Living ethics: a stance and its implications in health ethics

Moral or ethical questions are vital because they affect our daily lives: what is the best choice we can make, the best action to take in a given situation, and ultimately, the best way to live our lives? Health ethics has contributed to moving ethics toward a more experience-based and user-oriented theoretical and methodological stance but remains in our practice an incomplete lever for human development and flourishing. This context led us to envision and develop the stance of a "living ethics", described in this inaugural collective and programmatic paper as an effort to consolidate creative collaboration between a wide array of stakeholders. We engaged in a participatory discussion and collective writing process known as instrumentalist concept analysis. This process included initial local consultations, an exploratory literature review, the constitution of a working group of 21 co-authors, and 8 workshops supporting a collaborative thinking and writing process. First, a living ethics designates a stance attentive to human experience and the role played by morality in human existence. Second, a living ethics represents an ongoing effort to interrogate and scrutinize our moral experiences to facilitate adaptation of people and contexts. It promotes the active and inclusive engagement of both individuals and communities in envisioning and enacting scenarios which correspond to their flourishing as authentic ethical agents. Living ethics encourages meaningful participation of stakeholders because moral questions touch deeply upon who we are and who we want to be. We explain various aspects of a living ethics stance, including its theoretical, methodological, and practical implications as well as some barriers to its enactment based on the reflections resulting from the collaborative thinking and writing process.

Training Psychology and Psychiatry Diversity Dialogue Facilitators

This article describes a Diversity Dialogue Facilitator Training Program for Trainees, an innovative project that prepares psychology and psychiatry learners to facilitate diversity dialogues with healthcare professionals (i.e., clinical and research faculty, staff, and learners) in academic healthcare settings. Through participating in this program, trainees learn to facilitate discussions in which participants reflect upon oppression, discrimination, and disparities; explore their biases; connect and exchange views with colleagues regarding challenging societal events; and delineate action steps for advancing equity, inclusion, social responsivity, and justice in their professional and personal lives. After outlining contextual factors that informed project development, implementation, and dissemination, the iterative process of creating and implementing the training curriculum is detailed, with the aim of offering a model for other academic health center-based training programs interested in establishing a similar initiative. Lessons learned also are shared with the hope of contributing to future efforts to advance training in diversity dialogue facilitation and expand the role of psychologists in medical settings.

Identity development in multicultural context: Multidimensional self exploration approaches employed by Modern Orthodox women

The aim of this study is to examine identity development of Modern Orthodox women as they pursue their studies within a multicultural and multi-faith environment. Content analysis was used to analyze the final papers of undergraduate religious female students in Israel (N = 47) who participated in a semester-long dialogue course for Jewish students. The findings revealed three salient themes, suggesting that women's self-exploration developed noticeably within a rich multicultural context: (a) participants engaged in self-reflection by drawing comparisons between themselves and Arab students, leading to an exploration of their religious beliefs and group affiliations; (b) participants embraced their individuality within a multicultural context while balancing their religious duties; and (c) participants critically examined the status of Orthodox women in society, particularly within the family context. These findings highlight the process of identity exploration among Modern Orthodox women, complicated by intersections of religion, gender, and culture. In doing so, this study contributes to the understanding of identity development in multicultural societies.

Disclosure following a medical error: lessons learned from a national initiative of workshops with patients, healthcare teams, and executives

BACKGROUND

Despite the increase in disclosures of medical errors, transparency remains a challenge. Recognized barriers include shame, fear of litigation, disciplinary actions, and loss of patient trust. In 2018, the Israeli Ministry of Health initiated a series of workshops about disclosure of medical errors. The workshops involved medical center executives, healthcare providers, patients, and family members of patients who had previously been harmed by a medical error. This study presents the lessons learned about perceived challenges in disclosure of errors in 15 such workshops.

METHODS

Data collection included participant observations in 15 workshops, full audio recordings of all of the workshops, and documentation of detailed field notes. Analysis was performed under thematic analysis guidelines.

RESULTS

We identified four main themes: "Providers agree on the value of disclosure of a medical error to the patient"; "Emotional challenges of disclosure of medical error to patients"; "The medico-legal discourse challenges transparency"; and "Providers and patients call for a change in the culture regarding disclosure of medical errors". Participant observations indicated that the presence of a patient who had experienced a tragedy in another hospital, and who was willing to share it created an intimate atmosphere that enabled an open conversation between parties.

CONCLUSION

The study shows the moral, human, and educational values of open discourse in a protective setting after the occurrence of a medical error. We believe that workshops like these may help foster a culture of institutional disclosure following medical errors. We recommend that the Ministry of Health extend such workshops to all healthcare facilities, establish guidelines and mandate training for skills in disclosure for all providers.

It is Not Too Late for Reconciliation Between Israel and Palestine, Even in the Darkest Hour

The conflict in Gaza and Israel that ignited on October 7, 2023 signals a catastrophic breakdown in the possibility of ethical dialogue in the region. The actions on both sides have revealed a dissolution of ethical restraints, with unimaginably cruel attacks on civilians, murder of children, destruction of health facilities, and denial of basic needs such as water, food, and shelter. There is a need both to understand the nature of the ethical singularity represented by this conflict and what, if any, options are available to allow the reconstruction of communication between the warring parties. This article seeks to address these tasks by analysing the conflict as inherently an ethical one, in the sense that it exposes a rupture in the fabric of communicative relationships that has evolved systematically out of the deep cultural structures from which all protagonists have emerged. Drawing on the work of Levinas, Habermas, Arendt, and others, and referring to the specific circumstances in the region, it examines the ethical sources of the crisis and tries to identify conditions for its resolution. The possibility of reconciliation-that is, of refiguring relationships to open up a space for dialogue to create pathways to heal the ruptures-is examined. The dark legacy of the Holocaust is identified as an abiding cultural vulnerability for both societies. It is concluded, however, that the rich history of partnerships and collaborations between Jews and Palestinians provides a robust infrastructure on the basis of which a sustainable peace might be built, providing a much-needed source of hope.

Direct and indirect linguistic measures of common ground in dialogue studies involving a matching task: A systematic review

During dialogue, speakers attempt to adapt messages to their addressee appropriately by taking into consideration their common ground (i.e., all the information mutually known by the conversational partners) to ensure successful communication. Knowing and remembering what information is part of the common ground shared with a given partner and using it during dialogue are crucial skills for social interaction. It is therefore important to better understand how we can measure the use of common ground and to identify the potential associated psychological processes. In this context, a systematic review of the literature was performed to list the linguistic measures of common ground found in dialogue studies involving a matching task and to explore any evidence of cognitive and social mechanisms underlying common ground use in this specific experimental setting, particularly in normal aging and in neuropsychological studies. Out of the 23 articles included in this review, we found seven different linguistic measures of common ground that were classified as either a direct measure of common ground (i.e., measures directly performed on the referential content) or an indirect measure of common ground (i.e., measures assessing the general form of the discourse). This review supports the idea that both types of measures should systematically be used while assessing common ground because they may reflect different concepts underpinned by distinct psychological processes. Given the lack of evidence for the implication of other cognitive and social functions in common ground use in studies involving matching tasks, future research is warranted, particularly in the clinical field.

Emergence of Meaning Amidst a Tension Between Forms and Contents

In this paper, I propose an analysis of the tension between forms and contents as a condition of emergence of meaning. I refer to Vygotsky's earlier work "Psychology of Art" as an inspiration, to develop my own model. This leads me to present an analysis of how forms overcome contents in a monological way, but also in a dialogical perspective. I also present two windows of emergence capturing the dynamics occurring in the temporal boundary before the stabilization of a new form (what happens between the form deconstruction and the emergence of a new form). I apply it to how elders experienced the pandemic and its aftermath, using the analysis of discourse of elders participating in a group-intervention and in an action-research project. This enables me to partially respond to some of the challenges identified by Greve (2023, this Special Issue) -an author I was asked to comment-, but also to go beyond his propositions.

ChatSubs: A dataset of dialogues in Spanish, Catalan, Basque and Galician extracted from movie subtitles for developing advanced conversational models

The ChatSubs dataset [5] contains dialogue data in Spanish and three of Spain's co-official languages (Catalan, Basque, and Galician). It has been obtained from OpenSubtitles, from which we have gathered the movie subtitles in our languages of interest and processed them to generate clearly segmented dialogues and their turns. The data processing code is publicly accessible. The result is 206.706 JSON files with more than 20 million dialogues and 96 million turns, which represents one of the biggest dialogue corpus available, as other similar datasets in better resourced languages do not reach 500k dialogues or present less defined conversations. Thus, the ChatSubs dataset is an ideal resource for research teams that are interested in training dialogue models in Spanish, Catalan, Basque, and Galician.

Designing a youth-led Dialogue Forum tool: The CO-CREATE experience

While obesity prevention represents an established field of research, the inclusion of young people, who are regularly cited as an important priority group, are rarely actioned in long-term studies. This paper focuses on the development of a dialogue tool intended to tackle this issue, engaging, and eliciting insights on the theme of obesity prevention, by young people and for young people. As part of the CO-CREATE project, this tool was co-developed by designers, public health, and youth participation experts, researchers, and young people. Co-creation is a key methodology in the design of the dialogue tool, as young people were involved in all stages of the development process. This paper elaborates on the process of co-designing a dialogue tool that helps explore obesity prevention policy ideas from multiple perspectives, and describes the design principles that informed the process and the final versions of the tool. The purpose of the Dialogue Forum tool is for youth to engage policymakers and other relevant stakeholders to discuss and refine co-created and youth-initiated ideas for healthier food and physical activity environments. We analyze how specific design principles were integrated into different prototypes and the value of this within the project and the field.

The other side of the social interaction: Theory of mind impairments in people with schizophrenia are linked to other people's difficulties in understanding them

BACKGROUND

People with schizophrenia (SZ) often present with theory of mind (ToM) deficits and with speech production deficits. While a link has been established between ToM abilities and symptoms of thought disorder, much less is known about other aspects of speech production in SZ.

STUDY DESIGN

This is a case-control study in which 25 stable outpatients with recent-onset SZ (27.1 years, 22 men) and 22 matched healthy controls (25.6 years, 16 men) performed a collaborative, verbal production task with a real interaction partner. Blind raters scored how easy participants made it to understand them (Facility ratings), how interesting they were to listen to (Interest ratings) and how expressive they were (Expressivity ratings). ToM was assessed with the Combined Stories Test and Sarfati's cartoon task. Symptoms were assessed with the PANSS five-factor version.

STUDY RESULTS

Compared to healthy controls, SZ received significantly lower ratings for all three aspects of their verbal productions (Facility, Interest and Expressivity), despite the raters being blind to group membership. Interestingly, the Facility ratings were linked to ToM performance in the SZ group, which suggest that SZ participants who have difficulties understanding others (ToM deficits) also make it harder for others to understand them. Other notable findings include a strong link between the Expressivity ratings and the Interest ratings for both groups, and significant correlations between the Facility ratings and Cognitive/Disorganisation symptoms, and between the Expressivity ratings and both Negative and Depression/Anxiety symptoms in SZ.

CONCLUSION

Studying speech production during real, collaborative social interactions could help move beyond the individual approach to SZ deficits, making it possible to involve the interaction partners to promote more efficient communication for people with schizophrenia.

The interactional communication of feedback in clinical education: A focused ethnographic study in a hierarchical and collectivist culture

Background

The definition of feedback in clinical education has shifted from information delivery to student-teacher dialogue. However, based on Hofstede's theory, countries with large power distance or a robust social hierarchy and collectivistic cultural dimensions can reduce the feedback dialogue to a minimum. Indonesia is classified in this group, with some Asian, African, Mediterranean, and Latin American countries. This study explores the interactional communication of feedback during clinical education in a hierarchical and collectivistic context.

Methods

The focused ethnographic approach was applied to the clinical rotation program in an Indonesian teaching hospital. Data sources included observations of feedback episodes during workplace-based assessments followed by interviews with clinical supervisors and students. The data were compiled within 16 weeks of observation in 7 groups of clinical departments, consisting of 28 field notes, audiotaped interviews including nine focus group discussions of students (N = 42), and seven in-depth interviews with clinical supervisors. Data were analyzed through transcription, coding, categorization, and thematic analysis using the symbolic interactionist perspective.

Results

We identified four themes representing actual interactional communication and its 'meaning' or interpretation. The interactional communication in feedback is described in the first and second themes, such as 1) Students play the subordinate roles in a feedback dialogue; 2) The feedback content is focused on explanation and students' limitations. The third and fourth themes represent the clinical supervisors' and students' interpretation of their feedback experience, such as 3) Clinical supervisors' perspectives are mostly on dissatisfaction and teaching authority; 4) Students' acceptance of reality and negative affection.

Conclusions

This study shows that the social gap between students and clinical supervisors in Indonesia, and other countries in the same cultural classification, potentially causes communication barriers in the feedback dialogue. The adaptation of 'feedback as a dialogue' requires further effort and research to develop communication strategies in feedback that consider the national culture and context.

academic medical center

BACKGROUND

The Vanderbilt Community Circle (VC2) was designed to provide all faculty, staff, and students within the entire Vanderbilt University Medical Center community a dedicated venue to discuss current events and ongoing societal issues.

APPROACH

During the 2017-18 academic year, four VC2 events were held on: "Race, identity, and conflict in America," "Gun violence in America," "Gender in the workplace," and "Immigration in America." Facilitators guided participants to share their views and perspectives on these matters with pre-developed open-ended questions. Attendees started discussions in small groups and then eventually combined into a large one. Pre- and post-event surveys were administered to measure the program's effectiveness.

EVALUATION

One-hundred and twenty-four participants were included, 75 of whom completed both the pre- and post-event surveys. Sixty-four of the 75 (85%) agreed or strongly agreed that "multiple perspectives and opinions were represented" and 73% felt that their "own perspective was broadened on the issue." Most (89%) believed that the format and setting of the event was conducive to dialogue and discussion, and almost all (91%) reported that they would attend a similar event in the future. Groningen Reflection Ability Scale scores were high before (94 [25th-75th: 88-99]) and remained high after the events (93 [25th-75th: 88-93.3], p > 0.05).

REFLECTION

We successfully implemented a medical center-wide, recurring current events and dialogue forum in hopes of increasing reflection, unity, and understanding across our own community.

Dialogic Problematization of Academic Integrity Education

Many university educators have argued for a need for academic integrity education as an alternative to a focus on students' and scholars' compliance with academic rules and conventions (Brimble, 2016; Christensen Hughes & Bertram-Gallant, 2016; Hutton, 2006). I argue that the universal ethical-moral discourse of academic integrity disciplines subjects to comply with frequently alienating academic practices. This ethical discourse focuses on individual responsibility, in turn rendering invisible the authority of sometimes dysfunctional and oppressive instructional and summative assessment practices. Taking a Bakhtinian dialogic authorial perspective, the paper calls on students, scholars, instructors, and academic advisors to engage in critical ontological dialogue on diverse responses and motivations in regard to academic demands and deeds. Dialogue on situated instead of universal ethics in academic settings contextualizes and problematizes not just individual actions but also the ethics of the summative assessment regime, the instruction, the curriculum, authority dynamics, and the educational system as a whole. This discussion on academic integrity violations calls on educators to consider the ethical value of separating summative assessment from instruction.

Negotiating scientific knowledge in the development of an eHealth MOOC

Interdisciplinary team communication in eHealth development is challenging because all disciplines have unique, intrinsic discursive practices, theories and artefacts. Due to these factors, members of interdisciplinary teams can experience problems in communication and collaboration. Through a centered focus, members can benefit individually, inspire one another, and ultimately reach a timely delivery of their common pedagogical goal(s). Using the lens of dialogism, this paper aims to identify the conceptual considerations that arose during the development of a Massive Open Online Course (MOOC) for higher education in eHealth. Methods included auto-ethnography and interdisciplinary dialogue supported by literacy artefacts, including visual material. Results yielded a visual tool for meta-assessment of team communication, and an organizing principle for topics in the MOOC. A major implication is that especially for eHealth, scientific communicative competence of experts-while establishing a common understanding-can lead to a unique and meaningful delivery of high pedagogical quality.

Dialogue as a tool of nutrition literacy in an agricultural intervention programme in Odisha, India

BACKGROUND

An ongoing action research nutrition literacy programme based on Freire's approach of raising critical consciousness through the use of dialogue as a pedagogic tool is being implemented as part of a nutrition sensitive agricultural intervention in tribal Odisha. One hundred and eight adults, referred to as Community Hunger Fighters (CHFs) underwent two modules of a residential training programme of two and a half days each, spread over two months. Through discussion they explored the reasons behind the lack of diversity in their daily diets and identified the social, economic and cultural barriers to food intake in the context of their own poverty. They undertook collective exercises in nutrition sensitive agricultural planning. The transformative behaviour of the CHFs was captured through observation, interviews and focus group discussion with a set of qualitative indicators.

RESULTS

The methodology of dialogue as a pedagogic tool generated a discussion about food security among the community. CHFs identified key messages and shared them with fellow villagers in imaginative ways. The process of critical reflection and analysis helped understand gender disparities, the bottlenecks in food production, brought in life style changes to improve food intake and created a demand for technical training for improving agricultural productivity. Thirty eight had started a nutri-garden and several took on leadership roles on other issues of importance besides food security.

CONCLUSION

Dialogue as a pedagogic tool for nutrition literacy in an agricultural intervention programme has the potential to facilitate a process of critical reflection on the socio cultural and economic barriers to food production and consumption thereby leading to transformative action.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1186/s43170-022-00090-x.

Supervisory dyads' communication and alignment regarding the use of workplace-based observations: a qualitative study in general practice residency

BACKGROUND

In medical residency, performance observations are considered an important strategy to monitor competence development, provide feedback and warrant patient safety. The aim of this study was to gain insight into whether and how supervisor-resident dyads build a working repertoire regarding the use of observations, and how they discuss and align goals and approaches to observation in particular.

METHODS

We used a qualitative, social constructivist approach to explore if and how supervisory dyads work towards alignment of goals and preferred approaches to performance observations. We conducted semi-structured interviews with supervisor-resident dyads, performing a template analysis of the data thus obtained.

RESULTS

The supervisory dyads did not frequently communicate about the use of observations, except at the start of training and unless they were triggered by internal or external factors. Their working repertoire regarding the use of observations seemed to be primarily driven by patient safety goals and institutional assessment requirements rather than by providing developmental feedback. Although intended as formative, the institutional test was perceived as summative by supervisors and residents, and led to teaching to the test rather than educating for purposes of competence development.

CONCLUSIONS

To unlock the full educational potential of performance observations, and to foster the development of an educational alliance, it is essential that supervisory dyads and the training institute communicate clearly about these observations and the role of assessment practices of- and for learning, in order to align their goals and respective approaches.

Response-A Critical Response to "Discourse Communities and the Discourse of Experience"

In their article Little, Jordens, and Sayers developed the notion of "discourse communities"-as groups of people who share an ideology and common "language"-with the support of seminal ideas from M.M. Bakhtin. Such communities provide benefits although they may also impose constraints. An ethical community would open to others' discourse and be committed to critique. Those commitments may counter the limitations of discourse communities. Since their paper was published in 2003, the notion of "discourse communities" has been widely adopted and applied in healthcare and beyond. Their ideas were influential in the founding of an ethics centre in Sydney and contributed to articulating the values which underpin this journal. This commentary notes that an ethical community is fragile in responding to current onslaughts on truth and meaning-potencies inherent in discourse communities. The essay takes Bakhtin's ideas further to explore intrinsic forces at play in dialogue, language, and art. This leads to discussing the centrality of ethics in Bakhtin's thought. For him, the essence of discourse is a dialogic exchange which comprises both art and ethics. It is art in that self and other are created in the exchange. It is ethical in that "I" am answerable to the other, as a phenomenological reality, in the moment of intersubjectivity.

Multiple perspectives and dialogue in understanding experiences of living with eating disorders: Two narratives-four unpackings

BACKGROUND

This is a response to Conti et al.'s article, "Listening in the dark: why we need stories of people living with severe and enduring anorexia nervosa" (published in JED, 2016), and its call for relational metaphors and a relational approach to supplement the traditional medical/psychological diagnostic language used to describe the life experiences and complex emotions of people affected by an eating disorder.

METHODS

Four authors with different backgrounds unpack two narratives, 'The Prima Donna with the Green Dress' and 'Breaking down the Wall', both narrated during fieldwork in multifamily therapy. The narratives are unpacked from the perspective of a therapist within multifamily therapy, a researcher who conducted the fieldwork, a researcher based in phenomenology and a researcher based in narrative inquiry. The authors enter into dialogue with the narratives, and with each other.

RESULTS

The four authors focus on different elements within the narratives and understand them differently. One, focuses on strength and pride, and art expression as a different form of language for people living with an eating disorder. Another, on the experience of isolation, boundaries, and balancing openness and closedness. A third, sees the narratives as expressing a wish to see and be seen, and the fourth focuses on the absence of, and longing for, a shared space to explore.

CONCLUSION

The aim is not to reach a correct or shared interpretation of the narratives but to explore how different perspectives may contribute to different insights, not only about one family in particular but about, more generally, the experiences of people living with an eating disorder. Our work shows the significance of engaging with multiple perspectives and dialogue as supplements to the traditional medical/psychiatric diagnostic language in both clinical practice and research.

Time to re-envisage integrity among nurse leaders

AIM

This paper highlights integrity as a central tenet in the journey of ethical leadership among nurse leaders, and dialogue as a way of working within integrity.

BACKGROUND

Nurse leaders play a critical role in ensuring ethically sound, safe patient care by supporting staff and fostering positive working environments. Although there is an abundance of literature on leadership, no universally accepted leadership theory exists. Hence, it can be difficult to apply leadership theory and principals to real-life clinical practice.

EVALUATION

From the literature, it is evident that integrity is a crucial aspect of leadership. This paper proposes suggestions for nurturing integrity and fostering open and honest dialogue.

KEY ISSUES

Globally, public health care is complex and evolving and effective nursing leadership is paramount to meet public health needs and support healthcare systems.

CONCLUSION

This paper explores integrity with leadership, re-envisaging personal and professional integrity as a portal to authentic leadership, which has human relationships and dialogue at its core.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse leaders need support in guiding the nursing profession and promoting ethically sound patient care. The true nature of leadership is dialogue and nurturing a culture of listening and openness at different levels within an organisation is crucial.

Intergenerationality in the Light of Indeterminacy

This Special Issue aims to shed light on the undetermined nature of intergenerational trajectories. Indeterminacy has been suggested to the author as an avenue to tackle the dynamic aspect -which entails looking at tensions in an unfolding process- of intergenerationality. We present the paper in this Special Issue by insisting on their main contributions, we identify HOW they define the concept of generation, particularly in reference to indeterminacy.

Interlocutor modelling in comprehending speech from interleaved interlocutors of different dialectic backgrounds

It has been shown that, in language comprehension, listeners model certain attributes of their interlocutor (e.g., dialectic background, age, gender) and interpret speech against that model; for example, they understand cross-dialectally ambiguous words such as flat and gas for their American English (AE) meanings more often when listening to an AE interlocutor than a British English (BE) interlocutor. This study further investigated whether listeners construct concurrent interlocutor models when communicating with interleaved interlocutors of different dialectic backgrounds, and, if they do, how they choose between concurrent models to interpret words. In two experiments, participants heard a word (e.g., flat) spoken by a BE or AE interlocutor and provided a word associate (indicating which meaning of the word was accessed). When different interlocutors were encountered in separate blocks, participants accessed more AE meanings when listening to an AE rather than a BE interlocutor, and the accent effect was not larger for words pronounced more differently in BE and AE (e.g., fall sounds more distinctly British vs. American than flat does). These results suggest that participants constructed an interlocutor model (e.g., of a BE or an AE speaker) and used it (instead of accent details in a word) to guide word meaning access. When interlocutors were interleaved in the same block, we observed a comparable accent effect, which increased as a function of between-accent differences in pronunciation. These results suggest that participants constructed concurrent interlocutor models and used accent details in a word to select the appropriate interlocutor model. We also observed that the accent effect was comparable for two interleaved interlocutors of the same gender (e.g., a female BE interlocutor and a female AE interlocutor) and for two interleaved interlocutors of different genders (e.g., a female BE interlocutor and a male AE interlocutor). These results suggest that participants did not use gender-related voice details for model selection when accent details were sufficient for interlocutor model selection.

The Substance and Circumstances of Race and Immigration Talk in High School Gender and Sexuality Alliances

Gender & Sexuality Alliances (GSAs) are school-based clubs that support youth of diverse sexual orientations and gender identities. As identity-centered spaces, GSAs could also foster discussions related to race and immigration (i.e., race and immigration talk). We conducted semi-structured interviews from 2016 to 2018 with 38 GSA members (ages 13-20 years old) of diverse racial/ethnic, immigrant-origin (first and second generations in the United States born of immigrant parents), sexual orientation, and gender identities. Race and immigration talk often occurred when discussing current events (e.g., the 2016 US Presidential Election). Students reported that race and immigration talk depended on representation (i.e., GSA demographics), if it was deemed personally relevant to members, and whether students perceived issues of race and immigration as part of the agenda of the GSA. Some students indicated motivation to discuss racism and nativism yet refrained from doing so due to discomfort or fear of misspeaking. Overall, youth primarily viewed the GSA as a space for LGBTQIA+-oriented discussions and support yet expressed potential for fostering productive race and immigration talk in GSAs given the ongoing US sociopolitical climate. Discussions facilitated by advisors focusing on inter-connected oppression (e.g., intersections of racism and heterosexism) and that leverage brave space discussion dynamics may help students develop competencies to engage in race and immigration talk.

When non-salient information becomes salient in conversational memory: Collaboration shapes the effects of emotion and self-production

People's memory of what was said and who said what during dialogue plays a central role in mutual comprehension and subsequent adaptation. This article outlines that well-established effects in conversational memory such as the self-production and the emotional effects actually depend on the nature of the interaction. We specifically focus on the impact of the collaborative nature of the interaction, comparing participants' conversational memory in non-collaborative and collaborative interactive settings involving interactions between two people (i.e., dialogue). The findings reveal that the amplitude of these conversational memory effects depends on the collaborative vs. non-collaborative nature of the interaction. The effects are attenuated when people have the opportunity to collaborate because information that remained non-salient in the non-collaborative condition (neutral and partner-produced words) became salient in the collaborative condition to a level similar to otherwise salient information (emotional and self-produced words). We highlight the importance of these findings in the study of dialogue and conversational memory.

EXPRESS: Comparing individual and collective management of referential choices in dialogue

Past research shows that when a discourse referent is mentioned repeatedly, it is usually introduced with a full NP and maintained with a reduced form such as a pronoun. Is this also the case in dialogue, where the same referent may be introduced by one person and maintained by another person? An experiment was conducted in which participants either told entire stories to each other or told stories together, thus enabling us to contrast situations in which characters were introduced and maintained by the same person (control condition) and situations in which the introduction and the maintaining of each character were performed by different people (alternating condition). Story complexity was also manipulated through the introduction of one or two characters in each story. We found that participants were less likely to use reduced forms to maintain referents in the alternating condition. The use of reduced forms also depended on the context in which the referent was maintained (in particular, first or second mention of a character) and on story complexity. These results shed light on how the pressure to signal understanding to one's conversational partner affects referential choices throughout the interaction.

Using intervention mapping to develop 'Healthy HR' aimed at improving sustainable employability of low-educated employees

BACKGROUND

The perspectives of low-educated employees are often neglected when designing sustainable employability (SE) interventions. As a result, the interventions offered by the employer do often not align with the needs of low-educated employees. This particular group should therefore be actively involved in the process of developing and implementing SE interventions in their work organizations. The current paper describes the development process of a web-based intervention for HR managers and direct supervisors aimed at improving the SE of low-educated employees. This intervention is specifically designed to involve low-educated employees.

METHODS

The first four steps of the Intervention Mapping (IM) approach were used to systematically develop the intervention with the active involvement of stakeholders. Step 1 comprised a needs assessment including a literature review, empirical evidence, scoping search and several focus group interviews with employees and with representatives of employers. Step 2 formulated the intervention objective. During step 3, suitable theoretical methods were selected and translated to practical applications. Step 4 involved the development of a web-based intervention by integrating all information from the preceding steps.

RESULTS

The needs assessment indicated that the employees' active involvement and employees-employer genuine dialogue should be essential characteristics of an SE intervention for low-educated employees. The online toolkit 'Healthy HR' (HHR) was developed, which contains eight steps. Each step consists of one or more tasks helping the employer and employees with developing and implementing SE interventions themselves. One or more dialogue-based tools support each task. The leading principle providing structure within HHR was Adapted Intervention Mapping.

CONCLUSION

Principles of IM appeared to be useful to develop the intervention HHR systematically. This development process resulted in a practical online toolkit that supports employers in the development and implementation of local SE interventions tailored to the needs of low-educated employees. These employees should be actively involved in the process through a dialogue-based approach. By using IM principles, HHR is expected to increase the effectiveness in bettering the health and well-being of low-educated employees.

Repurposing Case-Based Learning to a Conversational Agent for Healthcare Cybersecurity

A crucial factor for successful cybersecurity education is how information is communicated to learners. Case-based learning of common cybersecurity issues has been shown to improve human behaviour for prevention. However, some delivery methods prevent realistic critical appraisal and reflection of awareness. Conversational agents can scaffold healthcare workers' understanding and promote deterrence strategies. The challenges of repurposing material to create a case-based agent were explored, and the ASPIRE process was modified. Heuristic evaluation from 10 experts in innovative educational technology resulted in the desired outcomes of usability, however Natural Language Understanding improvements were needed. Discussion of best practice when repurposing into conversational agents suggested modification of the ASPIRE process is feasible for future use.

On the Sociality and Immersiveness of the Introspective Encounter

Scientifically accessing and systematically approaching self-reports and a research subject's reflection is a central task of psychological research. However, psychological research often fails to account for the sociality of the individual's self-reports and reflection. In fact, addressing the complexity of the multi-faced reciprocal relations, how individuals get in touch with themselves through the encounter with the 'other' occupies psychology since its beginning up to the present day. A recently published volume edited by Gobodo-Madikizela (2021) delivers an in-depth analysis of the mutual encounters of second-generation descendants of perpetrators and survivors of the Holocaust and stresses the importance of "engaging with the past through second generation dialogue", showing that the introspective, dialogical encounter offers fruitful insight to processes that frequently remain 'invisible' and under the surface of intergenerationally travelling trauma, shame and guilt. Using the example of Gobodo-Madikizela's volume (2021), this article seeks to highlight contemporary applications of the introspectiv encounter and shows its value for locating psychology beyond a strict natural scientific discipline-understanding. By developing the notion of the introspective encounter 'of the first and the second degree', this article aims at showing how Gobodo-Madikizela's volume immerses readers, not only showing how psychology can produce a scientific outcome by crossing the border of the classic subject-object separation (first degree), but also facilitating the reader to enter an introspective dialogue with herself (second degree). By this analysis, this article challenges the way we currently converse in psychological research.

Speakers extrapolate community-level knowledge from individual linguistic encounters

Speakers' lexical choices are affected by interpersonal-level influences, like a tendency to reuse an interlocutor's words. Here, we examined how those choices are additionally affected by community-level factors, like whether the interlocutor is from their own or another speech community (in-community vs. out-community partner), and how such interpersonal experiences contribute to the acquisition of community-level linguistic knowledge. Our three experiments tested (i) how speakers' lexical choices varied depending on their partner's choices and speech community, and (ii) how speakers' extrapolation of these choices to a subsequent partner was influenced by their partners' speech communities. In Experiment 1, Spanish participants played two sessions of an online picture-matching-and-naming task, encountering the same pictures but different confederates in each session. The first confederate was either an in-community partner (Spanish) or an out-community partner (Latin American); the second confederate was either from the same community as the first confederate or not. Participants' referential choices in Session 1 were influenced by their partner's choices, but not by their community. However, participants' likelihood to subsequently maintain these choices was affected by their partners' communities. Experiment 2 replicated this pattern in Mexicans, and Experiment 3 confirmed that these results were driven by confederates' communities, rather than perceived linguistic status. Our results suggest that speakers encode speech community information during dialogue and store it to inform future contexts of language use, even when it has not affected their choices during that particular encounter. Thus, speakers learn community-level knowledge by extrapolating linguistic information from interpersonal-level experiences.

Many lenses for planetary health: seeding citizen engagement for sustainable futures visioning with new ways of seeing

OBJECTIVES

This pilot project sought to seed citizen engagement processes for sustainable futures visioning with ideas, perspectives, and processes informed by Indigenous ways of knowing.

METHODS

Five circle dialogues were convened with students, faculty, and members of the public, in the spring of 2019, using Indigenous talking circle methodology and intentionally seeded with "disruptive" ideas to encourage reflexivity and open space for "out-of-the-box" thinking. These were complemented by a series of one-on-one dialogues with members of the pan-Canadian research team. Pre- and post-dialogue surveys, notes taken by participants, team members, and co-facilitators, as well as notes from one-on-one interviews, constituted the data drawn upon for this paper.

RESULTS

Participants were overwhelmingly positive about their experience, noting they were able to go further and deeper in their thinking and listening, and that they valued the Indigenous talking circle methodology, even if they stopped short of claiming the experience had transformed their way of seeing the world. Key points raised in the dialogues included the need for a more relational worldview, the need to repair severed relations with the land and nature, the importance of Indigenous ways of knowing, the importance of community building, and the need to question the fundamental assumptions undergirding contemporary Western societies.

CONCLUSIONS

While caution must be exercised in drawing conclusions and extrapolating from this modest pilot project, our experience underscores the value of processes that intentionally catalyze critical reflexivity and openness to other ways of seeing, informed by Indigenous ways of knowing and talking circle methodology.

A systematic review

OBJECTIVE

To systematically review evidence on the characteristics, experiences and impact of an open dialogue about complementary and alternative medicine (CAM) integrated in oncology care.

METHODS

We searched MEDLINE, EMBASE, AMED, Scopus, ProQuest Dissertations and Thesis, Cochrane Central Register, clinicaltrials.gov, forskningsdatabase.dk and PROSPERO. Two reviewers screened title, abstract and full-text articles. Each study was appraised using the Critical Appraisal Skills Programme (CASP) and synthesized narratively. PROSPERO registration CRD42019112242.

RESULTS

We retrieved 4736 articles and included 5; 3 received 9 ½, 1 received 9, and 1 received 5 points on the CASP score. Predominately, the open dialogue was one or two individual, patient-centered, face-to-face consultations led by oncology physicians. In one study, it was a tele-phone consultation and in another it was structured counseling led by pharmacists. Integrated information and recommendations about CAM contributed to high level of satisfaction and improvement in concerns, quality of life and well-being.

CONCLUSION

Integration of open dialogue about CAM in oncology care including acknowledging patients' preferences, values, wishes and knowledge, and providing information about CAM expands the opportunities for improving patients' health, quality of life and well-being.

PRACTICE IMPLICATIONS

Open dialogue about CAM has potentials, but research on how it specifically helps patients, is needed.

Making oneself predictable in linguistic interactions

While language production is a highly demanding task, conversational partners are known to coordinate their turns with striking precision. Among the mechanisms that allow them to do so is listeners' ability to predict what the speaker will say, and thus to prepare their response in advance. But do speakers also play a role in facilitating coordination? We hypothesized that speakers contribute by using coordination smoothers - in particular by making their turns easier to predict. To test this, we asked participants to type definitions for common English words, either on their own (n = 26 individuals) or interacting with a partner (n = 18 pairs), and we measured the timing with which they produced the definitions. In a post-test, additional participants (n = 55) attempted to predict the final word of these definitions and rated them for quality. We found that interacting speakers initiated their turns with less variable delays than solo individuals. In contrast, our post-test measures suggested that jointly produced definitions were in fact of lower predictability and quality than those produced by individuals, but the analysis revealed these findings were likely confounded by task difficulty. We propose that the reduction in temporal variability observed for interacting speakers may facilitate prediction and thus act as a coordination smoother in linguistic interactions.

The "things themselves": challenging heuristics and inciting empathy via Husserlian phenomenology

I propose that the phenomenology of Edmund Husserl provides a meaningful mode of access to the patient experience. By reflecting on a real-life encounter with grief, my own medical training, and two works of literature, Nausea and Love in the Time of Cholera, I illustrate the application of philosophy and specifically phenomenology to clinical education. Phenomenology allows clinicians to strip away assumptions, habits of thinking, and normative ideas within the clinical encounter in order to enter the descriptive world of the patient. In suspending presuppositions and heuristics, the clinician can better empathize with the vivid, embodied stories that the patient is describing. Finally, the practice of phenomenology makes tangible the complexities of medical illnesses, emotions, and lived experiences.

Patient-Initiated Follow-Up (PIFU) as reorganized support for increased patient involvement - focus group discussions among patients' with inflammatory arthritis

Background

Inflammatory Arthritis is characterized by lifelong medical treatment and an unpredictable trajectory because of the fluctuating nature of the diseases. Proactive disease management is recommended, which includes close monitoring of disease activity that traditionally has been ensured by outpatient visits to rheumatologists at various fixed intervals. Internationally, there is a growing interest in how healthcare systems can be more flexible, individual-oriented and increasingly involve patients with lifelong diseases in their own treatment and care. We aimed to explore how patients with Inflammatory Arthritis with low disease activity or remission (DAS-CRP < 2.9) experience patient involvement in a reorganized follow-up care based on flexibility and patient-initiated contact.

Methods

We conducted a qualitative study based on four mixed group discussions focused on patients with inflammatory arthritis (rheumatoid arthritis [n = 21], axial spondyloarthritis [n = 3] and psoriatic arthritis [n = 1]) participating in a reorganized follow-up care. Changes in follow-up included access to a nurse and patient-initiated follow-up (PIFU). The analysis was based on content analysis. The reporting adheres to the Consolidated Criteria for Reporting Qualitative Research (COREQ).

Results

In total, 25 patients (20 females (80%), mean age 61.8 [range 28–79]) participated. We identified three categories. 1) Patient-Initiated Follow-Up do not affect patients’ perceived support in disease control; this refers to patients’ experience of more time available through better resource utilization, as well as trust that access to professional support would be available whenever needed. The category 2) Information is valued by patients to delineate responsibilities in a new patient role reflects patients’ uncertainty in the transition to PIFU, combined with confusion about the distribution of responsibilities. 3) Patients need both extended perspectives of their arthritis and focused dialogue is about expanding patients’ understanding of their arthritis by interaction over time with both a rheumatologist and a rheumatology nurse in a focused dialogue to involve the patient.

Conclusions

Patients participating in PIFU welcome the flexibility and involvement. However, patients need relevant information to act adequately within a new patient role. Interaction with both rheumatologists and nurses, combined with sufficient time for dialogue, broaden patients’ perspective, make opportunities for action visible, and contribute to patients’ ability to participate in follow-up care.

Discursive and Non-discursive Symbolization during couple's Conflict

The purpose of this article was exploring the role of discursive and non-discursive symbolization - specifically gestures - in the negotiation of differences in couples´ interactions. Five married heterosexual couples were invited to hold a conversation about an unsolved problem in their relationship. A videographic analysis was carried out to explore gestures in dialogical sequences and Microgenetic Semiotic Analysis (ASM) was conducted. The results showed that gestures complemented verbal signs as semiotic devices in the regulation of meaning construction and differences in negotiation, displaying strategies for facing and avoiding conflict, as well as resources for undergoing tension dealing with personal objectives and emotional difficulties; Its role is discussed as preparation of the verbal communicative expression, as devices for self-regulation and access to tension relief. Further, the discussion addresses their function as paths for encounter, mutuality and closeness.

Improving dialogue among researchers, local and indigenous peoples and decision-makers to address issues of climate change in the North

The Circumpolar North has been changing rapidly within the last decades, and the socioeconomic systems of the Eurasian Arctic and Siberia in particular have displayed the most dramatic changes. Here, anthropogenic drivers of environmental change such as migration and industrialization are added to climate-induced changes in the natural environment such as permafrost thawing and increased frequency of extreme events. Understanding and adapting to both types of changes are important to local and indigenous peoples in the Arctic and for the wider global community due to transboundary connectivity. As local and indigenous peoples, decision-makers and scientists perceive changes and impacts differently and often fail to communicate efficiently to respond to changes adequately, we convened a meeting of the three groups in Salekhard in 2017. The outcomes of the meeting include perceptions of how the three groups each perceive the main issues affecting health and well-being and recommendations for working together better.

Gifts of wise women: A reflection on enduring ideas in nursing that transcend time

In this essay, I propose there are enduring ideas in the works of nurse theorists from the 1960s and 1970s that were valuable not only in the past, but in nursing today as well as in possibly shaping the future of nursing knowledge development. I identify these as gift ideas and draw on the work of Wiedenbach for the gift of dignity in nursing philosophy, and the gifts of dialogue from Orlando, behavioral systems from Johnson, context from Roy, self-care from Orem, and finally the gift of nursing science as emergent in understanding life processes from Rogers. Although the core of nursing knowledge may be elusive, the gift ideas mentioned in this essay provide some guideposts in articulating and developing that core in the present as well as in the future.

Linguistic Convergence to Observed Versus Expected Behavior in an Alien-Language Map Task

Individuals shift their language to converge with interlocutors. Recent work has suggested that convergence can target not only observed but also expected linguistic behavior, cued by social information. However, it remains uncertain how expectations and observed behavior interact, particularly when they contradict each other. We investigated this using a cooperative map task experiment, in which pairs of participants communicated online by typing messages to each other in a miniature "alien" language that exhibited variation between alien species. The overall task comprised three phases, in each of which participants were told that they would be paired with a different partner. One member of the pair was given explicit linguistic expectations in each phase, while the software controlled whether or not observed behavior from their partner would be consistent or inconsistent with these expectations. The other participant was given no such expectations, allowing us to control for the role of expectation. Participants converged to both observed and expected linguistic behavior, and convergence was boosted when observation and expectation were aligned. When expected and observed behavior were misaligned, participants updated their expectations, though convergence levels did not drop. Furthermore, participants generalized what they learned about one partner to apparent novel partners of the same alien species. We also discuss individual variation in convergence patterns and the lack of a relationship between linguistic convergence and success at the map task. Findings are consistent with observations outside the laboratory that language users converge toward expected linguistic behavior. They also have broader implications for understanding linguistic accommodation and the influence of social information on linguistic processing and production.

The social-mediated crisis communication research: Revisiting dialogue between organizations and publics in crises of China

The rapid diffusion of social media is ushering in a new era of crisis communication. To enhance our understanding of the social-mediated dialogue between organizations and their publics in crises of China, this study conducts a content analysis of 61 relevant journal articles published in 2006-2018. Results of this research present an overview of ongoing research trends such as theoretical frameworks and methodological preferences. This research also explores how the unique Chinese social media characteristics affect the dialogue between types of organizations and their publics. Contextual factors such as face and favor, relationship (Guanxi) and sentiment (Renqing), and the centralized political system that may facilitate/inhibit dialogue in crises of China are identified as well. Finally, this study suggests promising new directions such as a scholarly assessment tool for the social-mediated crisis communication research in China.

Are People Sensitive to Problems in Communication?

Recent research indicates that interpersonal communication is noisy, and that people exhibit considerable insensitivity to problems in communication. Using a dyadic referential communication task, the goal of which is accurate information transfer, this study examined the extent to which interlocutors are sensitive to problems in communication and use other-initiated repairs (OIRs) to address them. Participants were randomly assigned to dyads (N = 88 participants, or 44 dyads) and tried to communicate a series of recurring abstract geometric shapes to a partner across a text-chat interface. Participants alternated between directing (describing shapes) and matching (interpreting shape descriptions) roles across 72 trials of the task. Replicating prior research, over repeated social interactions communication success improved and the shape descriptions became increasingly efficient. In addition, confidence in having successfully communicated the different shapes increased over trials. Importantly, matchers were less confident on trials in which communication was unsuccessful, communication success was lower on trials that contained an OIR compared to those that did not contain an OIR, and OIR trials were associated with lower Director Confidence. This pattern of results demonstrates that (a) interlocutors exhibit (a degree of) sensitivity to problems in communication, (b) they appropriately use OIRs to address problems in communication, and (c) OIRs signal problems in communication.

Understanding beneficial self-management support and the meaning of user involvement in lifestyle interventions: a qualitative study from the perspective of healthcare professionals

BACKGROUND

In light of the high prevalence of overweight and obesity among adults and the subsequent stigmatization and health consequences, there is a need to develop effective interventions to support lifestyle change. The literature supports the key role of healthcare professionals (HPs) in facilitating self-management through lifestyle interventions for those with chronic conditions. However, there is a lack of knowledge about how HPs practice self-management support (SMS) and user involvement for persons afflicted by overweight or obesity in lifestyle interventions in primary care Healthy Life Centres (HLC). The aim of this study was to explore how HPs provide SMS and what user involvement implies for HPs in HLCs.

METHODS

An interpretative exploratory design, using qualitative thematic analysis of data from two focus group interviews with ten HPs from eight different HLCs, was conducted.

RESULTS

The analysis resulted in one overall theme; A partnership based on ethical awareness, non-judgemental attitude, dialogue and shared responsibility, comprising four interrelated themes: 1) Supporting self-efficacy, self-worth and dignity through an attitude of respect, acknowledgement and generosity, 2) Promoting self-belief and self-perceived health, 3) Collaborating and sharing responsibility, and 4) Being flexible, adjusting and sharing time.

CONCLUSION

HPs in HLCs see service users as equal partners in a collaboration based on shared responsibility, acknowledgement and generosity. In order to help, their practice involves a heightened level of ethical awareness, including a non-judgemental attitude and dialogue. HPs in HLCs have something to teach us about ethical acting and helping persons who are struggling with overweight or obesity to change their lifestyle and regain dignity. They seem to see the service users' existential needs and have learned the art of meeting the other in her/his most vulnerable situation i.e., seeking help for a "wrong lifestyle". It may be time to highlight the need for SMS and user involvement to focus on shared responsibility in partnership rather than personal responsibility. More research is required to explore the conditions for such practice.

When Genetics Meets Religion: What Scientists and Religious Leaders Can Learn from Each Other

INTRODUCTION

To date scientists and religious leaders have not yet engaged in sustained face-to-face conversation concerning precision public health-related genetic technologies.

OBJECTIVES

To elucidate areas of commonality and divergence in scientists' and religious leaders' views of precision genetic technologies, and extract lessons conveyed by religious leaders to scientists, and scientists to religious leaders through participatory dialogue.

METHODS

Six 1.5-h dialogue sessions were held between 6 religious leaders, 8 University of Michigan scientists, and 3 additional public health/genetic counseling graduate students between October 2016 and September 2017, followed by an open conference at the Ann Arbor Public Library (n = 46). Statements were organized into thematically arranged duets comparing views of scientists and religious leaders. Duets were further ordered into interpretive levels. Comparative techniques were used to assure category agreement and face validity.

RESULTS

The analysis yielded 20 duets and 3 interpretive levels (expositional; implications and consequences; and integrative, bridging concepts). Scientists emphasized the value of epigenetic testing for health promotion, and cost saving for some forms of early genetic testing for adult-onset conditions. Religious leaders stressed care for an individual's willingness to change over technical fixes for behavioral conditions and, together with public participants, the importance of allocating money for societal needs. Both expressed caution on the use of nuclear transfer for mitochondrial DNA replacement and secondary uses of genetic data. Lay conference participants pointed towards a middle ground on the release of genetically edited mosquitoes for disease eradication.

DISCUSSION

Scientists stressed the value of professional guidance; religious leaders listened to family needs. Dialogues met four literature-based criteria for stakeholder involvement in deliberative processes.

CONCLUSION

While scientists and religious leaders differ in their points of emphasis and faith orientations (professional competency versus drawing on compassion), they can successfully collaborate in reaching mutual understanding and specific areas of agreement on precision genetic technologies relating to public health.

The potential of dialogues on social identity and diversity for immigrant civic integration

Local governments have become increasingly important in the governance of immigration. The present study evaluates a local government sponsored dialogue on social identity and diversity aimed at promoting the civic integration of immigrant participants. Based on models for community dialogues across cultural differences and on the literature on immigrant civic integration, the researcher designed, implemented and evaluated the dialogue. The evaluation was based on an exit questionnaire completed by participants, observation notes taken by the researcher, and a follow-up interview with the program coordinator. The evaluation suggests that dialogues among newcomers about social identity and diversity that match most of the ideal conditions for positive intergroup contact stated in the literature likely facilitate immigrant civic integration. Participants reported improved feelings of mutual understanding and inclination to collaborate across cultural differences. The findings also indicate that participants developed a capacity to balance appreciation for cultural differences and group identities with proclivity to collaboration across cultural groups.

Learning to interact and interacting to learn: a substantive theory of clinical workplace learning for diverse cohorts

Social interactions are integral to clinical workplace functioning and are recognised to play an important role in clinical workplace learning. How, why and to what end students, in the context of today's culturally and linguistically diverse cohorts, interact with members of clinical workplace communities during clinical workplace learning is not well understood. The aim of this research was to generate a theoretical understanding of students' interactive processes in clinical workplace learning that accounted for high levels of cultural/linguistic diversity. In accordance with constructivist grounded theory methods, data collection and analysis were premised on theoretical sampling and constant comparative analysis, and undertaken from an informed and reflexive stance. This involved iterations of survey, interview and diary data from two diverse cohorts of final year veterinary students who had undergone 11 months of clinical workplace learning. Clinical preceptors were also interviewed. As an aid to theory building, testing and refinement, and in order to test the theory's relevance, usefulness and transferability beyond veterinary clinical education, critical feedback was sought from medical and allied health educators. Our substantive level theory demonstrates that upon entering the clinical workplace community, students learn how to 'harness dialogue' in order to effectively coordinate three, inter-related interactive processes: (i) functioning in the workplace, (ii) impression management and (iii) learning-in-the-moment. We found both positive and negative consequences ensued, depending on how students harnessed dialogue. The theory responds to a perceived need in international student education to move away from a deficit discourse by developing educational theory which focuses on the nature of participation, rather than the nature of the student.

The Added Value of Studying Embodied Responses in Couple Therapy Research: A Case Study

This article reports on the added value of embodied responses identified through sympathetic nervous system (SNS) activity in couple therapy research. It focuses on moments of change and the timing of therapeutic interventions or therapeutic moves in a couple therapy session. The data for this single-case study comprise couple therapy process videotapes recorded in a multi-camera setting, and measurements of participants' SNS activity. The voluntary participants were a marital couple in their late thirties and two middle-aged male psychotherapists. The division into topic segments showed how the key issue of seeking help, which was found to comprise three separate components, was repeatedly dealt with in the session. SNS activity showed different degrees of synchronization between the couple, between the therapists, and between the couple and therapists during the dialogue pertaining to these three components. The issue of timing emerged as a complex, even ambivalent, phenomenon. Arousal in the therapists was in line with their therapeutic activity, whereas in the clients it was more anticipatory. The approach used here rendered visible some of the intensity that therapeutic dialogue can generate when dealing with issues of relationship change in the couple context and showed how this intensity can be dialogically regulated in the therapeutic system.

Empirically supported out-of-the-box strategies for science communication by environmental scientists

Scientists are expected to communicate their research to a wide audience, while often lacking appreciable training. Environmental science poses many value-laden and ethical questions. This necessitates the identification and use of specific strategies or guidelines, which encourage 2-way communication and enable trust in both the experts and the scientific results. The objective of this paper is to give environmental scientists tools for effective science communication based on sound scientific evidence that does not require further specialization in communication studies. Using common scientific search engines in Europe, scientific communication literature that met specific parameters was identified. The summarized data contextualize the importance of science communication in environmental sciences but also highlight the need of scientists for communication experts to aid in establishing objectives for particularly complex topics and audiences. Integr Environ Assess Manag 2019;15:499-504. © 2019 SETAC.

A Dialogue-Based Approach to Subjective Well-Being: Co-Interpreting the Meaning of Daily Experiences

Different from statistically analyzed self-reports of Subjective Well-Being (SWB), we explored how dialogue engenders the meaning of SWB as constituted through an individual's daily experiences. A revised Day Reconstruction Method (DRM; Kahneman et al. 2004) was used to describe the participants' previous day episodically, followed by a semi-structured life world interview (Kvale 1996) for the explication through dialogue of those episodes. The results of qualitative analyses on the structure and contents of the discourse of the DRM and interviews with three participants highlighted the following: 1) the participants construed the meaning of daily experiences by organizing and weighting them in individualized ways; 2) the meaning of daily episodes emerged and was clarified in the process of collaborative dialogue in the interview as well as in the analyses, and was vividly expressed in particular protocol sequences; and 3) Kelly's (1955) notion of Personal Construct is applicable to make sense of individualized narratives as a form of Well-Being. We concluded that the subjectivity of SWB does not merely imply the first-person authority in charge of the evaluation in the questionnaires, but rather is understood as a construct that reveals the personal meaning of one's daily experiences. The emergent quality of this process is crucial for understanding the nature of subjectivity in SWB.

Three visions of doctoring: a Gadamerian dialogue

Medicine in the twenty-first century faces an 'identity crisis,' as it grapples with the emergence of various 'ways of knowing,' from evidence-based and translational medicine, to narrative-based and personalized medicine. While each of these approaches has uniquely contributed to the advancement of patient care, this pluralism is not without tension. Evidence-based medicine is not necessary individualized; personalized medicine may be individualized but is not necessarily person-centered. As novel technologies and big data continue to proliferate today, the focus of medical practice is shifting away from the dialogic encounter between doctor and patient, threatening the loss of humanism that many view as integral to medicine's identity. As medical trainees, we struggle to synthesize medicine's diverse and evolving 'ways of knowing' and to create a vision of doctoring that integrates new forms of medical knowledge into the provision of person-centered care. In search of answers, we turned to twentieth-century philosopher Hans-Georg Gadamer, whose unique outlook on "health" and "healing," we believe, offers a way forward in navigating medicine's 'messy pluralism.' Drawing inspiration from Gadamer's emphasis on dialogue and 'practical wisdom' (phronesis), we initiated a dialogue with the dean of our medical school to address the question of how medical trainees and practicing clinicians alike can work to create a more harmonious pluralism in medicine today. We propose that implementing a pluralistic approach ultimately entails 'bridging' the current divide between scientific theory and the practical art of healing, and involves an iterative and dialogic process of asking questions and seeking answers.

[Cardiovascular protection of diabetic patient with chronic renal disease and particular case of end-stage renal disease in elderly patients]

Type 2 diabetes has an increasing prevalence. Life expectancy is dominated by cardiovascular risk, which is the leading cause of death in these patients. Up to one third of diabetic patients will develop diabetic nephropathy related to micro-angiopathy. Renal impairment further increases cardiovascular risk. Reducing cardiovascular morbidity and mortality is a major public health issue, as well as early preventing and managing chronic kidney disease (CKD). Good glycemic control prevents the micro-vascular complications of the disease (retinopathy, nephropathy, etc.) and, more recently recognized through prolonged monitoring of the VADT cohort, prevents cardiovascular complications. Control of blood pressure and dyslipidemia are essential in primary or secondary cardiovascular prevention. In addition, the blockers of the renin-angiotensin system slow down the progression of the MRC. Elderly patients with chronic kidney disease (CKD) form another growing group of the nephrologist daily patient pool. Especially for very elderly patients with comorbidities, the question of favoring conservative treatment rather than starting or pursuing dialysis may arise. Survival and quality of life are indeed not necessarily better in elderly patients undergoing dialysis, complications can occur eventually leading to discontinuation, and are occasionally associated with a feeling of stubbornness. Creation of prognostic score is a useful tool to help the decision-making process. However, dialogue with the patient and his/her family, as well as multidisciplinary collaboration remain fundamentals to determine the most suitable care.

Analysis of environmental communication and its implication for sustainable development in Ethiopia

BACKGROUND

Environmental issues have been causing debates around the globe. These issues have also got much attention in Ethiopia. Ethiopia has been adversely affected by the environmental crisis. Developing countries and the poor were depicted as unfortunate victims of climate change. The causes of climate change include deforestation, industries, mismanagement of the environment, and utilization of natural resources. One of the effects of climate change brought natural disaster what we call a drought. Drought affected many people, even recently, in Ethiopia. Concerning the environmental problems and issues in Ethiopia, there are beginnings at the policy level. However, the practical aspects of communicating and addressing these issues could not get much attention from the authority.

OBJECTIVE

The aim of the research is to analyze environmental communication of Amhara National Regional State-Environmental Protection Authority.

METHOD

Case study as a qualitative research method is used. The case design type is descriptive. The researcher selected two techniques of collecting data: in-depth interview and documents.

RESULTS

The results show that the authority is unable to communicate environmental issues which were stated in the different conventions and policies.

CONCLUSION

There are gaps that could be considered from the outcome of the research. The major gaps and challenges in addressing practical issues of environment are identified namely poor environmental information systems, lack of awareness creation through communications, and weak public dialogue and genuine participation consideration.

Universal Principles of Human Communication: Preliminary Evidence From a Cross-cultural Communication Game

The present study points to several potentially universal principles of human communication. Pairs of participants, sampled from culturally and linguistically distinct societies (Western and Japanese, N = 108: 16 Western-Western, 15 Japanese-Japanese and 23 Western-Japanese dyads), played a dyadic communication game in which they tried to communicate a range of experimenter-specified items to a partner by drawing, but without speaking or using letters or numbers. This paradigm forced participants to create a novel communication system. A range of similar communication behaviors were observed among the within-culture groups (Western-Western and Japanese-Japanese) and the across-culture group (Western-Japanese): They (a) used iconic signs to bootstrap successful communication, (b) addressed breakdowns in communication using other-initiated repairs, (c) simplified their communication behavior over repeated social interactions, and (d) aligned their communication behavior over repeated social interactions. While the across-culture Western-Japanese dyads found the task more challenging, and cultural differences in communication behavior were observed, the same basic findings applied across all groups. Our findings, which rely on two distinct cultural and linguistic groups, offer preliminary evidence for several universal principles of human communication.