Ethnographic research as an evolving method for supporting healthcare improvement skills: a scoping review

Background The relationship between ethnography and healthcare improvement has been the subject of methodological concern. We conducted a scoping review of ethnographic literature on healthcare improvement topics, with two aims: (1) to describe current ethnographic methods and practices in healthcare improvement research and (2) to consider how these may affect habit and skill formation in the service of healthcare improvement. Methods We used a scoping review methodology drawing on Arksey and O’Malley’s methods and more recent guidance. We systematically searched electronic databases including Medline, PsychINFO, EMBASE and CINAHL for papers published between April 2013 – April 2018, with an update in September 2019. Information about study aims, methodology and recommendations for improvement were extracted. We used a theoretical framework outlining the habits and skills required for healthcare improvement to consider how ethnographic research may foster improvement skills. Results We included 283 studies covering a wide range of healthcare topics and methods. Ethnography was commonly used for healthcare improvement research about vulnerable populations, e.g. elderly, psychiatry. Focussed ethnography was a prominent method, using a rapid feedback loop into improvement through focus and insider status. Ethnographic approaches such as the use of theory and focus on every day practices can foster improvement skills and habits such as creativity, learning and systems thinking. Conclusions We have identified that a variety of ethnographic approaches can be relevant to improvement. The skills and habits we identified may help ethnographers reflect on their approaches in planning healthcare improvement studies and guide peer-review in this field. An important area of future research will be to understand how ethnographic findings are received by decision-makers.

Clearing of the Ground - Ambedkar's Method of Reading

This essay attempts to study and explicate the method of reading as operative in Ambedkar’s writings. The essay is organized around five thematic sections, each aimed at discussing a methodological concern guiding Ambedkar’s investigations. His engagements with the religious texts of Hinduism in general and the Manusmriti (The Laws of Manu or The Law Code of Manu) in particular have been used here to explicate the substance and implications of what has been described by Aishwary Kumar as Ambedkar’s ‘politics of reading’, a highly suggestive phrase that points towards the political as well as epistemic stakes of Ambedkar’s acts of reading.

PROBLEMATIZAÇÕES CONTEMPORÂNEAS SOBRE A ESCALARIDADE: FORMA, NATUREZA E ORGANIZAÇÃO DAS ESCALAS GEOGRÁFICAS

O “problema da escala” emerge na Geografia no momento em que a necessidade de organizar as unidades espaciais possíveis de serem identificadas é ressaltada como uma preocupação metodológica, sendo assim explicitado e tratado no âmbito acadêmico da Geografia sobretudo a partir da década de 1950. A difusão de certos referenciais teórico-políticos nas pesquisas sócio-espaciais possibilitou que a questão escalar fosse, nos anos seguintes, observada desde abordagens para as quais dividir e organizar o espaço não era uma questão meramente metodológica, mas também epistemológica, política e, portanto, diretamente ligada à prática e à ação social. Mas a proliferação de trabalhos sobre as escalas geográficas não ocorreu homogeneamente nos diferentes ambientes linguísticos da literatura especializada. No caso anglófono, foi a partir do final da década de 1980 que isso aconteceu, processo que ficou conhecido como de “abertura” do conceito de escala na Geografia. O objetivo destas páginas é caracterizar os principais eixos do debate sobre as escalas geográficas que se desenrolou entre aproximadamente a última década do século XX e a primeira década do século XXI nas pesquisas realizadas no ambiente da Geografia anglófona de forma a incrementar a pluralidade de questões que fertilizam as compreensões sobre a escala geográfica.Palavras-chave: Escala geográfica; História do Pensamento Geográfico; Geografia anglófona. CONTEMPORARY TOPICS ON SCALARITY: FORM, NATURE, AND ORGANISATION OF GEOGRAPHICAL SCALESAbstract: The “scale problem” emerges in Geography at the moment in which the need to organize the possibly identifiable spatial units is highlighted as a methodological concern. Thus, it became explicit and treated in this academic field, specially from the 1950s onward. In the following years the diffusion of other theoretical-political references in Western socio-spatial research allowed the scalar issue to be observed from approaches for which the act of divide and organize the space was not merely a methodological issue, but also an epistemological and political one ―and, therefore, scale was recognized as directly linked to the practice and social action. But the proliferation of works on geographical scales did not occur homogeneously in the different linguistic environments of the specialized literature. In the Anglophone case, for example, it was from the end of the 1980s that this happened. The aim of this article is to characterize the main axes of the debate on geographical scales that took place between approximately the last decade of the twentieth century and the first decade of the twenty-first century in the research carried out in the environment of Anglophone Geography in order to increase the plurality of issues that fertilize the understandings on geographical scale.Keywords: Geographical scale; History of Geographical Thought; Anglophone geography.CUESTIONES CONTEMPORÁNEAS SOBRE LA ESCALARIDAD: FORMA, NATURALEZA Y ORGANIZACIÓN DE LAS ESCALAS GEOGRÁFICASResumen: El “problema de la escala” surge en Geografía en el momento en que se pone de manifiesto la necesidad de organizar las unidades espaciales identificables como una preocupación metodológica. Así, el tema se vuelve explícito y tratado en este ámbito académico principalmente a partir de la década de 1950. La difusión de ciertas referencias teórico-políticas en las investigaciones socio-espaciales ocidentales permitió que la cuestión escalar fuera, en los años siguientes, observada desde enfoques para los que dividir y organizar el espacio no era una cuestión meramente metodológica, sino también epistemológica y política ―y, por lo tanto, directamente vinculada a la práctica y a la acción social. Pero la proliferación de trabajos sobre escalas geográficas no se produjo de forma homogénea en los distintos ámbitos lingüísticos de la literatura especializada. En el caso anglófono, por ejemplo, eso ocurrió a partir de finales de los años ochenta. El objetivo de este artículo es caracterizar los principales ejes del debate sobre las escalas geográficas que tuvo lugar aproximadamente entre la última década del siglo XX y la primera del siglo XXI en las investigaciones realizadas en el entorno de la Geografía anglófona con el fin de aumentar la pluralidad de cuestiones que alimentan las reflexiones sobre la escala geográfica.Palabras clave: Escala geográfica; Historia del Pensamiento Geográfico; Geografía anglófona.

The Value of Total Body Photography for the Early Detection of Melanoma: A Systematic Review

Early detection of melanoma is critical to reduce the mortality and morbidity rates of this tumor. Total body photography (TBP) may aid in the early detection of melanoma. To summarize the current evidence on TBP for the early detection of melanoma, we performed a systematic literature search in Medline, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) for eligible records up to 6th August 2020. Outcomes of interest included melanoma incidence, incisional and excisional biopsy rates, as well as the Breslow’s index of detected tumors. Results from individual studies were described qualitatively. The risks of bias and applicability of the included studies was assessed using the QUADAS-2 checklist. In total, 14 studies published between 1997 and 2020 with an overall sample size of n = 12,082 (range 100–4692) were included in the qualitative analysis. Individuals undergoing TBP showed a trend towards a lower Breslow’s thickness and a higher proportion of in situ melanomas compared to those without TBP. The number needed to excise one melanoma varied from 3:1 to 14.3:1 and was better for lesions that arose de novo than for tracked ones. The included studies were judged to be of unclear methodological concern with specific deficiencies in the domains “flow and timing” and “reference standard”. The use of TBP can improve the early detection of melanoma in high-risk populations. Future studies are warranted to reduce the heterogeneity of phenotypic risk factor definition and the technical implementation of TBP. Artificial intelligence-assisted analysis of images derived from 3-D TBP systems and digital dermoscopy may further improve the early detection of melanoma.

Professor tradicional: entre as ideologias de direita e de esquerda

No sistema educacional brasileiro, a figura do professor é controvertida. Em alguns casos, acusam-no de autoritário, despreparado para lidar com as novas tecnologias ou incapaz de compreender as transformações pelas quais a contemporaneidade passa. Em outros, ao contrário, dizem que está sufocado pelas pressões da sala de aula e que, por distintas causas, minam a sua autoridade. Há ideologias que combatem a figura do professor tradicional relacionando-o com a Ditadura Militar de 64. Contudo, mesmo com um currículo democrático e com constante preocupação didático-metodológica, os índices de aprendizado da educação básica, desde a Redemocratização, não são satisfatórios. Vez ou outra aparecem escolas isoladas, privadas ou estatais, que apresentam bons resultados e, quando analisasadas detalhadamente, nota-se que há rechaço, explícito ou tácito, a muitas das ideias preconizadas pela educação progressista. Por tudo isso, o objetivo deste artigo é analisar o papel do professor tradicional e da escola estatal no contexto da sociedade democrática atual.Palavras-chave: Professor tradicional. Escola pública. Educação progressista. Democracia.Traditional teacher: between the right and left ideologiesABSTRACTIn the Brazilian educational system, the figure of the teacher is controversial. In some cases, they accuse him of being authoritarian, unprepared to deal with new technologies, or unable to understand the transformations that contemporary times go through. In others, on the contrary, they say that he is suffocated by classroom pressures and that, for different causes, undermine his authority. There are ideologies that counteract the figure of the traditional teacher by relating him to the Military Dictatorship of 64. However, even with a democratic curriculum and constant didactic-methodological concern, the learning indices of basic education since Redemocratization are not satisfactory. Occasionally, isolated private or state schools appear, which have good results, and when you look at them in detail you find that there is an explicit or tacit rejection of many of the ideas advocated by progressive education. Therefore, the aim of this paper is to analyze the role of the teacher and the traditional school in the context of the current democratic society.Keywords: Traditional teacher. Public school. Progressive education. Democracy.Profesor tradicional: entre las ideologías de derecha y de izquierdaRESUMENEn el sistema educativo brasileño, la figura del profesor está controvertida. En algunos casos, nos acusan de autoritario, sin preparo para lidiar con las nuevas tecnologías o incapaz de comprender las transformaciones por las cuales la contemporaneidad pasa. En otros, al contrario, dicen que está sofocado por las presiones del aula y que, por diferentes causas, disminuyen su autoridad. Hay ideologías que combaten la figura del profesor tradicional relacionándolo con la Dictadura Militar del 64. Pero, mismo con un currículo democrático y constante preocupación didáctico-metodológica, los índices de aprendizaje de la educación básica, desde la Redemocratización, no son satisfactorios. De vez en cuando, aparecen escuelas aisladas, privadas o estatales, que presentan buenos resultados, y cuando se las analiza detalladamente, se nota que hay rechazo, explícito o tácito, de muchas ideas preconizadas por la educación progresista. Por esta razón, el objetivo de este artículo es analizar el papel del profesor tradicional y de la escuela estatal en el contexto de la sociedad democrática actual.Palabras clave: Profesor tradicional. Escuela pública. Educación progresista. Democracia.

Ideal and Nonideal Theory in Political Philosophy

The distinction between ideal and nonideal theory is an important methodological concern in contemporary political theory. At issue is the extent to which political theorizing is a practical endeavor and, consequently, the extent to which real-world facts should either be factored into political theorizing or else be assumed away. The distinction between ideal theory and nonideal theory was first introduced by John Rawls in his classic A Theory of Justice. Rawls’s ideal theory is an account of the society we should aim for, given certain facts about human nature and possible social institutions, and involves two central assumptions. First, it assumes full compliance of relevant agents with the demands of justice. Second, it assumes that historical and natural conditions of society are reasonably favorable. These two assumptions are individually necessary and jointly sufficient for his ideal theory. For Rawls, nonideal theory primarily addresses the question of how the ideal might be achieved in practical, permissible steps, from the actual, partially just society we occupy. The account of ideal and nonideal theory advanced by Rawls has been subject to criticism from different directions. Amartya Sen accepts Rawls’s distinction between ideal and nonideal theory but argues that Rawlsian-style nonideal theory is too ideal. Given the many and severe injustices we face we do not need to know what ideal (or “transcendental”) justice looks like; our focus should not be on how to transition toward this ideal. Instead, the advancement of justice requires a comparative judgment which ranks possible policies in terms of being more or less just than the status quo. G. A. Cohen, by contrast, argues that Rawlsian-style ideal theory is not really ideal theory as such, but instead principles for regulating society. Our beliefs about normative principles should, ultimately, be insensitive to matters of empirical fact; genuine ideal theory is a form of moral epistemology (an exercise of identifying normative truths).

A systematic review exploring the evidence reported to underpin exercise dose in clinical trials of rheumatoid arthritis

We aimed to evaluate the evidence reported to underpin exercise dose in randomised controlled trials (RCTs) using strengthening exercise in RA. We searched six different databases between 1 January 2000 and 3 April 2019. We included RCTs, where a main component of the intervention and/or control used strengthening exercise. Evidence sources cited to underpin dose were judged for their quality, consistency and applicability. Thirty-two RCTs were reviewed. Four (12.5%) piloted the intervention without using dose-escalation designs to determine optimal dose-response. Twenty (62.5%) reported no evidence underpinning dose. Where reported, quality, consistency and applicability of the underpinning evidence was a cause for methodological concern. The majority of RCTs did not report the evidence underpinning dose. When reported, the evidence was often not applicable to the clinical population. Frequently, the dose used differed to the dose reported/recommended by the underpinning evidence. Our findings illustrate exercise dose may not be optimised for use with clinical populations prior to evaluation by RCT.

Unit of Analysis in Digitally-Enabled Electronic Procurement Research

E-procurement systems that have been in place for over a decade have begun incorporating digital tools like big data, cloud computing, internet of things, and data mining. Hence, there exists a rich literature on earlier e-procurement systems and advanced digitally-enabled e-procurement systems. Existing literature on these systems addresses many research issues (e.g., adoption) associated with e-procurement. However, one critical issue that has so far received no rigorous attention is about “unit of analysis,” a methodological concern of importance, for e-procurement research context. Hence, the aim of this chapter is twofold: 1) to discuss how the notion of “unit of analysis” has been conceptualised in the e-procurement literature and 2) to discuss how its use has been justified by e-procurement scholars to address the research issues under investigation. Finally, the chapter provides several interesting findings and outlines future research directions.

Remittances and Labour Supply Revisited: New Evidence from the Macedonian Behavioural Tax and Benefit Microsimulation Model

The objective of the paper is to revisit the role of remittances for labour-supply responses. Previous studies documented conflicting results, while the key methodological concern – remittances’ endogeneity about labour supply – has not been resolved convincingly. We construct behavioural tax and benefit microsimulation model and simulate labour-market responses of singles and couples had remittances not existed in their households. This is a novel methodological approach avoiding the usual trap of utilisation of inappropriate instruments to remittances. Our results suggest that remittances are prevalently associated with lower labour-market activity, especially for women. However, the labour-supply response is found quite feeble and only in single families. Hence, while previous findings are not entirely rebutted, they may have been overstated and are highly dependent on the construct of the receiving household.