Patients’ attitude and factors influencing the acceptance of medical students’ participation in pelvic examination

Introduction: Pelvic examination of patients in the department of obstetrics and gynaecology (Ob-Gyn) is an important skill for medical students. Because it involves a physical assessment of the patients' genitalia, patients may refuse medical students to participate in the examination, affecting the medical students' clinical skills. Methods: This cross-sectional study was conducted at Naresuan University Hospital to determine the factors that influence the acceptance of medical student participation in the pelvic examinations. A total of 198 out-patients from the Ob-Gyn department were included. A Likert scale questionnaire was designed which featured topics on patients’ attitudes and circumstances related to medical student involvement in gynaecological procedures. Results: The majority of outpatients (71.7%) accepted the participation of medical students in pelvic examinations. Patients with prior experiences in physical and pelvic examination by medical students had a significant impact on the patients' acceptance (P-value<0.001). The patients’ impressions had an influence on the decision to accept students in pelvic exam participation. Approximately 40% of patients were concerned about the breach of confidentiality. However, most patients strongly agreed that allowing medical students to perform pelvic examination would benefit their medical education. Conclusion: Most of the participants permitted medical students to participate in pelvic examinations and preferred that the medical instructor be the one to request permission. The patients’ impressions of medical students were crucial factors that significantly influence their decision whether to allow or deny them to participate in the procedure. Disclosure of confidentiality was found to be matters of concern to most patients.

Fixing Subjects, Fixing Outcomes: Civic Epistemologies and Epistemic Agency in Participatory Governance of Climate Risk

Participatory forms of policy-making have often been criticized for insufficiently theorizing the coproduction of publics and matters of concern. This paper seeks to investigate this relationship further by analyzing how the concept of civic epistemologies (CEs) can provide insights for understanding how political contexts shape both publics and contestable debates. Presenting fieldwork on cyclone governance in Odisha, India, based on the analysis of interviews with vulnerable fishing communities and state actors, the article shows how CEs influence the interdependent formation of vulnerable fisher and state subjectivities on one hand with representations of risk located in external biophysical atmospheric gases on the other, thereby sustaining reductive roles and futures. At the same time, the paper develops the concept of CEs by examining them as performative acts carried out by marginalized communities and state actors at the subnational level of a nonindustrialized country, thereby indicating sites at which epistemic agency can be increased and governed. Participatory knowledge production needs to understand how it is affected by CEs if it is to generate effective expertise for transformative futures in the face of increasing climatic risks.

Negacionistas são os outros? Verdade, engano e interesse na era da pós-verdade

Os debates públicos sobre o fenômeno do negacionismo parecem se pautar sobre a ambiguidade da noção de engano: os “negacionistas profissionais” seriam aqueles que enganam, os cientistas seriam os que não (se) enganam e as “pessoas comuns” seriam as mais suscetíveis a se enganarem ou serem enganadas. Porém, estudos mostram que os negacionistas consideram sua própria atitude como uma precaução contra o engano; por isso, explicações que os tratam como anticientificistas, antidemocráticos e ignorantes não dão conta do fenômeno em toda sua complexidade. Neste artigo, recorro à noção nietzschiana de “vontade de verdade” para pensar o negacionismo como um efeito deletério da imagem da ciência como um escudo desinteressado contra o engano. Mais que isso, examino a hipótese de que a oposição verdade/engano nos torna a todos potenciais negacionistas, e proponho, como proteção contra esse risco, admitir os interesses que levam as pessoas a disputar os fatos científicos. Discuto também o contexto sociopolítico no qual o negacionismo pôde emergir e apresento alguns caminhos para uma noção de verdade mais condizente com as “questões de preocupação” (matters of concern) atuais.

Trans-Tasman Border Stories: Actor-Network Theory and Policy Narrative in Action

<p>This thesis explores the relationship between narrative and action in the policy practice of border management in trans-Tasman regional economic integration. Using the European Union, the most developed form of regional integration, as a point of reference, it examines five stories of policy practice relating to the joint Prime Ministerial announcement on 2 March 2009 that committed Australia and New Zealand to ‘reduce remaining barriers at the borders to ensure that people and goods can move more easily between the two countries’ (Key & Rudd, 2009a). Actor-network theory (ANT) is the theoretical frame, drawing particularly on the works of Bruno Latour, John Law and Vicky Singleton, Michel Callon, and Barbara Czarniawksa, enhanced with aspects of the narrative theory of Hannah Arendt and Paul Ricoeur. This frame aligns with and builds on the policy narrative work of Rod Rhodes and Maarten Hajer and is applied to both regional integration and policy practice. New knowledge comes from identifying border management as a domain of policy practice, and extending Callon’s concept of marketization to border management, which is shown to be part of the global trading narrative that underpins regional integration. In trans-Tasman regional economic integration, narratives are revealed as a mix of economic, political and cultural matters of concern that are enacted with different types of separation and integration effects. The trans-Tasman relationship features as a macro-actor from which a mix of narrative effects emerges. The combination of economic, political and cultural narratives revealed in trans-Tasman regional economic integration can be seen in the EU, but with different emphases and effects arising from the interaction between them. This finding suggests a potential anatomy of border management policy in regional integration. Through tracing the actions of officials, this thesis reveals Trans-Tasman policy narratives to be performative, made up of the many little translations that occur in day-to-day policy practice, into which are woven the above broader connections. It also reveals that narrative is not only a way to tell the stories of what is being done, but that the narratives of matters of concern drive the action, and the action itself tells its own story. Narratives thus cannot be separated from action. These policy narratives are multiple and affect action in different ways, both positively and negatively, depending on the matters of concern, the relational power (who’s speaking on behalf of whom or what) and how they interact with one another. A point of departure for this thesis is the use of ANT to explore policy narrative, and the potential for applying the concept of performativity to other approaches of policy narrative. The narrative aspect of ANT is underemphasised yet it is a powerful analytical tool that has the potential to add to the effectiveness of the practice of policy. Incorporating aspects of narrative theory together with ANT is shown to enhance the insights.</p>

Trans-Tasman Border Stories: Actor-Network Theory and Policy Narrative in Action

<p>This thesis explores the relationship between narrative and action in the policy practice of border management in trans-Tasman regional economic integration. Using the European Union, the most developed form of regional integration, as a point of reference, it examines five stories of policy practice relating to the joint Prime Ministerial announcement on 2 March 2009 that committed Australia and New Zealand to ‘reduce remaining barriers at the borders to ensure that people and goods can move more easily between the two countries’ (Key & Rudd, 2009a). Actor-network theory (ANT) is the theoretical frame, drawing particularly on the works of Bruno Latour, John Law and Vicky Singleton, Michel Callon, and Barbara Czarniawksa, enhanced with aspects of the narrative theory of Hannah Arendt and Paul Ricoeur. This frame aligns with and builds on the policy narrative work of Rod Rhodes and Maarten Hajer and is applied to both regional integration and policy practice. New knowledge comes from identifying border management as a domain of policy practice, and extending Callon’s concept of marketization to border management, which is shown to be part of the global trading narrative that underpins regional integration. In trans-Tasman regional economic integration, narratives are revealed as a mix of economic, political and cultural matters of concern that are enacted with different types of separation and integration effects. The trans-Tasman relationship features as a macro-actor from which a mix of narrative effects emerges. The combination of economic, political and cultural narratives revealed in trans-Tasman regional economic integration can be seen in the EU, but with different emphases and effects arising from the interaction between them. This finding suggests a potential anatomy of border management policy in regional integration. Through tracing the actions of officials, this thesis reveals Trans-Tasman policy narratives to be performative, made up of the many little translations that occur in day-to-day policy practice, into which are woven the above broader connections. It also reveals that narrative is not only a way to tell the stories of what is being done, but that the narratives of matters of concern drive the action, and the action itself tells its own story. Narratives thus cannot be separated from action. These policy narratives are multiple and affect action in different ways, both positively and negatively, depending on the matters of concern, the relational power (who’s speaking on behalf of whom or what) and how they interact with one another. A point of departure for this thesis is the use of ANT to explore policy narrative, and the potential for applying the concept of performativity to other approaches of policy narrative. The narrative aspect of ANT is underemphasised yet it is a powerful analytical tool that has the potential to add to the effectiveness of the practice of policy. Incorporating aspects of narrative theory together with ANT is shown to enhance the insights.</p>

Buying Up, Not Selling Out

All too often, artists who are attentive to the 'business' of their creative practice are accused of 'selling out'. But for many working artists, that attention to business — to revenue generation, asset accrual, the arts economy — is what enables an artist to not just survive, but to thrive. When artists follow their mission, or organizations theirs, they don’t sell out, they spiral up by keeping mission at the forefront. Money and other tangible assets are not their end goal — they are instead the means toward the end of artistic and cultural production. As I talked with artists and arts infrastructure leaders about what makes their work sustainable, an unexpected theme emerged: property ownership. This essay looks at artists, organizations, and communities that own property to see the ways in which missions drive decision-making, assets are maximized, and 'success', however it is defined, can be sustained. When property ownership is part of that sustainability equation, history, agency, and racial equity also become matters of concern.

Gastric antral duplication cyst: A case report

Alimentary tract duplications may be symptomatic or may be discovered incidentally. They are named for the organ with which they are associated.1 Congenital gastrointestinal (GI) tract duplication cysts are commonly located in the ileum (53%), mediastinum (18%), colon (13%), stomach (7%), duodenum (6%), rectum (4%), or oesophagus (2%)2. A single theory is insufficient to explain all types of duplications.3 Children may present with symptoms like vomiting, abdominal pain, lumps, or weight loss.4 The presence of ectopic gastric mucosa and the potential for malignancy remain matters of concern.2 Surgical management is essential for these rare cysts.5 We encountered a Bangladeshi boy with a gastric duplication cyst (GDC) that was pre-operatively diagnosed as a pancreatic cyst. A variety of imaging modalities failed to indicate GDC before the operation. Here we present the clinical course of the case and discuss the difficulties and problems in diagnosing GDC.

MRSA Femoral Osteomyelitis From Superinfected Scabies Lesions: a Pediatric Case Report

Scabies is a skin infestation from the Sarcoptes scabiei. It is considered a public health issue causing concern in developing countries and is one of the World Health Organization (WHO) Neglected Tropical Disease. Scabies skin lesions may cause severe itch and can be the portal of entry for opportunistic and pathogenic bacteria which can cause serious systemic infections. We report the case of a 3 year-old-boy with recurrent scabies infection presenting to the Emergency Department because of fever and refusal to walk. At medical examination he looked unwell, right thigh was extremely painful on palpation and blood test showed neutrophilic leucocytosis and significantly increased C reactive protein (CRP) and procalcitonin. Magnetic resonance imaging (MRI) showed an osteomyelitis of metaphysis and distal diaphysis of the right femur with associated subperiosteal purulent collection and concomitant pyomyositis and fasciitis of the distal right thigh. Blood cultures turned positive for Methicillin-Resistant Staphylococcus aureus. He received a long course of intravenous antibiotic therapy and his condition slowly improved. Follow-up femur X-ray showed a mixed pattern of erosion and sclerosis at meta-diaphyseal region and periosteal reaction at diaphyseal region. This case highlights the importance of early scabies diagnosis even in Western countries where poverty and household overcrowding are not matters of concern. Early diagnosis, timely begin of proper treatment and evidence of clinical resolution are important elements to prevent recurrence of infection and serious systemic superinfections even from multi-drug resistant bacteria. Clinical consequences from unrecognized disease or inadequate eradication are preventable.