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PubMedDate not supplied

Conversational discourse analysis as a method for evaluating progress in aphasia: a case report.

The gains made by a woman with Broca's aphasia as documented by traditional measures were paralleled by changes in conversation, including increased verbal output and efficiency, and changes in conversation repair patterns. Her conversational partner decreased her verbal output, as predicted. The progress documented with conversational discourse analysis was not observable from other test measures. Clinical and theoretical implications are discussed.

Aphasia, Broca↗
PubMed1988

EEG frequency analysis in conversion and somatoform disorder.

Patients with "hysterical" neurologic symptoms have long puzzled neurologists and psychiatrists. "Hysteria" has recently been subdivided into conversion and somatoform disorder. We applied computerized EEG frequency analysis to 10 patients with diagnosed conversion disorder, 10 somatoform disorder patients, and 10 control subjects. One minute EEG samples composed of 4 sec epochs were recorded from left frontal (F7-C3), right frontal (F8-C4), left posterior (T5-01) and right posterior (T6-02) derivations. Spectral power was calculated for 4 bands (0.25-4HZ, 4.25-8Hz, 8.25-13Hz, and 13.25-30Hz), and for the full frequency range. Low (0.25-8Hz) and high (8.25-30Hz) frequency bands were compared to determine high/low power ratios on the left and right (PHLL) and (PHLR), ratios of left/right front (PLRF) and posterior (PLRP) power, mean alpha frequency deviation frontally (FLRF) and posteriorly (FLRP), and mobility of left and right frontal power (MOLF and MORF). No significant differences were found between conversion disorder patients and controls in PHLL, PHLR, PLRP, and MORF. PLRF, FLRF and MOLF differed significantly between patients and controls. Power and frequency ratios of right frontal mobilities suggested a decrease in high frequency power, reduction in mean alpha frequency, and lower predominant frequency in the right frontal area in somatoform disorder patients as compared to controls, but significance was not reached. Somatoform and conversion disorder patients differed significantly in these spectral measures. These observations suggest that the two "hysterical" disorders may have distinct pathophysiology, and may be due to eventually identifiable cerebral dysfunction in some cases.

Adult↗
PubMed2003

A conceptual framework for person-centred practice with older people.

This paper presents a conceptual framework for person-centred practice with older people. The research from which the framework was developed was guided by hermeneutic philosophy and integrated processes of conversation analysis and reflective conversation in data collection and analysis. The research findings suggested that nurses need to be able to particularize the person that the patient is, the relationship that exists between them and the patient, and the understandings and expectations implicit in the relationship. From these findings a conceptual framework for person-centred practice was developed. In the framework, person-centredness is premised on the concept of authentic consciousness and is operationalized through five imperfect duties. The factors that enable person-centredness to operate in practice are identified as the patient's values, the nurse's values and the context of the care environment. Considerations for implementing the model in practice are highlighted.

Aged↗
PubMed1994

Assessing functional communication in aphasia: clinical utility and time demands of three methods.

A variety of methods has recently been used to assess everyday communication abilities in aphasic adults. This study compares three such methods for their clinical utility and the amount of a therapist's time they use. The three methods employed a standard rating schedule completed by relatives, analysis of speech elicited through role-play and a partial analysis of everyday conversation samples. The utility of these assessments as a clinical tool was measured in terms of the therapist's time needed, and the assessment's ability to show stability or change of communicative effectiveness on test-re-test measures and to illuminate areas for therapeutic intervention. Eight aphasic adults (five acute and three chronic) were tested on all three assessments, then re-tested after a period of 3 months. The results suggested that, although more time-consuming, the partial conversational analysis was a more sensitive measure of stability or change of communicative effectiveness over time than the other two measures, and had the potential advantage for indirect intervention of revealing conversational strategies used by the partner as well as those used by the aphasic individual.

Acute Disease↗
PubMed1995

Complete nucleotide sequence of RNA segment 3 of bluetongue virus serotype 2 (Ona-A). Phylogenetic analyses reveal the probable origin and relationship with other orbiviruses.

The nucleotide sequence of the RNA segment 3 of bluetongue virus (BTV) serotype 2 (Ona-A) from North America was determined to be 2772 nucleotides containing a single large open reading frame of 2703 nucleotides (901 amino acid). The predicted VP3 protein exhibited general physiochemical properties (including hydropathy profiles) which were very similar to those previously deduced for other BTV VP3 proteins. Partial genome segment 3 sequences, obtained by polymerase chain reaction (PCR) sequencing, of BTV isolates from the Caribbean were compared to those from North America, South Africa, India, Indonesia, Malaysia and Australia, as well as other orbiviruses, to determine the phylogenetic relationships amongst them. Three major BTV topotypes (Gould, A.R. (1987) Virus Res. 7, 169-183) were observed which had nucleotide sequences that differed by approximately 20%. At the molecular level, geographic separation had resulted in significant divergence in the BTV genome segment 3 sequences, consistent with the evolution of distinct viral populations. The close phylogenetic relationship between the BTV serotype 2 (Ona-A strain) from Florida and the BTV serotypes 1, 6 and 12 from Jamaica and Honduras, indicated that the presence of BTV serotype 2 in North America was probably due to an exotic incursion from the Caribbean region as previously proposed by Sellers and Maaroof ((1989) Can. J. Vet. Res. 53, 100-102) based on trajectory analysis. Conversely, nucleotide sequence analysis of Caribbean BTV serotype 17 isolates suggested they arose from incursions which originated in the USA, possibly from a BTV population distinct from those circulating in Wyoming.

Amino Acid Sequence↗
PubMed1994

Meiotic gene conversion tract length distribution within the rosy locus of Drosophila melanogaster.

Employing extensive co-conversion data for selected and unselected sites of known molecular location in the rosy locus of Drosophila. we determine the parameters of meiotic gene conversion tract length distribution. The tract length distribution for gene conversion events can be approximated by the equation P(L > or = n) = phi n where P is the probability that tract length (L) is greater than or equal to a specified number of nucleotides (n). From the co-conversion data, a maximum likelihood estimate with standard error for phi is 0.99717 +/- 0.00026, corresponding to a mean conversion tract length of 352 base pairs. (Thus, gene conversion tract lengths are sufficiently small to allow for extensive shuffling of DNA sequence polymorphisms within a gene). For selected site conversions there is a bias towards recovery of longer tracts. The distribution of conversion tract lengths associated with selected sites can be approximated by the equation P(L > or = n/ selected) = phi n(1 - n + n/phi), where P is now the probability that a selected site tract length (L) is greater than or equal to a specified number of nucleotides (n). For the optimal value of phi determined from the co-conversion analysis, the mean conversion tract length for selected sites is 706 base pairs. We discuss, in the light of this and other studies, the relationship between meiotic gene conversion and P element excision induced gap repair and determine that they are distinct processes defined by different parameters and, possibly, mechanisms.

Animals↗
PubMed2004

Structuring health needs assessments: the medicalisation of health visiting.

This paper draws on Foucault to understand the changing discourse and impact of structured 'health needs assessments' on health visiting practice. Literature about this activity makes little mention of the long-standing social purposes of health visiting, which include surveillance of vulnerable and invisible populations, providing them, where needed, with help and support to access protective and supportive services. Instead, the discourse has been concerned primarily with an epidemiological focus and public health, which is associated with risk factors and assessments. The use of pre-defined needs assessment schedules suggests that health visiting activity can be sanctioned and clients' needs serviced only if they reach the threshold of pre-determined, epidemiologically-defined risk. Their effect on practice is examined through a conversation analysis of ten health visitor/client interactions using two different structured needs assessment tools. The study indicates that the health visitors, like their clients, were controlled by institutional expectations of their role; analysis of their conversations shows how they achieved the requirements of the organisational agenda. Structuring client needs and health visiting practice through the use of formal needs assessment tools emphasises the epidemiological focus of the health service above the need to arrange support for vulnerable individuals. In this respect, it serves as a marker in the continued medicalisation of health visiting.

Attitude of Health Personnel↗
PubMed1987

A comparison of four modes of evaluating depth of cure of light-activated composites.

Four commonly used methods for evaluating depth of cure in light-activated composites were compared. Optical and scraping methods correlate well, but severely overestimate depth of cure as compared with hardness testing or degree of conversion analysis. Degree of conversion appears to be the most sensitive test of depth of cure.

Chemical Phenomena↗
PubMed2001

Broadcasting the royal role: constructing culturally situated identities in the Princess Diana Panorama interview.

We examine critically the two traditions of work that have informed discursive approaches to identity: social constructionism and conversation analysis. Within both strands, identity is theorized as a flexible phenomenon that is situated in conversations. But although constructionists locate identity within the social, such work remains at a theoretical and rather abstract level and often fails to interrogate the discursive practices through which identity is constituted. Conversely, this attention to the occasioning of identity in everyday talk is precisely the focus of the second, conversation analytic strand of work. Whereas constructionists attend to the wider cultural positioning of identities, conversation analysts resist commenting upon the social significance of what is constructed in interaction. Conversation analysis is therefore limited by its restricted notion of culture in the study of the situated social self. Despite the apparent conflict between these approaches, we suggest that a synthesis of the two provides a comprehensive framework for analysing identity. Drawing upon the BBC Panorama interview between Martin Bashir and Princess Diana, we explore how culturally situated identities are located in this conversational context. We conclude that analysts must not only attend to the micro-level organization of identities but also engage in a wider understanding of the cultural framework within which they are located.

Cultural Characteristics↗
PubMed2001

Gatekeeping and legitimization: how informal carers' relationship with health care workers is revealed in their everyday interactions.

AIM(S) OF THE STUDY: This study explores the relationship between informal carers of older people, and health care workers within the context of a hospital ward. Through an analysis of their language-based encounters the purpose of the study was to identify the discursive processes involved in face-to-face informal carer-health care worker interactions, during the course of carers' visits to one elderly care rehabilitation hospital ward. DESIGN: An ethnomethodological research design, which encompassed the concerns of conversation analysis and the study of institutional interaction, was used. The study involved videotape recording informal carers naturally occurring spontaneous interactions with a range of health care workers on the ward. Data collection was carried out for between 1 and 3 hours, two to three times a week over a period of 3 months. The data comprised: 30 dyadic and group interactions involving 19 different carers and 25 different health care workers, including nurses (qualified and unqualified), physiotherapists, occupational therapists, dieticians, ambulance personnel, housekeepers and nursing auxiliaries. Detailed transcriptions of the data were produced and analysis was undertaken using a modified conversation analysis approach. FINDINGS: Analysis revealed that a central aspect of the way the relationship between informal carers and health care workers is framed is by the way information and access to information is obtained. This paper examines some of the aspects of informal carer-health care worker discourse, which denote both parties as gatekeepers. In doing so it considers the roles that legitimatization of competence and knowledgeability have in facilitating informal carers interactions with health care workers. CONCLUSIONS: We conclude that the accomplishment of legitimacy is largely a collaborative undertaking on behalf of health care workers and informal carers. The implications of these findings for carers, health care workers, policy and future research are discussed.

Adult↗
PubMed1990

Communication between nurses and post-anaesthetic patients.

This paper explores the verbal and non-verbal communication between nurses and post-anaesthetic patients in the recovery unit of an inner London hospital. Although the patients had only minor operations the study findings and the method of conversation analysis provide ideas which could have wider relevance in intensive care. A video camera was used to record nurses' conversations with dental patients recovering from their operations. The resultant tape was studied for the utterances and body movement used by the nurses in order to engage the patient in conversation. Analysis indicated that the nurses were skilled communicators who took into account the patients' low level of consciousness and lack of physical orientation when initiating and maintaining interaction. This is an important factor in the care of post-anaesthetic patients, as the recovery nurse may need to gain the patient's attention to converse with him for a variety of reasons, including safety and the need to orientate the patient to his environment in order to reduce anxiety (Mallett, 1986). The ability of the nurse to communicate successfully is, therefore, one of the prerequisites for adequate nursing care in the Recovery Unit. In addition, the notion of therapeutic communication as a separate entity to skillful conversation is raised.

Adult↗
PubMedDate not supplied

The effect of right cerebral hemisphere damage on collaborative planning in conversation: an analysis of intentional structure.

This study investigated the impact of right cerebral hemisphere damage on the capacity to take shared responsibility for the development of an intentional structure in conversation. Intentions are important determiners of both discourse structure and utterance meaning in context. Right-hemisphere damaged (RHD) individuals have been reported to have difficulty in the use of prosody as well as performing and appreciating the process of discourse tailoring which is dependent on recognizing speakers intentions. Audio taped samples of naturalistic conversations between RHD individuals and normal speakers were analysed. Text-level discourse processing analyses involved measures of global discourse structure and self-monitoring accuracy. Prosodic analyses included fundamental frequency (F0) resetting, pause durations and inter-turn intervals. The results revealed that speakers with right cerebral hemisphere damage do not, first, use prosody to alert listeners to changes in discourse structure, and, second, assume equal responsibility for the development and maintenance discourse structure.

Adult↗
PubMed1998

Analysis of conversion tracts associated with recombination events at the am locus of Neurospora crassa.

In cross B163, heteroallelic am1 am6 and heterozygous for both conventional genetic flanking markers and closer molecular markers, we previously found that the majority on flanker exchanges were remote from events that generated prototrophic recombinants. We report here that natural polymorphisms distinguishing the parents of cross B163 also include sequences within and closely flanking am. Segregation of these markers in B163 prototrophs confirms that the majority of meiotic recombination events at am resulted from gene conversion. Conversion of am6, the distal allele, is more frequent than conversion of am1. Twelve percent of tracts in am6 convertants were discontinuous while 30% of continuous tracts converting am6 extend less than 741 bp.

Alleles↗
PubMed2003

Empowerment or control? An analysis of the extent to which client participation is enabled during health visitor/client interactions using a structured health needs assessment tool.

The demand for explicitness in the way health visitors target their services has given rise to a plethora of different health needs assessment tools (HNATs). This paper describes an in-depth conversational analysis of the use in practice of these structured health needs assessment tools (HNATs) in two different NHS Community Trusts in England. These HNATs aimed to enable clients to participate in the assessment of their own health needs, as well as fulfilling the political requirements of justifying the expenditure of health visitor time where needs are identified. However, conversational analysis of 10 interactions showed that use of the instruments was associated with a failure to either identify needs that are relevant to the client or to enable clients to participate in the process. Use of the structured instrument simultaneously emphasises the significance of a professional lead, instead of client participation, and minimises the importance of inter-personal relationships and communication. In one site, a directly controlling style was apparent in the practice of health visitors who were, themselves, explicitly controlled by their managers. In the other site, professional expertise was emphasised, and a covert assessment style acted to disempower clients. The controlling nature of the interactions, the number of missed cues and the possibility of distress caused by the insensitivity of questioning style are all potentially harmful side effects of using structured instruments to assess needs. The problems seem to stem from the use of a pre-determined list of questions that form the basis for assuming that any family's health promotion needs can be categorised and predicted in advance. In conclusion, therefore, it is recommended that health visitors should use the open, conversational style of needs assessment that has been shown to be effective and acceptable, rather than an approach based on a structured instrument.

Communication↗
PubMedDate not supplied

Empathy in general practice consultations: a qualitative analysis.

AIMS: Empathy is an important basis of all provider-patient interaction, including general practice. Little has been known about the details of how general practitioners express empathy to their patients. In the present study, it was a main aim to carry out a detailed qualitative study of actual sequences through which empathy was achieved, by focusing on the form, function, and categorisation of such sequences. METHODS: The study drew on the qualitative method of conversation analysis. Transcriptions of 77 British general-practitioner-patient interactions were analysed in detail in order to identify and characterise sequences in which empathy was achieved. RESULTS: Four types of empathy were identified, described, and analysed: cognitive empathy, affective empathy, sharing empathy, and nurturant empathy. Although sequences involving empathy typically were brief and occurred relatively rarely, the analyses demonstrated that the sequences often concerned matters of great importance to the interactants. CONCLUSIONS: The study underlined the need to focus also on phenomena that occur relatively rarely in consultations. For this purpose, the method of conversation analysis was a useful tool.

Adolescent↗
PubMed2006

Parametric quantitative acoustic analysis of conversation produced by speakers with dysarthria and healthy speakers.

PURPOSE: This study's main purpose was to (a) identify acoustic signatures of hypokinetic dysarthria (HKD) that are robust to phonetic variation in conversational speech and (b) determine specific characteristics of the variability associated with HKD. METHOD: Twenty healthy control (HC) participants and 20 participants with HKD associated with idiopathic Parkinson's disease (PD) repeated 3 isolated sentences (controlled phonetic content) and 2 min of conversational speech (phonetic content treated as a random variable). A MATLAB-based program automatically calculated measures of contrastivity: speech-pause ratio, intensity variation, median and maximum formant slope, formant range, change in the upper and lower spectral envelope, and range of the spectral envelope. t tests were used to identify which measures were sensitive to HKD and which measures differed by task. Discriminant analysis was used to identify the combination of measures that best predicted HKD, and this analysis was then used as a general measure of contrastivity (Contrastivity Index). Differential effects of HKD on maximum and typical contrastivity levels were tested with interaction of maximum, minimum, and median observations of individual speakers and with pairwise comparisons of skewness and kurtosis of the contrastivity index distributions. RESULTS: Group differences were detected with pairwise comparisons with t tests in 8 of the 9 measures. Percentage pause time and spectral range were identified as the most specific (95%) and accurate (95%) differentiators of HKD and HC conversational speech. Sentence repetition elicited significantly higher levels of contrastivity than conversational speech in both HC and HKD speakers. Maximum and minimum contrastivities were significantly lower in HKD speech, but there was no evidence that HKD affects maximum contrastivity levels more than median contrastivity levels. The HKD speakers' contrastivity distributions were significantly more skewed to lower levels of production. CONCLUSION: HKD can be consistently distinguished from HC speech in both sentence repetition and conversational speech on the basis of intensity variation and spectral range. Although speakers with HKD were effectively able to produce higher contrastivity levels in sentence repetition tasks, they habitually performed closer to the lower end of their production ranges.

Adult↗