Maggie Mort

This article reports on a project, led jointly by Lancaster University and Save the Children UK, that used mobile, creative, and performance-based methods to understand children’s experiences and perceptions of the 2013–2014 UK winter floods and to promote their voices in flood risk management. We argue that our action-based methodology situated the children as “flood actors” by focusing on their sensory experience of the floods and thus their embodied knowledge and expertise. The research activities of walking, talking, and taking photographs around the flooded landscape, as well as model making and the use of theater and performance, helped to “mobilize” the children not only to recall what they did during the floods but also to identify and communicate to policy makers and practitioners how we can all do things differently before, during, and after flooding.

Internal jugular cannulation may lead to serious complications. Ultrasound guidance is advocated; however, procedural complications remain a concern. Inconsistent education may be in part responsible for this. This study examined how internal jugular cannulation is taught and learned. An ethnographic approach was used in two acute hospitals. Methods comprised interviews, observations and focus groups. An inductive thematic analysis was undertaken. Three themes were identified: apprenticeship, trust and reciprocity. In apprenticeship, a new form of apprenticeship learning, necessitated by the structure of training is described. In trust the strategies by which trainers assess trainees’ competence in order to allow them to gain experience is explored. In reciprocity the beneficial influence of trainees is illustrated. This study demonstrates how high-stakes procedures are learned. It provides insights into under-investigated topics such as the use of ‘permitted mistakes’ to stimulate reflection and the role played by trainees in promoting good practice.

Following a series of recent devastating storms across England with large numbers of homes and businesses evacuated, and despite widespread consensus that further severe flooding is expected, a large section of the population continues to be excluded from developments in flood risk management. We argue that the absence of children and young people from assessments of both the effects of flooding and ways in which it can be mitigated, undermines the effectiveness and legitimacy of policy making. Drawing on in-depth participative research with two groups of flood-affected children and young people we show the range of ways in which they are affected by flooding, some ways they can be better supported, and then how their valuable experience can help shape positive change in policy and practice before, during and after floods. Children developed Flood Manifestos for Change in a direct challenge to their omission from flood governance. The Manifestos and the steps children took to advocate for them can be seen as acts of citizenship, highlighting the capacities of children and young people as flood actors, rather than flood victims.

Summary: Previous studies of critical care admissions have largely compared patients that have been granted or declined admission. To better understand the decision process itself, our ethnographic approach combined observation of and interviews with critical care physicians in a large English hospital. We observed 30 critical care doctors managing 71 referrals and conducted ten interviews with senior decision‐makers to explore the themes raised by our observations. We analysed data using the constant comparative method. We found that the decision to move a patient to critical care was just one way in which the trajectory of critical illness could be modified. When patients were admitted to critical care, it was not always for invasive monitoring or advanced organ support, with some admitted for more general medical and/or nursing care. When patients were declined admission, they were not simply forgotten or left behind; they nevertheless underwent careful assessment and follow‐up. Thus, depicting admission or refusal as a binary event is misleading. We suggest that prescriptive admission algorithms are problematic for clinicians, in that they may not take into account the complexity of clinical practice.

Background: National guidelines advocating ultrasound guidance for internal jugular venous cannulation were introduced in the United Kingdom in 2002, followed by international guidelines a decade later. However, the benefits of ultrasound guidance do not appear to have universally translated into clinical practice. This study aimed to investigate the effect of ultrasound on the practice of internal jugular vein cannulation. Methods: We conducted an ethnographic study incorporating observations, interviews, and focus groups in 2 hospitals in the north of England over a 4-month period. Results: Twenty-seven clinical observations, 10 interviews, and 3 focus groups were conducted. In 25 clinical episodes, ultrasound guidance was used. Four distinct needling techniques were observed, which we classified in terms of needle angulation: the traditional landmark technique, the ultrasound-guided traditional approach, ultrasound-guided medial angulation, and the ultrasound-guided steep approach. The latter 2 techniques represent a departure from conventional practice and appear to have developed alongside ultrasound guidance. Although no serious complications were observed, there appears to be enhanced potential for complications to occur with medial angulation and the steep approach. Participants described a loss of anatomic knowledge and a false sense of security associated with the adoption of ultrasound guidance, which may account for the emergence of new, potentially riskier needling techniques. Conclusions: The introduction of safe technologies may lead to unintended consequences, and clinicians should attempt to recognize and mitigate them when they occur. Education to increase awareness of the pitfalls of ultrasound guidance is recommended.

This article explores material from a citizen’s inquiry into the social and ethical implications of health biosensors. In ‘Our Bodies, Our Data’ a space was afforded for members of the public to examine two forms of health biosensing, and for the authors to research what happens when such examination shifts from the domain of experts to that of citizens. Drawing on data from this inquiry, which form part of a wider research project, ‘Living Data: making sense of health biosensors’, we open up conceptual and methodological questions about how to study innovative health technologies and contribute to debates about the direction of health biosensing by bringing forward the views of a group rarely heard in this domain: the public. The panel of 15 participants was shown examples, handled devices and heard evidence about the development of home ovulation monitoring and direct-to-consumer genetic testing. Citizens identified key areas of concern around the development, design and marketing of these devices, implicating technology companies, public bodies and civil society organisations. The panel articulated serious concerns relating to ethics, trust, accountability, quality and governance of health biosensors that operate ‘outside the clinic’. Their deliberations reflect concern for what kind of society is being made when genetic testing and home reproductive technologies are promoted and sold directly to the public. The panel process allowed us to re-imagine biosensors, wresting their narratives from the individualising discourses of self-optimisation and responsibilisation which have dominated their introduction in Euro-US markets.

This article explores the nature of calls for risk‐based policy present in expert discourse from a cultural theory perspective. Semi‐structured interviews with professionals engaged in the research and management of livestock disease control provide the data for a reading proposing that the real basis of policy relating to socio‐technical hazards is deeply political and cannot be purified through ‘escape routes’ to objectivity. Scientists and risk managers are shown calling, on the one hand, for risk‐based policy approaches while on the other acknowledging a range of policy drivers outside the scope of conventional quantitative risk analysis including group interests, eventualities such as outbreaks, historical antecedents, emergent scientific advances and other contingencies. Calls for risk‐based policy are presented, following cultural theory, as ideals connected to a reductionist epistemology and serving particular professional interests over others rather than as realistic proposals for a paradigm shift.

Using biosensors, or devices that provide biological information to users about their own bodies, to map ovulation and time intercourse is a practice of rising significance in economically privileged countries. Based on an ethnographic study of ovulation biosensing, this paper explores the contradictions between device manufacturers' figurations of reproductive heterosex as a natural and pleasurable experience facilitated by fertility monitoring technology, and heterosexual women users' accounts of the pleasures and difficulties of ovulation monitoring and associated sexual encounters. Drawing on Science and Technology Studies and the concept of ‘script’, we examine the frameworks of action defined by makers of ovulation biosensors and how these are accepted, refused or remade by users. Within the scientific romance configured by manufacturers, reproductive heterosex emerges as exciting and fun, whilst the hard, ‘technical’ work of conception is done by ovulation technologies. Yet ovulation monitoring is described by many heterosexual women users as an exciting and yet anxiety-producing practice through which they come to know their bodies differently, often through online discussions with other women. Living a ‘conceptive imperative’, women engaging with ovulation sensing reconfigure their reproductive embodiment and shift their relationship to male partners in ways that reveal heterosexual ‘baby-making’ as a complex and nuanced practice worthy of critical engagement.