dallo storico Freiherr Götz von Pölnitz a Schloss Wässerndorf in Franconia, furono colà bruciati negli ultimi giorni della guerra durante un’azione di rappresaglia eseguita dall’esercito americano. Anche se nella letteratura specialistica non mancano gli accenni alla distruzione dei capitolari, non si apprende quali documenti comprendessero e quali ne fossero i contenuti; restano sconosciute pure le circostanze in cui avvenne la loro distruzione, e non si precisa come potrebbero eventualmente essere sostituiti. Nel presente contributo si tenta di dare una risposta quanto più esauriente possibile a tali quesiti. Da una parte si vuole in tal modo aggiungere un ulteriore tassello alla storia delle distruzioni di archivi durante la seconda guerra mondiale, e dall’altra parte stimolare la ricerca sulla storia commerciale e dei contatti tra i territori tedeschi e veneziani nell’epoca moderna.

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ABSTRACT Objectives: analyze agreement between nursing prescriptions recorded in medical files and patients' care needs; investigate the correlation between the nurses' professional background and agreement of prescriptions. Method: descriptive study with quantitative and documentary approach conducted in the medical clinic, surgical, and specialized units of a university hospital in the interior of São Paulo, Brazil. The new validated version of a Patient Classification Instrument was used and 380 nursing prescriptions written at the times of hospital admission and discharge were assessed. Results: 75% of the nursing prescriptions items were compatible with the patients' care needs. Only low correlation between nursing prescription agreement and professional background was found. Conclusion: the nursing prescriptions did not fully meet the care needs of patients. The care context and work process should be analyzed to enable more effective prescriptions, while strategies to assess the care needs of patients are recommended.

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RiassuntoDopo la riconquista della liberta nel 1369 si poneva come uno dei primi doveri della politica di Lucca di riformulare gli Statuti cittadini. Oltre agli Statuti generali si rivolse una maggiore attenzione agli Statuti particulari relativi al sistema giudiziario. Gli Statuti per il giudice di appello, redatti nel 1372, sono piu dettagliati in confronto con la prima versione del 1331. Venivano precisate le varie istanze la cui ultima era comunque rappresentata da una corte cittadina. Era pertanto garantito anche a livello dell’organizzazione giudiziaria l’indipendenza da qualsiasi potere esterno, anche da quello dell’imperatore che del resto accordava a Lucca altri importanti privilegi. Si stabilivano poi le sanzioni per i giudici di prima istanza che avevano malgiudicato un caso o avevano tralasciato di documentare con atti scritti i processi da loro presieduti. Dall’altro lato si confermavano i piu antichi Statuti conservati relativi al giudice di sindacatura, creando un’apposita istanza a livello ordinario e regolare. Nella precisione di regolamentazione e ricchezza di dettagli tutt’e due gli Statuti sono unici esempi per l’Italia del Trecento, e per questo motivo vengono editi qui.

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Objective: To characterize the clinical and sociodemographic profile of people with venous ulcers followed up in a specialize outpatient clinic of a university hospital. Method: documentary study carried out in a general surgery outpatient clinic of a university hospital. 104 instruments applied in the first nursing consultation were reviewed. Results: there was a predominance of females, with a mean age of 54 years. The majority did not perform paid work, the wound being the reason for leaving work activities. Systemic arterial hypertension and obesity were the most prevalent comorbidities. The person with venous ulcer was the main person involved in direct care of the wound. Conclusion: the profile of the study population is compatible with other studies in different contexts in Brazil. The results allow a reflection on the assistance provided and the effectiveness of the implemented interventions.

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ABSTRACT This study aimed to examine how the media articulates the knowledge and positions involved in the process of death and dying. Documentary research in the field of post-structuralist cultural studies. The empirical material consisted of ten interviews, published in the magazines Época and Veja, between 2000 and 2012. To delimit the corpus of analysis, we used discursive mapping by means of the software ATLAS.ti. The findings were submitted to discourse analysis inspired by Foucault. In the reports, nursing appeared linked to care for the body and technical procedures, leading to the conclusion that the media constructs the professionals' image, according to the historical attributes linked to the professions. The knowledge of medicine and of justice is authorized to teach the subject to decide and to plan the death. Power/knowledge relations are outlined that legitimize the discourse on the production of a singularized death, which must be provided by the subjects using an expert of health.

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The complex and technical subject of bank reform has scarcely been more popular. Events in Cyprus have demonstrated banks are a way of investing money for a return, with all the risk that entails. Van and minibus entrepreneur Dave Fishwick has created a documentary —Bank of Dave— which shows banking can be a simple entrepreneurial function providing a safe return to savers at the entrepreneur’s risk. It’s award-winning and a soar-away popular success. Of course, thanks to regulators, it’s not actually a bank: it’s a savings and loans firm. Whereas these route savings to borrowers, a bank creates credit. That is, banks lend money into existence. It is that distinction, together with other features of the financial system, which has led the world into crisis. It is both one of the least well-understood economic phenomena of our time and the most central to our present difficulties. Yet, astonishingly, Dave Fishwick has struck on a model of ban-king close to a theoretical ideal: he carries his own commercial risks and, even if he could take deposits, he wouldn’t provide cre-dit in excess of savings. It is towards this model the world should move.

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ABSTRACT Objective to identify outcome indicators of the multi-professional Diabetes Mellitus care of a reference outpatient service. Method a descriptive study of evaluative nature, according to the health evaluation framework, carried out by documentary analysis of 173 medical charts, from August to October 2018. The variables were analyzed in the Statistical Package for the Social Science (SPSS), version 22.0, by descriptive statistics, as well as the association of variables, with the Chi-square, Mann-Whitney, and Wilcoxon tests being used, considering p-values ≤ 0.05 as statistically significant. Results predominance of older adult women, with a mean diagnosis time of 11.9 years. The tracking of complications due to Diabetes Mellitus occurred in 90.2% of the users, with a prevalence of 68.2%, of which 34.7% were diagnosed in the service. Absenteeism was 21.4%. The systolic and diastolic arterial pressure and total cholesterol parameters were in line with the proposed goals, while glycated hemoglobin (A1c), fasting glycaemia, HDL-c, LDL-c, triglyceride fractions, and BMI did not reach the target range. There was a significant reduction in final A1c, comparing to initial A1c, as well as an increase in the proportions of users who reached the goals in glycemic control. Conclusion a significant improvement in glycemic control, despite the fact that the parameters did not fully meet the goals, ratifying the importance of an effective assistance model for successful care strategies of Diabetes Mellitus.

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Negli ultimi vent’anni si sono diffuse e perfezionate nella pratica clinica specifiche tecnologie per il trattamento delle ferite di difficile guarigione, come la terapia a pressione negativa (negative pressure wound therapy, NPWT). Tale terapia consente l’accelerazione dei tempi di guarigione di ferite inveterate e una sicura riduzione dei tempi di degenza nei pazienti ricoverati. All’interno di un reparto clinico per acuti risulta tuttavia indispensabile definire le corrette indicazioni ed il modello organizzativo che consenta di ottimizzare le risorse, ridurre gli sprechi e dare risposte tempestive ed efficaci alle persone che possono beneficiare di questo trattamento. È stata condotta un’analisi quantitativa sull’uso della metodica NPWT nei reparti acuti dell’Ospedale Beata Vergine di Mendrisio nell’anno 2017, base per la realizzazione di un audit clinico; i dati ottenuti sono stati rapportati alle attuali evidenze scientifiche sul tema per evidenziare allineamenti e/o scostamenti nella pratica clinica quotidiana. L’audit è uno strumento di Governo Clinico; utilizzare questa metodologia vuol dire favorire una migliore conoscenza da parte degli operatori sanitari delle attività cliniche e gestionali. È, infatti, un processo di revisione strutturata fra pari che ha come obiettivo quello di individuare le opportunità di miglioramento al fine di introdurle nella pratica professionale quotidiana. Gli assistiti che necessitano di medicazione NPWT hanno solitamente un grado di complessità medio-alta, richiedono quindi un assessment preciso ed approfondito, oltre ad una presa a carico multiprofessionale. Gli staff infermieristici necessitano di formazione specifica, consulenza medica e/o infermieristica esperta, adeguato supporto documentale ed informatico al fine di assicurare sicurezza, qualità e razionalità delle cure, outcome positivi di salute. Molti sono gli articoli scientifici e le esperienze a favore di una presa a carico infermieristica di pazienti con medicazioni complesse gestite tramite dispositivi NPWT. I presupposti affinché questo possa avvenire in sicurezza prevedono un processo definito in modo chiaro e condiviso fra professionisti sanitari ed assistiti, formazione aggiornata, documentazione corretta. During last twenty years, tailored technologies were spread and improved; they are aimed to support the treatment of difficult-toheal wounds, such as negative pressure wound therapy (NPWT). This type of treatment lead to promote healing process and to reduce hospital stay of patients. In an acute care setting, planning and managing these new technologies represent a key-point. We did a retrospective study about NPWT in acute care setting in Beata Vergine Regional Hospital in 2017, aimed at performing a clinical audit; the results were compared to scientific literature to detect differences in daily clinical practice. Audit is a very helpful tool for Clinical Government: this method leads to improve the management of clinical activities because the entire staff (physicians and nurses) obtains important data about care setting. Patients treated by NPWT are usually difficult to treat and need a correct assessment and a multidisciplinary approach. Consequently, fundamental aspects are represented by nursing staff education and its relationship with medical staff, data collections and computer-assisted technologies development. Significant scientific literature and clinical experience seem to recommend a nursing management of NPWT patients. This aspect is very interesting and it can be improved by specific education, adequate organization and correct data collection.

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ABSTRACT Objective To carry out an analysis of postgraduate education in Nutrition in Brazil in the period 2009-2018, including distance learning. Methods The article presents a historical-documentary analysis of the trajectory of Nutrition courses from 2009 to 2018. The bibliographic survey was carried out in the electronic databases of the Scientific Electronic Library Online, the National Library of Medicine, Google Academic databases, and through data collection in government websites and other institutions. Results In December 2018, there were 709 face-to-face and 1,094 distance learning Undergraduate Courses in Nutrition in the country. In the period, there was a 181.5% increase in the number of face-to-face courses, being 195.1% in the private sector, responsible for 89.1% of the total courses in the country. The highest concentration identified was in the Southeast Region did not change substantively in the period. Conclusion With 1,803 undergraduate courses in Nutrition in Brazil, of which the majority is composed of distance learning courses, the current scenario may be the most dramatic in the history of nutrition education in Brazil. Care must be taken to ensure that it is consistent, marked by opportunities for learning in society, in which the student can develop an investigative, critical, innovative spirit, having their professional identities clear in a multidisciplinary work team. The expansion of the offer of undergraduate courses in Nutrition did not correct regional asymmetries.

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PurposeThe purpose of this study is to draw on multiple streams analysis (MSA) and to investigate how policy change emerged from two inquiries into allegations of abusive hospital care in National Health Service (NHS) hospitals in the United Kingdom (UK) in the 1960s.Design/methodology/approachThe methodology of this study is regarding a historical case study of two inquiries.FindingsThe Sans Everything and Ely inquiries had the same legal standing and terms of reference, but the second put psychiatric hospital reform on the agenda, while the first did not. The main factor making Ely rather than Sans Everything the turning point seems to have been concerned with “agency”, linked with a few key individuals.Research limitations/implicationsA study of 1960s event necessarily relies heavily on documentary and archival sources, and cannot draw on interviews which are an important ingredient of many case studies.Originality/valueThe originality of the study is to examines inquiries, which have been largely neglected in MSA, despite their obvious potential role in placing issues on the agenda. Previous studies of MSA have devoted little attention to the ability of the media to provide the focus on “focusing events”.

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ABSTRACT Objective: to analyze the concept of critical thinking (CT) in Rodger's evolutionary perspective. Method: documentary research undertaken in the Cinahl, Lilacs, Bdenf and Dedalus databases, using the keywords of 'critical thinking' and 'Nursing', without limitation based on year of publication. The data were analyzed in accordance with the stages of Rodger's conceptual model. The following were included: books and articles in full, published in Portuguese, English or Spanish, which addressed CT in the teaching and practice of Nursing; articles which did not address aspects related to the concept of CT were excluded. Results: the sample was made up of 42 works. As a substitute term, emphasis is placed on 'analytical thinking', and, as a related factor, decision-making. In order, the most frequent preceding and consequent attributes were: ability to analyze, training of the student nurse, and clinical decision-making. As the implications of CT, emphasis is placed on achieving effective results in care for the patient, family and community. Conclusion: CT is a cognitive skill which involves analysis, logical reasoning and clinical judgment, geared towards the resolution of problems, and standing out in the training and practice of the nurse with a view to accurate clinical decision-making and the achieving of effective results.

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ABSTRACT Objective: to verify causes of inactivity in the Home Delivery Medicament Program, as referred by users from a Primary Health Care Service in São Paulo, comparing them to the causes registered in the program and analyzing them in the theoretical model Concept of Access to Health. Methods: cross-sectional study, interviewing 111 inactive users; and documentary study in the program records. Results: half of the users did not know the condition of inactivity. Discrepancies were found between the user's and the program's information, observing different levels of agreement: Absence of physician and administrative staff member 0%; Transfer to other service 25%; Death 50%; Option to quit 50%; Address change 57% and Change in therapeutic schedule 80%. The users' feeling of accepting the program was observed. In the health access concept, inactivity can be explained in the information dimension, in the degree of asymmetry between the patient's and the health professional's knowledge, identified through the indicators: education, knowledge and information sources. Conclusions: due to the low education level, the user does not assimilate the information on the steps of the program flowchart, does not return for the assessment that guarantees its continuity. Consequently, (s)he stops receiving the medication and spends a long time without treatment, increasing the cardiovascular risk of hypertensive (92% of the sample), diabetic (44%) and dyslipidemic patients (31%).

Abstract:

RÉSUMÉContexte : Il existe différentes stratégies pédagogiques permettant l’apprentissage, tant en milieu universitaire qu’en milieu professionnel. Parmi toutes ces stratégies, on note l’émergence de simulation ayant recours au concept de jeu d’évasion.Objectif : L’objectif était de recenser les modalités entourant l’utilisation, la conception et la réalisation de jeux d’évasion dans le domaine de la santé.Sources des données : Les recherches sur Pubmed, Embase et CINAHL ont été effectuées jusqu’au 3 décembre 2018. Sélection des études : Toutes les études portant sur la conception ou la réalisation de jeux d’évasion dans le domaine de la santé, en anglais et en français, ont été incluses. Extraction des données : Le pays, la population cible, la conception, la réalisation, la méthode d’évaluation et les résultats ont été extraits.Synthèse des données : Sept résumés de communication affichée et neuf articles ont été inclus. Douze jeux d’évasion ont été réalisés aux États-Unis. Ils sont utilisés en médecine (n = 5), en pharmacie (n = 4), en sciences infirmières (n = 4) ainsi que dans d’autres disciplines (n = 3), principalement dans un cadre pédagogique universitaire (n = 12) mais aussi professionnel (n = 4). Leurs objectifs visaient à améliorer les connaissances (n = 8), à augmenter l’intérêt et la motivation des participants pour un sujet précis (n = 2) et à améliorer la cohésion et la communication dans une équipe (n = 2). Dix des jeux d’évasion décrits dans les articles étaient basés sur un scénario orienté vers la clinique. Dix équipes ont réalisé un débriefing avec les participants, une équipe n’en a pas fait et cinq articles ne mentionnaient pas cette information.Conclusion : Il existe peu de données entourant l’utilisation de jeux d’évasion en santé. Il est trop tôt pour juger de l’efficacité de cette approche. Toutefois, l’intérêt grandissant justifie l’instauration d’une veille documentaire pour suivre l’évolution et mieux comprendre la place de ce type de stratégie dans l’apprentissage en santé.ABSTRACTBackground: Many different teaching strategies are used to promote learning in an academic or professional environment. Among these can be noted the emergence of simulation, based on the concept of escape games.Objective: To identify methodologies relating to the use, design, and implementation of escape games in health care.Data Sources: The Pubmed, Embase, and CINAHL databases were searched up to December 3, 2018.Study Selection: All studies focusing on the design or development of escape games in the health care field (published in English or French) were included.Data Extraction: For each study, the country, target population, design, development, method of evaluation, and results were extracted for analysis.Data Synthesis: Seven poster abstracts and 9 published articles were included. Twelve escape games were developed in the United States. They were used in medicine (n = 5), pharmacy (n = 4), nursing (n = 4) and other fields (n = 3), mainly within academic teaching contexts (n = 12) but also in professional settings (n = 4). Their goals were to improve knowledge (n = 8), to increase participants’ interest and motivation regarding a specific topic (n = 2), and to improve cohesion and commu-nication within a team (n = 2). Ten of the escape games described in the articles were based on a clinical scenario. Ten of the research teams held debriefings with participants, and one did not; 5 articles did not report information about debriefing.Conclusions: Few data exist concerning the use of escape games in the health care setting, and it is too early to judge the efficiency of this approach to learning. However, growing interest justifies systematic monitoring of the literature to follow the evolution of such strategies and to better understand their place in health care education.

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Abstract Background Hospitals in many countries are encouraged to develop audits to assess and improve the quality of care. Ward audit is a specific form of audit and feedback that is commonly used but little studied. The aim of this study is to describe the content and application of hospital ward audit in order to identify potential enhancements to such audits. Methods Multiple qualitative methods were used to study a diversity sample of four English National Health Service organisations over a 16-month period. We undertook semi-structured interviews (n = 32), documentary analysis (n = 44) and 25 h of observations of healthcare workers involved in the design and implementation of ward audit. Data were analysed using framework analysis. Findings were presented iteratively to stakeholders who used them to develop a description of the content and delivery of ward audit. Results Ward audit consisted of seven stages: impetus; method; preparation of staff; assessing practice; analysis; feedback; and decide on action to improve. Two key stages were the monthly assessment of practice using case note data extraction, and the resulting feedback to clinical staff, ward managers, matrons and directors of nursing. At three organisations, the case note data were extracted by staff and there was evidence that this resulted in misrepresentation of the clinical performance audited. The misrepresentation appeared to be associated with the anticipation of punitive feedback from directors of nursing and matrons, as well as time pressures and a lack clarity about the method of audit data collection. Punitive feedback was reported to occur if no data were collected, if data demonstrated poor performance or if performance did not improve. Conclusions Organisations invest considerable clinical resources in ward audit, but such audits may have unintended, potentially negative, consequences due to the impacts from punitive feedback. We discuss potential enhancements to ward audit (e.g. providing feedback recipients with suggested actions for improvement) and discuss implications for theory. There is a need to reduce the use of punitive feedback.

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In the last decade, the cell phone’s transformation from a tool for mobile telephony into a multi-modal, computational “smart” media device has engendered a new kind of emplacement, and the ubiquity of technological mediation into the everyday settings of urban life. With it, a new kind of media literacy has become necessary for participation in the networked social publics (Ito; Jenkins et al.). Increasingly, the way we experience our physical environments, make sense of immediate events, and form impressions is through the lens of the camera and through the ear of the microphone, framed by the mediating possibilities of smartphones. Adopting these practices as a kind of new media “grammar” (Burn 29)—a multi-modal language for public and interpersonal communication—offers new perspectives for thinking about the way in which mobile computing technologies allow us to explore our environments and produce new types of cultural knowledge. Living in the Social Multiverse Many of us are concerned about new cultural practices that communication technologies bring about. In her now classic TED talk “Connected but alone?” Sherry Turkle talks about the world of instant communication as having the illusion of control through which we micromanage our immersion in mobile media and split virtual-physical presence. According to Turkle, what we fear is, on the one hand, being caught unprepared in a spontaneous event and, on the other hand, missing out or not documenting or recording events—a phenomenon that Abha Dawesar calls living in the “digital now.” There is, at the same time, a growing number of ways in which mobile computing devices connect us to new dimensions of everyday life and everyday experience: geo-locative services and augmented reality, convergent media and instantaneous participation in the social web. These technological capabilities arguably shift the nature of presence and set the stage for mobile users to communicate the flow of their everyday life through digital storytelling and media production. According to a Digital Insights survey on social media trends (Bennett), more than 500 million tweets are sent per day and 5 Vines tweeted every second; 100 hours of video are uploaded to YouTube every minute; more than 20 billion photos have been shared on Instagram to date; and close to 7 million people actively produce and publish content using social blogging platforms. There are more than 1 billion smartphones in the US alone, and most social media platforms are primarily accessed using mobile devices. The question is: how do we understand the enormity of these statistics as a coherent new media phenomenon and as a predominant form of media production and cultural participation? More importantly, how do mobile technologies re-mediate the way we see, hear, and perceive our surrounding evironment as part of the cultural circuit of capturing, sharing, and communicating with and through media artefacts? Such questions have furnished communication theory even before McLuhan’s famous tagline “the medium is the message”. Much of the discourse around communication technology and the senses has been marked by distinctions between “orality” and “literacy” understood as forms of collective consciousness engendered by technological shifts. Leveraging Jonathan Sterne’s critique of this “audio-visual litany”, an exploration of convergent multi-modal technologies allows us to focus instead on practices and techniques of use, considered as both perceptual and cultural constructs that reflect and inform social life. Here in particular, a focus on sound—or aurality—can help provide a fresh new entry point into studying technology and culture. The phenomenon of everyday photography is already well conceptualised as a cultural expression and a practice connected with identity construction and interpersonal communication (Pink, Visual). Much more rarely do we study the act of capturing information using mobile media devices as a multi-sensory practice that entails perceptual techniques as well as aesthetic considerations, and as something that in turn informs our unmediated sensory experience. Daisuke and Ito argue that—in contrast to hobbyist high-quality photographers—users of camera phones redefine the materiality of urban surroundings as “picture-worthy” (or not) and elevate the “mundane into a photographic object.” Indeed, whereas traditionally recordings and photographs hold institutional legitimacy as reliable archival references, the proliferation of portable smart technologies has transformed user-generated content into the gold standard for authentically representing the everyday. Given that visual approaches to studying these phenomena are well underway, this project takes a sound studies perspective, focusing on mediated aural practices in order to explore the way people make sense of their everyday acoustic environments using mobile media. Curation, in this sense, is a metaphor for everyday media production, illuminated by the practice of listening with mobile technology. Everyday Listening with Technology: A Case Study The present conceptualisation of curation emerged out of a participant-driven qualitative case study focused on using mobile media to make sense of urban everyday life. The study comprised 10 participants using iPod Touches (a device equivalent to an iPhone, without the phone part) to produce daily “aural postcards” of their everyday soundscapes and sonic experiences, over the course of two to four weeks. This work was further informed by, and updates, sonic ethnography approaches nascent in the World Soundscape Project, and the field of soundscape studies more broadly. Participants were asked to fill out a questionnaire about their media and technology use, in order to establish their participation in new media culture and correlate that to the documentary styles used in their aural postcards. With regard to capturing sonic material, participants were given open-ended instructions as to content and location, and encouraged to use the full capabilities of the device—that is, to record audio, video, and images, and to use any applications on the device. Specifically, I drew their attention to a recording app (Recorder) and a decibel measurement app (dB), which combines a photo with a static readout of ambient sound levels. One way most participants described the experience of capturing sound in a collection of recordings for a period of time was as making a “digital scrapbook” or a “media diary.” Even though they had recorded individual (often unrelated) soundscapes, almost everyone felt that the final product came together as a stand-alone collection—a kind of gallery of personalised everyday experiences that participants, if anything, wished to further organise, annotate, and flesh out. Examples of aural postcard formats used by participants: decibel photographs of everyday environments and a comparison audio recording of rain on a car roof with and without wipers (in the middle). Working with 139 aural postcards comprising more than 250 audio files and 150 photos and videos, the first step in the analysis was to articulate approaches to media documentation in terms of format, modality, and duration as deliberate choices in conversation with dominant media forms that participants regularly consume and are familiar with. Ambient sonic recordings (audio-only) comprised a large chunk of the data, and within this category there were two approaches: the sonic highlight, a short vignette of a given soundscape with minimal or no introduction or voice-over; and the process recording, featuring the entire duration of an unfolding soundscape or event. Live commentaries, similar to the conventions set forth by radio documentaries, represented voice-over entries at the location of the sound event, sometimes stationary and often in motion as the event unfolded. Voice memos described verbal reflections, pre- or post- sound event, with no discernable ambience—that is, participants intended them to serve as reflective devices rather than as part of the event. Finally, a number of participants also used the sound level meter app, which allowed them to generate visual records of the sonic levels of a given environment or location in the form of sound level photographs. Recording as a Way of Listening In their community soundwalking practice, Förnstrom and Taylor refer to recording sound in everyday settings as taking world experience, mediating it through one’s body and one’s memories and translating it into approximate experience. The media artefacts generated by participants as part of this study constitute precisely such ‘approximations’ of everyday life accessed through aural experience and mediated by the technological capabilities of the iPod. Thinking of aural postcards along this technological axis, the act of documenting everyday soundscapes involves participants acting as media producers, ‘framing’ urban everyday life through a mobile documentary rubric. In the process of curating these documentaries, they have to make decisions about the significance and stylistic framing of each entry and the message they wish to communicate. In order to bring the scope of these curatorial decisions into dialogue with established media forms, in this work’s analysis I combine Bill Nichols’s classification of documentary modes in cinema with Karin Bijsterveld’s concept of soundscape ‘staging’ to characterise the various approaches participants took to the multi-modal curation of their everyday (sonic) experience. In her recent book on the staging of urban soundscapes in both creative and documentary/archival media, Bijsterveld describes the representation of sound as particular ‘dramatisations’ that construct different kinds of meanings about urban space and engender different kinds of listening positions. Nichols’s articulation of cinematic documentary modes helps detail ways in which the author’s intentionality is reflected in the styling, design, and presentation of filmic narratives. Michel Chion’s discussion of cinematic listening modes further contextualises the cultural construction of listening that is a central part of both design and experience of media artefacts. The conceptual lens is especially relevant to understanding mobile curation of mediated sonic experience as a kind of mobile digital storytelling. Working across all postcards, settings, and formats, the following four themes capture some of the dominant stylistic dimensions of mobile media documentation. The exploratory approach describes a methodology for representing everyday life as a flow, predominantly through ambient recordings of unfolding processes that participants referred to in the final discussion as a ‘turn it on and forget it’ approach to recording. As a stylistic method, the exploratory approach aligns most closely with Nichols’s poetic and observational documentary modes, combining a ‘window to the world’ aesthetic with minimal narration, striving to convey the ‘inner truth’ of phenomenal experience. In terms of listening modes reflected in this approach, exploratory aural postcards most strongly engage causal listening, to use Chion’s framework of cinematic listening modes. By and large, the exploratory approach describes incidental documentaries of routine events: soundscapes that are featured as a result of greater attentiveness and investment in the sonic aspects of everyday life. The entries created using this approach reflect a process of discovering (seeing and hearing) the ordinary as extra-ordinary; re-experiencing sometimes mundane and routine places and activities with a fresh perspective; and actively exploring hidden characteristics, nuances of meaning, and significance. For instance, in the following example, one participant explores a new neighborhood while on a work errand:The narrative approach to creating aural postcards stages sound as a springboard for recollecting memories and storytelling through reflecting on associations with other soundscapes, environments, and interactions. Rather than highlighting place, routine, or sound itself, this methodology constructs sound as a window into the identity and inner life of the recordist, mobilising most strongly a semantic listening mode through association and narrative around sound’s meaning in context (Chion 28). This approach combines a subjective narrative development with a participatory aesthetic that draws the listener into the unfolding story. This approach is also performative, in that it stages sound as a deeply subjective experience and approaches the narrative from a personally significant perspective. Most often this type of sound staging was curated using voice memo narratives about a particular sonic experience in conjunction with an ambient sonic highlight, or as a live commentary. Recollections typically emerged from incidental encounters, or in the midst of other observations about sound. In the following example a participant reminisces about the sound of wind, which, interestingly, she did not record: Today I have been listening to the wind. It’s really rainy and windy outside today and it was reminding me how much I like the sound of wind. And you know when I was growing up on the wide prairies, we sure had a lot of wind and sometimes I kind of miss the sound of it… (Participant 1) The aesthetic approach describes instances where the creation of aural postcards was motivated by a reduced listening position (Chion 29)—driven primarily by the qualities and features of the soundscape itself. This curatorial practice for staging mediated aural experience combines a largely subjective approach to documenting with an absence of traditional narrative development and an affective and evocative aesthetic. Where the exploratory documentary approach seeks to represent place, routine, environment, and context through sonic characteristics, the aesthetic approach features sound first and foremost, aiming to represent and comment on sound qualities and characteristics in a more ‘authentic’ manner. The media formats most often used in conjunction with this approach were the incidental ambient sonic highlight and the live commentary. In the following example we have the sound of coffee being made as an important domestic ritual where important auditory qualities are foregrounded: That’s the sound of a stovetop percolator which I’ve been using for many years and I pretty much know exactly how long it takes to make a pot of coffee by the sound that it makes. As soon as it starts gurgling I know I have about a minute before it burns. It’s like the coffee calls and I come. (Participant 6) The analytical approach characterises entries that stage mediated aural experience as a way of systematically and inductively investigating everyday phenomena. It is a conceptual and analytical experimental methodology employed to move towards confirming or disproving a ‘hypothesis’ or forming a theory about sonic relations developed in the course of the study. As such, this approach most strongly aligns with Chion’s semantic listening mode, with the addition of the interactive element of analytical inquiry. In this context, sound is treated as a variable to be measured, compared, researched, and theorised about in an explicit attempt to form conclusions about social relationships, personal significance, place, or function. This analytical methodology combines an explicit and critical focus to the process of documenting itself (whether it be measuring decibels or systematically attending to sonic qualities) with a distinctive analytical synthesis that presents as ‘formal discovery’ or even ‘truth.’ In using this approach, participants most often mobilised the format of short sonic highlights and follow-up voice memos. While these aural postcards typically contained sound level photographs (decibel measurement values), in some cases the inquiry and subsequent conclusions were made inductively through sustained observation of a series of soundscapes. The following example is by a participant who exclusively recorded and compared various domestic spaces in terms of sound levels, comparing and contrasting them using voice memos. This is a sound level photograph of his home computer system: So I decided to record sitting next to my computer today just because my computer is loud, so I wanted to see exactly how loud it really was. But I kept the door closed just to be sort of fair, see how quiet it could possibly get. I think it peaked at 75 decibels, and that’s like, I looked up a decibel scale, and apparently a lawn mower is like 90 decibels. (Participant 2) Mediated Curation as a New Media Cultural Practice? One aspect of adopting the metaphor of ‘curation’ towards everyday media production is that it shifts the critical discourse on aesthetic expression from the realm of specialised expertise to general practice (“Everyone’s a photographer”). The act of curation is filtered through the aesthetic and technological capabilities of the smartphone, a device that has become co-constitutive of our routine sensorial encounters with the world. Revisiting McLuhan-inspired discourses on communication technologies stages the iPhone not as a device that itself shifts consciousness but as an agent in a media ecology co-constructed by the forces of use and design—a “crystallization of cultural practices” (Sterne). As such, mobile technology is continuously re-crystalised as design ‘constraints’ meet both normative and transgressive user approaches to interacting with everyday life. The concept of ‘social curation’ already exists in commercial discourse for social web marketing (O’Connell; Allton). High-traffic, wide-integration web services such as Digg and Pinterest, as well as older portals such as Reddit, all work on the principles of arranging user-generated, web-aggregated, and re-purposed content around custom themes. From a business perspective, the notion of ‘social curation’ captures, unsurprisingly, only the surface level of consumer behaviour rather than the kinds of values and meaning that this process holds for people. In the more traditional sense, art curation involves aesthetic, pragmatic, epistemological, and communication choices about the subject of (re)presentation, including considerations such as manner of display, intended audience, and affective and phenomenal impact. In his 2012 book tracing the discourse and culture of curating, Paul O’Neill proposes that over the last few decades the role of the curator has shifted from one of arts administrator to important agent in the production of cultural experiences, an influential cultural figure in her own right, independent of artistic content (88). Such discursive shifts in the formulation of ‘curatorship’ can easily be transposed from a specialised to a generalised context of cultural production, in which everyone with the technological means to capture, share, and frame the material and sensory content of everyday life is a curator of sorts. Each of us is an agent with a unique aesthetic and epistemological perspective, regardless of the content we curate. The entire communicative exchange is necessarily located within a nexus of new media practices as an activity that simultaneously frames a cultural construction of sensory experience and serves as a cultural production of the self. To return to the question of listening and a sound studies perspective into mediated cultural practices, technology has not single-handedly changed the way we listen and attend to everyday experience, but it has certainly influenced the range and manner in which we make sense of the sensory ‘everyday’. Unlike acoustic listening, mobile digital technologies prompt us to frame sonic experience in a multi-modal and multi-medial fashion—through the microphone, through the camera, and through the interactive, analytical capabilities of the device itself. Each decision for sensory capture as a curatorial act is both epistemological and aesthetic; it implies value of personal significance and an intention to communicate meaning. The occurrences that are captured constitute impressions, highlights, significant moments, emotions, reflections, experiments, and creative efforts—very different knowledge artefacts from those produced through textual means. Framing phenomenal experience—in this case, listening—in this way is, I argue, a core characteristic of a more general type of new media literacy and sensibility: that of multi-modal documenting of sensory materialities, or the curation of everyday life. References Allton, Mike. “5 Cool Content Curation Tools for Social Marketers.” Social Media Today. 15 Apr. 2013. 10 June 2015 ‹http://socialmediatoday.com/mike-allton/1378881/5-cool-content-curation-tools-social-marketers›. Bennett, Shea. “Social Media Stats 2014.” Mediabistro. 9 June 2014. 20 June 2015 ‹http://www.mediabistro.com/alltwitter/social-media-statistics-2014_b57746›. Bijsterveld, Karin, ed. Soundscapes of the Urban Past: Staged Sound as Mediated Cultural Heritage. Bielefeld: Transcript-Verlag, 2013. Burn, Andrew. Making New Media: Creative Production and Digital Literacies. New York, NY: Peter Lang Publishing, 2009. Daisuke, Okabe, and Mizuko Ito. “Camera Phones Changing the Definition of Picture-worthy.” Japan Media Review. 8 Aug. 2015 ‹http://www.dourish.com/classes/ics234cw04/ito3.pdf›. Chion, Michel. Audio-Vision: Sound on Screen. New York, NY: Columbia UP, 1994. Förnstrom, Mikael, and Sean Taylor. “Creative Soundwalks.” Urban Soundscapes and Critical Citizenship Symposium. Limerick, Ireland. 27–29 March 2014. Ito, Mizuko, ed. Hanging Out, Messing Around, and Geeking Out: Kids Living and Learning with New Media. Cambridge, MA: The MIT Press, 2010. Jenkins, Henry, Ravi Purushotma, Margaret Weigel, Katie Clinton, and Alice J. Robison. Confronting the Challenges of Participatory Culture: Media Education for the 21st Century. White Paper prepared for the McArthur Foundation, 2006. McLuhan, Marshall. Understanding Media: The Extensions of Man. New York: McGraw-Hill, 1964. Nichols, Brian. Introduction to Documentary. Bloomington & Indianapolis, Indiana: Indiana UP, 2001. Nielsen. “State of the Media – The Social Media Report.” Nielsen 4 Dec. 2012. 12 May 2015 ‹http://www.nielsen.com/us/en/insights/reports/2012/state-of-the-media-the-social-media-report-2012.html›. O’Connel, Judy. “Social Content Curation – A Shift from the Traditional.” 8 Aug. 2011. 11 May 2015 ‹http://judyoconnell.com/2011/08/08/social-content-curation-a-shift-from-the-traditional/›. O’Neill, Paul. The Culture of Curating and the Curating of Culture(s). Cambridge, MA: MIT Press, 2012. Pink, Sarah. Doing Visual Ethnography. London, UK: Sage, 2007. ———. Situating Everyday Life. London, UK: Sage, 2012. Sterne, Jonathan. The Audible Past: Cultural Origins of Sound Reproduction. Durham, NC: Duke UP, 2003. Schafer, R. Murray, ed. World Soundscape Project. European Sound Diary (reprinted). Vancouver: A.R.C. Publications, 1977. Turkle, Sherry. “Connected But Alone?” TED Talk, Feb. 2012. 8 Aug. 2015 ‹http://www.ted.com/talks/sherry_turkle_alone_together?language=en›.

Abstract:

The borderline between fiction and non-fiction is, like much that is liminal, deeply attractive to observers, and among the consequences of this is a proliferation of names; 'faction', 'fictocriticism' and the shifting pairing of docudrama/dramadoc operate to indicate the blending of different types of fictional and non-fictional material. All of these produce that feeling of unease proper to liminal states. In his recent study, Derek Paget notes how it is the seriousness of the truth claims of that version of non-fiction called documentary that makes its mixing with drama so fraught with potential for controversy. In Queensland we might recall some of the arguments over the screening of Joh's Jury, but Paget underpins his analysis of material like the 1992 HBO/Granada production Hostages with reference to the four year sentence imposed in 1997 on German documentary maker Michael Born for faking material for his documentaries (1). Here not making clear the hybridity of the material was not just an impropriety, but a crime. Yet the liminal material that most fascinates me hides its hybrid nature behind a shifting collection of different terms, ones like 'projection', 'forecast', 'extrapolation' or even (on bad days) 'mission statement'. This particular body of writing is accessible non-fiction about the future. As one who has used science fiction as my basic tool for thinking about the future since I was a child, the question 'how do you write non-fictionally about something that has not yet happened?' fascinates me. That it does not seem to bother other people all that much is what seems strange. How is it that non-fiction about the future differs from science fiction about the future (and for those unfamiliar with or disdainful about the genre, sf can be set in the present, the past or the future)? Certainly one can see distinctions at the extremes; the arrival of tentacled telepathic aliens travelling faster than light characterises sf rather than science, but as another space probe sets off for the Red Planet and visionary future missions are planned, how smug can we be about the difference between the projections of what will be found and the calm descriptive passages of Kim Stanley Robinson's Red Mars? Indeed the example of the Mars probe was prompted by my current piece of sf reading -- Paul McCauley's Fairyland -- where the 21st century inhabitants of a nanotech-enhanced Europe pursue their affairs against the background of the arrival of television pictures of the first landing of humans on Mars. Sf really loves to vaunt its relationship to science. Devotees of sf, fans and aware readers alike, can reel off a collection of instances when sf seemed to have predicted future scientific or technological developments. The core one here is Arthur C. Clarke's statement of the principles of communication satellites over a decade before the launch of Telstar. (It is quite possible that those people under the age of 50 who know what Telstar is -- the 'r' is now a very important distinguishing feature -- only do so because of its function in this prime example.) Most of the other examples are at heart ones of naming rather than scientific principles -- waldos are now more or less what Robert Heinlein called them in the novella Waldo, and cyberspace is the word used to name something not very much like the inhabitable virtual space in William Gibson's Neuromancer, though many pretend otherwise. There are more, but they are vastly outnumbered by the instances of irrelevance or worse, failed prediction. Most readers have favourite moments when people in the control room of a space ship reach for a slide rule or feed in punch cards, but sf, especially genre sf (i.e. not literary fiction or utopian allegory set in the future), is in the business of entertainment not prediction. Science fiction needs science to give it generic clout, or as Darko Suvin demands, to provide the cognitive support for its imaginative operations (13). Sf writers, even those given to fantastic elements, like to provide acknowledgement pages where they thank the scientists who aren't to blame for any mistakes but helped a lot. Anne McCaffrey is much given to thanking Jack Cohen, but then so are a lot of other people -- Cohen is a biologist, great fan of the genre and a major deliverer of lectures on scientific topics at sf fan conventions. Writers like David Brin actually are scientists with serious credentials. People heavily involved in sf can trot out reams of these instances as well as mentioning how writers without scientific training can still stay within credible parameters when designing new worlds by feeding the data of their desired planet into a computer program which will give them its physical properties and save them from being bombarded with reader's letters pointing out their mistakes. But all of this wonderful fertile mix of science and fiction comes to an abrupt halt when the field of play is science itself in its public guise. Here science is real, science is earnest and sf is a serious problem -- it gives people bad ideas and worse it is popular, especially with the young. While sf is constantly trying to make claims for its own scientificity, trying to show that science and the fiction that has taken its name are absolutely made for each other, entwined together for ever and ever amen, science keeps disentangling the fictional tendrils, pushing off the importunate lover, and trying to deny it was ever tempted to get involved. Sf has so much to gain from the relationship -- status and difference from its fictional like; science has so much to lose. But there is something for science to gain -- and if it's not as even-handed as Fred Astaire giving Ginger Rogers class while she gave him sex appeal, that is a pretty accurate description of the trade (and yes, to continue the analogy, sf does have to do it backwards and in high heels). Sf is the blonde or the beefcake that pulls in the punters for the serious business of the factual, but having called people in, it must be disowned. If you haven't heard my title, you haven't been watching televised technology programmes like Australia's great export success (forget about Neighbours, I mean Beyond 2000, already operating to overcome the lack of prescience about how long the title would work) and you've been missing some news and current affairs too. It seems particularly common in non-fiction segments on robotics. A small mechanical device shambles towards the camera as a voice-over intones "This may look like science fiction, but it is actually a scene from a laboratory in downtown Tokyo" (or it might be from the Media Labs at MIT -- the difference being in the visible pizza boxes). The viewer has been hailed with something familiar and attractive, which has then been disavowed to allow the truth to shine through. Why does the catch phrase occur? Why invoke science fiction only to deny it? A piece of writing about the future cast in the non-fictional mode calls on science fiction for one of several reasons: it may want to attract readers; it may need an accompanying graphic; or it may want to talk about a wonderful new gizmo of some kind and feel the need to attach the unknown to something (however bizarrely) known. Sf is the solution to all these problems since it is arresting or popular (more fun that dusty old science might be feared to be -- I must say I don't have this view of science, but it underwrites the establishment of organisations for the Public Understanding of Science and other pieces of science PR) and it produces pictures purporting to be of the future that have more appeal than the other bodies of futurological graphics. If you don't use stills from sf films or TV (and these are certainly preferable in terms of respectability to the kind of material used for the covers of sf novels or comics), what you are left with are graphs or architects' drawings and these can only do so much. I don't really know all that many people who share my fondness for the Southern Oscillation Index graph on the weather forecast, after all. I recently came across a different use of sf in something of a scientific context. It was not disavowed quite, and I did not even find it accurate, but it points to the symbiotic elements of the couple which is not a couple. It was a review of Richard Ellis's The Search for the Giant Squid (Guardian Weekly 10 Jan. 99). Much of the material referred to in the book was fictional, but the squid and the core of the book was scientific. Michael Dirda, the reviewer, starts a paragraph in the middle of the review by saying: "When he wants to, Ellis can make his science almost science fictional: 'It is now assumed that the sperm whale captures its prey by emitting sound beams of such intensity that they can stun or even kill the prey.'" Now that doesn't sound science fictional to me -- it sounds pretty much pure David Attenborough. And neither Dirda nor Ellis appear to disavow the sf evoked. It is as if there was a convention by which a scientifically-inflected piece of journalism had to gesture to sf come what may, but only had to deny it if it involved the future where the risk of the truth claims of the scientific being compromised by the sf is presumably greater. The basic requirement in being seen to speak truthfully about the future is to reduce apparent fictionality. The best way to do this is to call on the most powerful available truth-speaking discourse, that is to speak scientifically or even more these days, economically. Science can talk very seriously indeed about the future (though it is being tempted into dangerous waters by computer technology working with terms like nanobots and foglets), but as for economics... Well, it has a whole practice which it calls futures, which is entirely speculative, but which can result in the most hallowed production of the 'real' to be encountered -- actual money. To a surprising, or perhaps that should be suspicious, extent, science disguises the fact that it speaks of the future. It engages in inventions which will become usable, discovers things which will change how current practices will be conducted, projects variations in demand; all these wonderful things which only reveal in the tense of the associated verb that their time of actuality is not quite yet. The area that is most overt about its practice of non-fictional future speaking is actually called futurology. Futurology is centred far more in the social sciences and this makes it comparatively weak from the outset. It may be that its honesty about what it engages in reduces its social power. Announcing oneself a futurologist may work as a chat-up line (though the social occasion at which it did so might give one pause) but it doesn't convert into truth-speaking power -- much better to claim to specialise in futures. Yet, when futurology calls on sf, at least it is not necessary for it to engage in the same processes of disavowal or even denial. Academics get used to being disappointed by articles that sound as if they would be really promising for a current or projected piece of work, but one of my greatest disappointments was with a brief piece by Jim Dator with the great title "What Do 'You' Do When Your Robot Bows, as Your Clone Enters Holographic MTV?". Dator is currently head of the Hawaii Research Center for Futures Studies at the University of Hawaii and chair of the World Future Studies Federation. He is thus someone who constantly works with the problem at the core of my concern. As I recall, when I went in search of the Dator article, I had expectations of an etiquette guide for the multiply present, but what I got was more a piece noting how wow! humans may not (continue to) be the peak of evolution for that much longer. Well, Charles Darwin died for that thought long ago anyway and why would Alan Turing have bothered with his Test if he hadn't suspected something similar. Although it's quite an old article at the speed Dator publishes, its calling on an sf scenario, however low-key, to draw attention to non-fictional writing is characteristic of the practice shared with science. I may have been saddened by its failure to even try to deliver on the promise of its title, but at least futurology does not see the necessity of disavowal. In all the reading I've done over the years in both areas there has only been one occasion when I've encountered any disclaimer in a science fictional work which has any parallel to the insistent disclaimers of science fictionality in science writing. It is not of course a disclaimer of scientificity. Instead it is an emphatic assertion of fictionality. What, you ask could possibly require this in a piece of science fiction? Ah, what but autobiography and within that the suspicion of sexual confession. Nicola Griffith puts a post-note to her most recent novel Slow River (both an ecological and a psycho-sexual thriller). It reads: "There is a disturbing tendency among readers -- particularly critics -- to assume that any woman who writes about abuse, no matter how peripherally, must be speaking from her own experience. This is, in Joanna Russ's terms, a denial of the writer's imagination. Should anyone be tempted to assume otherwise, let me be explicit: Slow River is fiction not autobiography. I made it up." So there you have a hierarchy of threats to status, perhaps: science, science fiction and (women's) autobiography. Observe however that I have not put the economic on the list. References Dator, Jim. "What Do 'You' Do When Your Robot Bows, as Your Clone Enters Holographic MTV?" Futures 21 (4 Aug. 1989): 361-5. Paget, Derek. No Other Way to Tell It: Dramadoc/Docudrama on Television. Manchester: Manchester UP, 1998. Suvin, Darko. Metamorphoses of Science Fiction: On the Poetics and History of a Literary Genre. New Haven: Yale UP, 1979 Recommendations Griffith, Nicola. Slow River. New York: Del Rey, 1995. McCauley, Paul. Fairyland. London: Vista, 1995. Citation reference for this article MLA style: Frances Bonner. "This May Look like Science Fiction, But..." M/C: A Journal of Media and Culture 2.1 (1999). [your date of access] <http://www.uq.edu.au/mc/9902/look.php>. Chicago style: Frances Bonner, "This May Look like Science Fiction, But...," M/C: A Journal of Media and Culture 2, no. 1 (1999), <http://www.uq.edu.au/mc/9902/look.php> ([your date of access]). APA style: Frances Bonner. (1999) This may look like science fiction, but... M/C: A Journal of Media and Culture 2(1). <http://www.uq.edu.au/mc/9902/look.php> ([your date of access]).