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© Crown copyright 2013. Contains public sector information licensed under the Open Government Licence v3.0© Queen’s Printer and Controller of HMSO 2019. This work was produced by Harriset al.under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.20132019Crown copyrightQueen’s Printer and Controller of HMSOBackgroundThe government response to the care failures at the Mid Staffordshire NHS Foundation Trust led to the policy imperative of ‘regular interaction and engagement between nurses and patients’ (Francis R.Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. London: The Stationery Office; 2013. © Crown copyright 2013. Contains public sector information licensed under the Open Government Licence v3.0) in the NHS. The pressure on nursing to act resulted in the introduction of the US model, known as ‘intentional rounding’, into nursing practice. This is a timed, planned intervention that sets out to address fundamental elements of nursing care by means of a regular bedside ward round.ObjectivesThe study aims were to examine what it is about intentional rounding in hospital wards that works, for whom and in what circumstances.DesignA multimethod study design was undertaken using realist evaluation methodology. The study was conducted in four phases: (1) theory development; (2) a national survey of all NHS acute trusts in England; (3) in-depth case studies of six wards, involving individual interviews, observations, retrieval of routinely collected ward outcome data and analysis of costs; and (4) synthesis of the study findings.SettingThe study was conducted in acute NHS trusts in England.ParticipantsA total of 108 acute NHS trusts participated in the survey. Seventeen senior managers, 33 front-line nurses, 28 non-nursing professionals, 34 patients and 28 carers participated in individual interviews. Thirty-nine members of nursing staff were shadowed during their delivery of intentional rounding and the direct care received by 28 patients was observed.Review methodsA realist synthesis was undertaken to identify eight context–mechanism–outcome configurations, which were tested and refined using evidence collected in subsequent research phases.ResultsThe national survey showed that 97% of NHS trusts had implemented intentional rounding in some way. Data synthesis from survey, observation and interview findings showed that only two of the original eight mechanisms were partially activated (consistency and comprehensiveness, and accountability). The evidence for two mechanisms was inconclusive (visibility of nurses and anticipation); there was minimal evidence for one mechanism (multidisciplinary teamwork and communication) and no evidence for the remaining three (allocated time to care, nurse–patient relationships and communication, and patient empowerment). A total of 240 intentional rounds were observed within 188 hours of care delivery observation. Although 86% of all intentional rounding interactions were observed to be documented, fidelity to the original intervention [i.e. the Studer Group protocol (Studer Group.Best Practices: Sacred Heart Hospital, Pensacola, Florida. Hourly Rounding Supplement. Gulf Breeze, FL: Studer Group; 2007)] was generally low.LimitationsIntentional rounding was often difficult for researchers to observe, as it was rarely delivered as a discrete activity but instead undertaken alongside other nursing activities. Furthermore, a lack of findings about the influence of intentional rounding on patient outcomes in the safety thermometer data limits inferences on how mechanisms link to clinical outcomes for patients.ConclusionsThe evidence from this study demonstrates that the effectiveness of intentional rounding, as currently implemented and adapted in England, is very weak and falls short of the theoretically informed mechanisms. There was ambivalence and concern expressed that intentional rounding oversimplifies nursing, privileges a transactional and prescriptive approach over relational nursing care, and prioritises accountability and risk management above individual responsive care.Future workIt is suggested that the insights and messages from this study inform a national conversation about whether or not intentional rounding is the optimum intervention to support the delivery of fundamental nursing care to patients, or if the time is right to shape alternative solutions.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

This paper describes an Experience-based Co-design (EBCD) project that aimed to increase patient activity within an acute stroke unit. We apply the concept of liminality to explore ways in which the EBCD process, a form of Participatory Action Research, may dilute or even dissolve social hierarchies and challenge assumptions about practices and constraints in this care setting, thereby opening up possibilities for transformation that enhances the therapeutic value of the space for patients and care providers alike. By occasioning a liminal phase of possibility for change, the work of one co-design group explored in detail here suggests that, in this process, the sociomaterial interactions involving patients, family members, staff, and the physical space are refashioned and re-inscribed in transformed ‘emplaced’ relationships of care., Highlights • EBCD improved an acute stroke unit environment to provide greater opportunity for social and therapeutic activity. • The structured EBCD approach provided a ‘liminal’ space within which collaborative change could be enabled. • Liminality facilitated trust and built a sense of community between participating patients, families and staff. • The different roles adopted by participants during the process challenged norms and effected change.

Regulation 2017/821 requires EU importers to ensure that minerals with which they work originate from responsible sources and that businesses comply with and report on supply chain due diligence obligations with special focus on so-called conflict-affected and high-risk areas (CAHRAs). This report presents the methodology proposed by RAND Europe to produce an indicative, non-exhaustive, regularly updated list of CAHRAs under Regulation 2017/821.

Data walls, used to display student data within schools, are a growing phenomenon internationally. Drawing on a conceptual model of data use, this systematic review examined 32 empirical sources from compulsory education settings to evaluate claims about the impact of data walls on teaching and learning. The review found details regarding goals for data walls and the displayed information, but there was limited evidence of how data analysis was used to guide improvement action and evaluation of impact. The review concluded that there is currently insufficient empirical research evidence to substantiate or refute claims about their educational effects.

Background Compassion is integral to professional nursing practice worldwide and a fundamental value in healthcare. Following serious care failures at a healthcare provider in the United Kingdom, a government commissioned report (the Francis Report) made several recommendations for strengthening compassion in nursing care and consequently ‘intentional rounding’ was incorporated into nursing practice in the United Kingdom. Intentional rounding is a structured process implemented primarily in the United Kingdom, North America and Australia, whereby nurses conduct 1–2 hourly checks on every patient using a standardised protocol and documentation. Objectives To examine the role of intentional rounding in the delivery of compassionate nursing care in England from multiple perspectives. Methods This paper reports qualitative findings from one phase of a realist evaluation of intentional rounding which used a mixed-methods approach. Individual, semi-structured interviews were undertaken with 33 nursing staff, 17 senior nurse managers, 34 patients and 28 family carers from three geographically spread case study hospital sites in England. Interviews elicited detailed reflections on the contexts, mechanisms and outcomes of intentional rounding and how it impacted the interviewee and those around them. Results This study found little evidence that intentional rounding ensures the comfort, safety or dignity of patients or increases the delivery of compassionate care. The systematised approach of intentional rounding emphasises transactional care delivery in the utilisation of prescribed methods of recording or tick boxes rather than relational, individualised patient care. It has the potential to reduce the scope of nursing care to a minimum standard, leading to a focus on the fundamentals as well as the prevention of adverse events. Its documentation is primarily valued by nursing staff as a means of protecting themselves through written proof or ‘evidence’ of care delivered, rather than as a means of increasing compassionate care. Conclusions This large-scale, theoretically-driven study of intentional rounding – the first of its kind – demonstrates that intentional rounding prioritises data collection through tick boxes or a prescriptive and structured recording of care. Thus, intentional rounding neither improves the delivery of compassionate nursing care nor addresses the policy imperative it was intended to target. This study raises questions about the role, contribution and outcomes from intentional rounding and suggests a need for a wider, international debate within the nursing profession about its future use. If an intervention to increase compassionate nursing care is required, it may be better to start afresh, rather than attempting to adapt the system currently implemented.

Background Clinically assisted hydration (CAH) at end of life is a contentious issue (Cabanero-Martinez et al, 2016) There is disagreement as to its benefits and this can lead to a lack of concordance between medical and nursing opinions, with nurses feeling unable to challenge doctors (Churchman, 2010; Van Der Riet, 2008; Mayashita, 2007). Prior to introducing a feasibility study on CAH (Davies, 2018) on one hospice site, an unpublished survey of nursing staff revealed widespread dissatisfaction with the standard practice of not routinely offering CAH. Following completion of the study a staff survey was undertaken to see if attitudes had changed. Aims To determine if nurses feel coerced into accepting the current hospice policy on CAH. To examine how nurses interacted with families when asked about CAH. To explore staff engagement with research on CAH. Method A semi-structured questionnaire sent to all nursing staff including HCA’s, with closed and open-ended questions. The responses were analysed using descriptive statistics and thematic analysis. Results The responses indicated that; The majority accept standard care without feeling coerced (68%). Nurses felt they could challenge accepted practice (62%). An overwhelming majority felt the hospice should be engaged in research on CAH (80%). Nursing staff expressed the following; Nurses wanted to be more involved in decision making around CAH. Many felt that a standard practice should be replaced with individual patient decisions. Staff were frequently asked about CAH and felt able to discuss the risks and benefits with families. Conclusions Overall, nurses accepted hospice standard practice on CAH and did not feel coerced. A few opposed further research, most welcomed it to establish an evidence base.

Background: There is growing attention in the UK and internationally to the representation of black and minority ethnic groups in healthcare education and the workplace. Although the NHS workforce is very diverse, ethnic minorities are unevenly spread across occupations, and considerably underrepresented in senior positions. Previous research has highlighted that this inequality also exists at junior levels with newly qualified nurses from non-White/British ethnic groups being less likely to get a job at graduation than their White/British colleagues. Although there is better national data on the scale of inequalities in the healthcare workforce, there is a gap in our understanding about the experience of job seeking, and the factors that influence disadvantage in nursing and other professions such as physiotherapy. Aim: This qualitative study seeks to fill that gap and explores the experience of student nurses (n=12) and physiotherapists (n=6) throughout their education and during the first 6-months post qualification to identify key experiences and milestones relating to successful employment particularly focusing on the perspectives from different ethnic groups. Participants: Participants were purposively sampled from one university to ensure diversity in ethnic group, age and gender. Methods: Using a phenomenological approach, in-depth semi-structured interviews were conducted at course completion and 6 months later. Results: Two main themes were identified. The ‘proactive self’ (‘It’s up to me’) theme included perceptions of employment success being due to student proactivity and resilience; qualities valued by employers. The second theme described the need to ‘fit in’ with organisational culture. Graduates described accommodating strategies where they modified aspects of their identity (clothing, cultural markers) to fit in. At one extreme, rather than fitting in, participants from minority ethnic backgrounds avoided applying to certain hospitals due to perceptions of discriminatory cultures, ‘I wouldn’t apply there ‘cos you know, it’s not really an ethnic hospital’. In contrast, some participants recognised that other graduates (usually white) did not need to change and aspects of their identity brought unsolicited rewards 'if your face fits then the barriers are reduced'. Conclusions: The findings indicate that success in getting work is perceived as determined by individual factors, and fitting in is enabled by strategies adopted by the individual rather than the workplace. Demands for change are more acute for graduates from black and minority ethnic backgrounds. This is an issue for healthcare organisations seeking to be inclusive and challenges employers and educators to acknowledge inequalities and take action to address them. Keywords: ethnicity; employability; nurses; physiotherapists; job seeking activities; equality of employment

This paper explores the acceptance of a “silent period” as a stage in second language development for children acquiring English as an Additional Language in Early Years settings. Current views suggest that it is normal for children to very quickly stop using their mother tongue and enter a period of silence. A positive perspective on this is that children may be using this time to observe and grow in understanding of the second language. However, there may also be negative effects, as children may become withdrawn and miss out on opportunities to develop relationships and language. It is the argument of this paper that if this silent period is normalised, there is potential for ambivalence around the well-being of the child which may run counter to best Early Years practice. This study consisted of a qualitative content analysis which drew on twenty case studies collected by Early Years Educators documenting children’s progress over the initial weeks and months in Early Years settings. The main findings were that some children did indeed enter a silent period and shyness was a risk factor for this being prolonged. Non-verbal communication was used positively by some children to develop relationships with other children, but negatively by others, in the form of aggression and frustration, until they developed enough language to communicate. The children who did best continued to use their home language and non-verbal communication which enabled them to form relationships. Over time this became a bridge into the second language. Strategies used by educators included supporting children in small groups and bringing the home language into the setting in keeping with recommendations of policy documents in Ireland. Ultimately, this paper argues that the normalisation of a silent period may infringe on children’s rights to be active participants in their own learning. Moreover, it may limit the extent to which they are meaningfully valued, respected, empowered, cared for and included in Early Years settings.

In December 1890, a 22-year-old woman named Gabrielle Bompard was accused of complicity in the brutal murder and robbery of a Parisian bailiff. The audacious view that Bompard had been completely unconscious of her acts was advanced by Jules Liegeois, Professor of Administrative Law at Nancy and the most outspoken disciple of the psychiatrist Hippolyte Bernheim. Liegeois expounded most volubly on the extra-medical realm of hypnosis as early as 1884 when he presented a memoir on its medico-legal implications to the Academie des Sciences Morales et Politiques before an audience of philosophers, publicists, social reformers, and medical men. The fact that the Parisians laboured to have the defendant condemned with a vehemence which matched the prosecution’s tends to suggest that moral and social issues outside the realm of medical doctrine alone influenced the position they upheld so rigidly in the courtroom.

This work analyses Albert Schweitzer's complex relationship to Africa, and places him within the context of medical missionizing. Although he worked in Africa for over fifty years, Schweitzer was strangely indifferent to the continent's culture. Unlike his fellow missionaries, he never learned native languages, and his service was primarily grounded in a Nietzschean rejection of European conventionalities and a desire to develop his unique ‘ethical personality’. Schweitzer's self-belief enabled him to create a village-hospital where the sick could come with their families for treatment and refuge, and contributed to his idea of the ‘reverence for life’, a secularized ethics of compassion and environmental protection that made him famous in the West. The village-hospital enabled him to tend the sick more effectively, but after the First World War it became more hierarchical and de-personalized. Schweitzer's missionary experiment in Lambaréné was simultaneously radical and conformist, daring and self-protectively conservative. His desire to serve was as profound as any of his clerical colleagues, but it was built, as will be seen, upon rebellious ethical foundations. Schweitzer stands out not so much for his therapeutic innovations (though these were important), as for his later formulation of a neo-Christian ecologism that assured his fame in Europe and America.

The value and importance of UK nursing research was given a resounding endorsement in a recent assessment of research quality, the Research Excellence Framework 2014 (REF2014). The overview report by the main panel A (MPA) of the REF2014 considered that diversity and quality of research submitted to the sub-panel unit of assessment (UOA) 3 (Allied Health Professions, Dentistry, Nursing and Pharmacy) to be strong. They concluded

Realist synthesis offers a novel and innovative way to interrogate the large literature on interprofessional teamwork in health and social care teams. This article introduces realist synthesis and its approach to identifying and testing the underpinning processes (or "mechanisms") that make an intervention work, the contexts that trigger those mechanisms and their subsequent outcomes. A realist synthesis of the evidence on interprofessional teamwork is described. Thirteen mechanisms were identified in the synthesis and findings for one mechanism, called "Support and value" are presented in this paper. The evidence for the other twelve mechanisms ("collaboration and coordination", "pooling of resources", "individual learning", "role blurring", "efficient, open and equitable communication", "tactical communication", "shared responsibility and influence", "team behavioural norms", "shared responsibility and influence", "critically reviewing performance and decisions", "generating and implementing new ideas" and "leadership") are reported in a further three papers in this series. The "support and value" mechanism referred to the ways in which team members supported one another, respected other's skills and abilities and valued each other's contributions. "Support and value" was present in some, but far from all, teams and a number of contexts that explained this variation were identified. The article concludes with a discussion of the challenges and benefits of undertaking this realist synthesis.

This article is the third in a series reporting the process and findings of a realist synthesis of interprofessional teamwork in health and social care. The synthesis articulated and tested four "mechanisms" (processes) of teamwork related to communication and found variable evidence to support them. Evidence was strongest for "efficient, open and equitable communication" and "tactical communication", but lacking for the shared responsibility element of the "shared responsibility and influence" mechanism. Little evidence was found to support or oppose the mechanism, "team behavioural norms", so its status as a mechanism of interprofessional teamwork is unclear. A striking finding for all the mechanisms was the dearth of information on how they affected patient clinical outcomes and experiences.

Realist synthesis is a theory-driven approach for evaluating complex interventions using empirical evidence, which seeks an explanatory analysis of who a complex intervention works for, how, why, and in what circumstances. Interprofessional teamworking in healthcare is one such complex intervention, as teams are influenced by social and organizational factors, which makes them highly variable and context dependent. This article concludes a series of four articles that report on a realist synthesis of interprofessional teamworking. The synthesis identified 13 mechanisms that are reported in the literature to be the underlying processes through which interprofessional teamworking produces its effects. This article explores four of these mechanisms: a shared purpose; critical reflection; innovation; and leadership. These mechanisms together explain how a team sets and maintains its focus and direction. This article highlights that whilst many assumptions are made within the healthcare literature about how these mechanisms operate within teams, these assumptions are not always founded upon strong empirical evidence.

SummaryIn the early 1950s, Albert Schweitzer was a heroic figure, arguably second only to Albert Einstein in renown. Today, many have scarcely heard of him and know nothing of his work as a medical missionary in Equatorial Africa, or of his receipt of the 1952 Nobel Peace Prize. Schweitzer's genius flourished when he felt he was able to operate between cultures. Convinced that he was uniquely able to mediate between opposites, whether it was between France and Germany, Jews and Christians, or Western and Eastern spirituality, Schweitzer was a tantalising figure, hovering on the verge of what we would today call ‘cross-cultural’ dialogue. Here I will examine his intellectual and ethical trajectory, and explore how his reaction to Africa produced an early liberation that stalled due to his inability to engage deeply with Africans and their culture. As the decades passed, he was increasingly cut adrift both from Europe and from changing currents within Africa, and became strangely absorbed in Indian thought,...

While feedback is a key factor for improving student learning, little is known about how students understand and experience feedback within the classroom. This study analysed 193 New Zealand primary and secondary students’ survey responses alongside drawings of their understandings and experiences of feedback to examine how they experience, understand, and respond to feedback. It found that despite New Zealand’s strong commitment to student-centred Assessment for Learning practices, the majority of students still drew, selected, and endorsed teacher-led feedback practices, with pictures dominated by written comments or grades. However, they generally depicted and described this feedback as positive and constructive, suggesting that negative emotional responses to evaluative comments and grades may be lessened if students perceive such feedback will help them improve.

Teachers’ understandings of feedback probably influence the type and quality of feedback that they provide. The beliefs of 518 New Zealand practicing teachers about feedback were evaluated with the Teachers’ Conceptions of Feedback (TCoF) inventory and related to practices these teachers considered to be feedback. Nine feedback factors and four practices factors were found and models were statistically invariant between primary and secondary teachers. New Zealand teachers’ understandings of feedback were strongly focused on improving learning instead of enhancing student well-being. Similar factors are expected in other contexts, though agreement rates should reflect local policy priorities and cultural values.

The recent finding that many permanent and semipermanent hair dyes are strongly mutagenic in a laboratory test, together with the fact that single female hair-dressers had higher than expected death rates from breast-cancer in 1959-63, prompted a study into the use of hair dyes by patients with breast cancer and by matched controls. There was no difference between the patients and their controls in their use of hair dyes. There were also no significant differences between the two groups when the analysis was confinedto women who had used dyes over four years and over nine years before diagnosis. The only significant findings were a higher proportion of past or present smokers among women aged over 50 who used hair dyes and an association between hair dyes use and age at first pregnancy. Further epidemiological studies are clearly needed in view of the mutagenicity found in the Ames test, and the fact th and several human carcinogens are also mutagenic according to this test.

Tests and assessments are valued in society, especially when the cost of getting it right matters, for example, when they are used to certify people we need to trust in order to assure public safety and well-being (e.g., engineers, doctors, pilots, train drivers, electricians, teachers, etc.). Without such formal assessments, we would need to rely solely on the attestation of some individual who may well be subject to the influences of collusion, corruption, and cheating (which is why tests were devised in the first place). Alternatively, we might have to rely on free market processes which would take time to weed out incompetents; we know that deficient practitioners (e.g., peddlers of quackery, pseudo-medicine, or health fraud) may well harm unsuspecting and naive citizens (e.g., Gerald Shirtcliff ’s engineering work, produced under false engineering credentials, may have contributed to a building collapse in the 2011 Christchurch earthquake with significant loss of life; Howe, 2014). Hence, society needs confidence that learners and professionals can perform satisfactorily the responsibilities we assign them and we rely on validated evidence of those competencies before opportunities are given.

State funded systems of health care in advanced economies are under severe pressure as a result of ageing populations, rising public expectations and increasing demands for health care. In the UK, ...

The aim of this study was to first evaluate whether the chitosan hydrochloride-genipin crosslinking reaction is influenced by factors such as time, and polymer/genipin concentration, and second, to develop crosslinked drug loaded microspheres to improve the control over drug release. Once the crosslinking process was characterized as a function of the factors mentioned above, drug loaded hydrochloride chitosan microspheres with different degrees of crosslinking were obtained. Microspheres were characterized in terms of size, morphology, drug content, surface charge and capacity to control in vitro drug release. Clarithromycin, tramadol hydrochloride, and low molecular weight heparin (LMWH) were used as model drugs. The obtained particles were spherical, positively charged, with a diameter of 1-10 microm. X-Ray diffraction showed that there was an interaction of genipin and each drug with chitosan in the microspheres. In relation to the release profiles, a higher degree of crosslinking led to more control of drug release in the case of clarithromycin and tramadol. For these drugs, optimal release profiles were obtained for microspheres crosslinked with 1 mM genipin at 50 °C for 5 h and with 5 mM genipin at 50 °C for 5 h, respectively. In LMWH microspheres, the best release profile corresponded to 0.5 mM genipin, 50 °C, 5 h. In conclusion, genipin showed to be eligible as a chemical-crosslinking agent delaying the outflow of drugs from the microspheres. However, more studies in vitro and in vivo must be carried out to determine adequate crosslinking conditions for different drugs.

While creativity can be present with other aspects that constitute giftedness, it can also emerge as a distinct, separate strength that overshadows the presence of other areas. The creatively gifted child is often a divergent, lateral thinker in a convergent, sequentially ordered world.

While teacher aides often provide individual and group reading instruction for at-risk readers, research suggests these interventions may not always bring about reading gains. This Australian study investigated upper primary school teacher aides’ definitions of reading, drawing on semi-structured interview responses and written definitions examined via categorical analysis. The analysis identified six categories classifying participant understandings: Translating, Making sense, Contextualising meaning, Generating an affective response, Using texts for practical purposes, and Growing as a person, with Making sense the most prevalent actual definition. Definitions did not include critical understandings of reading or digital reading practices. The study identifies that teacher aides require better conceptual understandings of reading, especially within upper primary or secondary contexts. However, if teacher aides are expected to obtain further educational credentials or professional learning, careful consideration is also needed about how these increased expectations should impact teacher aide status, working conditions, and remuneration in schools.

Gifted children often demonstrate advanced ability in language arts early (Clark, 1992; Sousa, 2009), comprehend verbal implications, utilize sophisticated language and linguistic subtleties such as intonation, are able to argue convincingly, and develop writing, reading, and spelling skills rapidly (Stage & Wagner, 1992).

In nineteenth-century France, science and religion have often been portrayed as irredeemably opposed to one another. This article seeks to revise this interpretation by showing how these apparently dissonant views intermingled in the study of hysteria. Through a survey of attitudes towards Catholicism and in their treatment of Catholic patients, the article shows how French psychiatrists and neurologists were deeply indebted to religious iconography and experience, despite their vehement anti-clericalism. Because of their hatred of the church, they focused on the treatment of female hysterics who manifested ‘religious’ symptoms – demonopathy, mystical states, and stigmata – in order to amass conclusive evidence of Catholic ‘superstition’. Their preoccupation with such patients meant, however, that they paradoxically re-embedded Catholicism into their scientific practice by incorporating religious motifs, bodily poses, and iconography into their diagnosis of hysteria. At the same time, their disdain for the Catholic religious imagination meant that they refused to explore the fantasies of their subjects. For physicians like Jean-Martin Charcot and the more subtle Pierre Janet – a contemporary and competitor of Sigmund Freud – fantasies of bodily suffering, unearthly physical perfection, and an array of Catholic maternal fantasies associated with images of Mary and Christ were all nothing more than delusions, not the stuff from which an appreciation or understanding of the ‘unconscious’ could emerge. The result was that French physicians offered no psychodynamic transformation or symbolic reinterpretation of their words or physical symptoms, a resistance that was one reason among many for their hostility to psychoanalysis.

Interprofessional teamwork is seen in healthcare policy and practice as a key strategy for providing safe, efficient and holistic healthcare and is an accepted part of evidence-based stroke care. The impact of interprofessional teamwork on patient and carer experience(s) of care is unknown, although some research suggests a relationship might exist. This study aimed to explore patient and carer perceptions of good and poor teamwork and its impact on experiences of care. Critical incident interviews were conducted with 50 patients and 33 carers in acute, inpatient rehabilitation and community phases of care within two UK stroke care pathways. An analytical framework, derived from a realist synthesis of 13 'mechanisms' (processes) of interprofessional teamwork, was used to identify positive and negative 'indicators' of teamwork. Participants identified several mechanisms of teamwork, but it was not a subject most talked about readily. This suggests that interprofessional teamwork is not a concept that is particularly important to stroke patients and carers; they do not readily perceive any impacts of teamwork on their experiences. These findings are a salient reminder that what might be expected by healthcare professionals to be important influences on experience may not be perceived to be so by patients and carers.

Interprofessional teamwork has become an integral feature of healthcare delivery in a wide range of conditions and services in many countries. Many assumptions are made in healthcare literature and policy about how interprofessional teams function and about the outcomes of interprofessional teamwork. Realist synthesis is an approach to reviewing research evidence on complex interventions which seeks to explore these assumptions. It does this by unpacking the mechanisms of an intervention, exploring the contexts which trigger or deactivate them and connecting these contexts and mechanisms to their subsequent outcomes. This is the second in a series of four papers reporting a realist synthesis of interprofessional teamworking. The paper discusses four of the 13 mechanisms identified in the synthesis: collaboration and coordination; pooling of resources; individual learning; and role blurring. These mechanisms together capture the day-to-day functioning of teams and the dependence of that on members' understanding each others' skills and knowledge and learning from them. This synthesis found empirical evidence to support all four mechanisms, which tentatively suggests that collaboration, pooling, learning, and role blurring are all underlying processes of interprofessional teamwork. However, the supporting evidence for individual learning was relatively weak, therefore there may be assumptions made about learning within healthcare literature and policy that are not founded upon strong empirical evidence. There is a need for more robust research on individual learning to further understand its relationship with interprofessional teamworking in healthcare.

In 1857, a series of psychic torments and bodily seizures erupted in Morzine, a Savoyard commune of some two thousand migrant masons and seasonal workers in the high country of the Chablais. The crisis began when young and adolescent girls claimed to see the Virgin Mary, but this transitory interaction with the Mother of God had neither the beatific nor the awesome qualities normally associated with contemporary visionary experience. Rather than heavenly smiles and bodily rapture, they instead had alarming convulsive attacks, had no message to relay, and relished blaspheming the Eucharist during their seizures. The women believed themselves possessed as a result of a mal donne, a witch's curse, and they sought to counterattack through magic, magnetism, and pilgrimage, going far from their village world in search of relief. Their errant life began when they felt abandoned by their parish priest: Abbe Pinguet and his minions had willingly exorcised them beginning in 1857, convinced such expedients would rid the community of the "devils," but the situation changed dramatically in 1860 when France annexed Savoy and the authorities pressured the priest to stop his "superstitious" practices. He retracted both his belief in their possession and his willingness to exorcise, and from that moment the intensity of the mal grew rapidly.' The degree of attention lavished on the girls and women-numbering around two hundred at the end of 1861 -is evidenced by the physicians whom

Background Informal carers frequently suffer adverse consequences from caring. General practice teams are well positioned to support them. However, what carers of stroke survivors want and expect from general practice, and the practical support measures they might like, remain largely unexplored. The aims of this study are twofold. Firstly it explores both the support stroke carers would like from general practice and their reactions to the community based support proposed in the New Deal. Secondly, perceptions of a general practice team are investigated covering similar topics to carer interviews but from their perspective. Methods Semi-structured interviews were conducted with 13 stroke carers and 10 members of a general practice team. Carers' experiences and expectations of general practice and opinions of support measures from recent government policy were explored. General practice professionals were asked about their perceived role and their perceptions of carers' support needs. Interviews were content analysed. Results Carers' expectations of support from general practice were low and they neither received nor expected much support for themselves. General practice was seen as reactive primarily because of time constraints. Some carers would appreciate emotional support but others did not want additional services. Responses to recent policy initiatives were mixed with carers saying these might benefit other carers but not themselves. General practice professionals' opinions were broadly similar. They recognise carers' support needs but see their role as reactive, focussed on stroke survivors, rather than carers. Caring was recognised as challenging. Providing emotional support and referral were seen as important but identification of carers was considered difficult. Time constraints limit their support. Responses to recent policy initiatives were positive. Conclusions Carers' expectations of support from general practice for themselves are low and teams are seen as reactive and time constrained. Both the carers and the general practice team participants emphasised the valuable role of general practice team in supporting stroke survivors. Research is needed to determine general practice teams' awareness and identification of carers and of the difficulties they encounter supporting stroke carers. Carer policy initiatives need greater specificity with greater attention to diversity in carer needs.

Conventional political history is notorious for the ‘maleness’ of its exposition, and standard accounts of the Dreyfus Affair all too readily conform to this stereotype. As an espionage tale, the Affair falls within the masculine arenas of diplomatic and military history, while as a story of political crisis, its main characters remain ministers, jurists, and polemicists.1 The history of the struggle between ‘intellectuals’ and ‘anti-intellectuals,’ moreover, focuses attention on the leading lights of French academia and literature, almost all men, who tussled over the primary values of French politics and society.2

A series of televised public service announcements (PSAs) about acquired immune deficiency syndrome (AIDS) was evaluated with 100 black participants attending a Sexually Transmitted Diseases Clinic in Atlanta, Georgia. Since the literacy level of the participants was suspected to be low, questions were administered orally and an electronic data collection technique was used which permitted the participants to push buttons, as opposed to speaking or writing responses. In this way, data were collected regarding: (i) the participants’ demographics; (ii) their self‐perceived AIDS knowledge and awareness; and (iii) their second‐by‐second continuous responses to the video presentation. Participants who perceived themselves to be at high risk of contracting human immunodeficiency virus (HIV) infection gave more positive continuous responses to the PSA sequence than did self‐perceived low‐risk participants. Men gave more approving responses than women. The results were considered in relation to previous ...

There has been substantial research on children's empathic responsiveness towards distressed people, and on the limited responsiveness of children with autism. To date, however, there have not been experimental studies to test how far children show concern towards someone who might be expected to feel badly, when that person has not (yet) expressed any negative feelings. We tested matched groups of children with autism and learning disability, and typically developing children of similar verbal mental age (approximately 6 years), with a novel procedure in which participants witnessed one person (E1) tearing the drawing of another (E2). In a comparison condition, a blank card was torn. In the torn-drawing condition, as predicted, fewer participants with autism orientated towards E2 with an immediate look, and as a group, they were rated as showing less concern for, and fewer concerned looks towards, E2. We discuss possible implications for theoretical perspectives on the early development of empathy in typically as well as atypically developing children.

BACKGROUND Little is known about the frequency with which information from the Internet is presented by patients within primary care consultations or the subsequent impact that it may have on those consultations. OBJECTIVES The aims of this study were to describe the frequency with which Internet information was presented within primary care consultations in one inner-city health authority and to describe the characteristics of the subsequent consultation from the perspective of the health professionals involved. METHODS A postal survey was used to estimate the frequency of Internet information presentation and eight in-depth interviews were used to obtain health professionals' perceptions of the consultations that followed. RESULTS Presentation of information from the Internet was relatively infrequent within primary care at the time of the survey (November 2000 to March 2001), but frequencies of presentation were higher for GPs than for any other health professional group. Health professionals have stereotypical views of Internet users and fear for their own professional status in relation to the Internet-informed patient or client. CONCLUSIONS Although presentation of information from the Internet to date remains relatively infrequent, health professionals appear to feel threatened by it and adopt strategies that minimize its impact on the subsequent consultation.