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The way we say the words we say helps us convey our intended meanings. Indeed, the tone of voice we use, the facial expressions and bodily gestures we adopt while we are talking, often add entirely new layers of meaning to those words. How the natural non-verbal properties of utterances interact with linguistic ones is a question that is often largely ignored. This book redresses the balance, providing a unique examination of non-verbal behaviours from a pragmatic perspective. It charts a point of contact between pragmatics, linguistics, philosophy, cognitive science, ethology and psychology, and provides the analytical basis to answer some important questions: How are non-verbal behaviours interpreted? What do they convey? How can they be best accommodated within a theory of utterance interpretation?

Research over the past decades has demonstrated the explanatory power of emotions, feelings, motivations, moods, and other affective processes when trying to understand and predict how we think and behave. In this consensus article, we ask: has the increasingly recognized impact of affective phenomena ushered in a new era, the era of affectivism?

This paper considers the extent to which lexical acquisition is an exercise of an associationist ability, a general mind-reading ability or a specifically pragmatic ability. Particular attention is paid to the role played in word-learning by natural communicative phenomena-gaze direction, facial expression, tone of voice etc.-and to the question of how such behaviours might be accommodated within a pragmatic theory. As well as sketching some possible directions in which future research into the pragmatics of lexical acquisition might proceed I will also suggest, given recent research in relevance theoretic lexical pragmatics, that there are interesting parallels to be drawn between the processes at work in lexical acquisition and those at work in adult comprehension. Este artículo considera hasta qué punto la adquisición del léxico es un ejercicio de una capacidad asociacionista, una capacidad general de lectura de la mente o una capacidad específicamente pragmática. Se presta una atención especial al papel que juegan en el aprendizaje de palabras los fenómenos comunicativos naturales - dirección de la mirada, expresión facial, tono de voz, etc. - y a la pregunta de cómo esta conducta podría ser incluida dentro de una teoría pragmática. Además de esbozar algunas direcciones posibles de futuras investigaciones sobre la pragmática de la adquisición de léxico, también sugeriré, dadas las recientes investigaciones en la pragmática léxica desde la teoría de la relevancia, que hay interesantes paralelismos que trazar entre los procesos que están activos en la adquisición del léxico y los que están activos en la comprensión de los adultos. Este artigo considera até que ponto a aquisição do léxico é um exercício de uma capacidade associacionista, de uma capacidade geral de leitura de mente ou de uma capacidade especificamente pragmática. Presta-se especial atenção ao papel que os fenômenos comunicativos naturais - direção do olhar, expressão facial, tom de voz, etc. - desempenham na aprendizagem de palavras, e à questão de como esses comportamentos poderiam ser incluídos dentro de uma teoria pragmática. Além de esboçar algumas direções possíveis de investigações futuras sobre a pragmática de aquisição do léxico, eu sugerirei, em função das recentes investigações em pragmática lexical fundamentada na teoria da relevância, que há paralelismos interessantes a serem traçados entre os processos que estão ativos na aquisição do léxico e os que estão ativos na compreensão de adultos.

This paper explores recipes and food writing from the perspective of linguistics—or, more specifically, pragmatics. It looks briefly at the discourse of recipes, at how they work and what kinds of linguistic structures are typically involved. The main theme of the paper, however, is that the best food writing is as much about the images and feelings the writer wants to conjure in the mind of the reader as it is about the words it contains, or the way that discourse is set out. In order to shed any real light on recipe writing, then, we need to explain how they manage to convey moods, impressions, emotions, and feelings. We need to go beyond the words. The paper features examples from, among others, the work of Elizabeth David and Edouard de Pomaine, serving to illustrate the theoretical points made.

Fullerenes are under intensive study for potential biomedical applications. We have previously reported that a C60 fullerene functionalized with three dimethylpyrrolidinium groups (BF6) is a highly active broad-spectrum antimicrobial photosensitizer when combined with white-light illumination. We asked whether this high degree of activity would translate into an therapeutic effect in two potentially lethal mouse models of infected wounds. We used stable bioluminescent bacteria and a low light imaging system to follow the progress of the infection noninvasively in real time. An excisional wound on the mouse back was contaminated with one of two bioluminescent Gram-negative species, (2.5 × 10 cells) and (5 × 10 cells). A solution of BF6 was placed into the wound followed by delivery of up to 180 J/cm of broadband white light (400-700 nm). In both cases there was a light-dose-dependent reduction of bioluminescence from the wound not observed in control groups (light alone or BF6 alone). Fullerene-mediated photodynamic therapy of mice infected with led to 82% survival compared with 8% survival without treatment (p < 0.001). Photodynamic therapy of mice infected with highly virulent did not lead to survival, but when photodynamic therapy was combined with a suboptimal dose of the antibiotic tobramycin (6 mg/kg for 1 day) there was a synergistic therapeutic effect with a survival of 60% compared with a survival of 20% with tobramycin alone (p < 0.01). These data suggest that cationic fullerenes have clinical potential as an antimicrobial photosensitizer for superficial infections where red light is not needed to penetrate tissue.

BackgroundAintree Hospital is an adult tertiary centre providing care to 330,000 patients. There is a paediatric centre of excellence located 4 miles away however, despite its close proximity, acutely unwell children still present to the Emergency Department. We noted that the clinical teams managing these children may not have had recent paediatric training or practical experience, and there was a need to increase knowledge, confidence and team working in managing these challenging cases.Summary of workWe distributed a survey to identify 1) training gaps 2) previous issues faced when managing paediatrics in the emergency department and 3) difficult cases clinicians attending wanted to simulate, in order to customise the course and improve knowledge retention¹. We sought advice from the radiology department and paediatric transfer service regarding which facilities are feasible in our location. Finally, we collaborated with the children’s hospital to devise and install a new paediatric trolley in the emergency department, which will be tested during the course.Summary of resultsThe survey revealed:Equipment and staff training were identified as obstacles hindering optimal management.57% of respondents were up to date with APLS.28% had managed a paediatric case in the emergency department within the last 3 years, 43% had not been involved in any cases.29% of anaesthetists had anaesthetised a child within the last year, 57% within 2 years and 86% within 3 years. One respondent hadn’t anaesthetised a child in over 10 years.Common themes requested for scenarios included: sepsis, status epilepticus, trauma and cases using very young children/neonates to provide challenging training.Discussion and conclusionsWith guidance from the survey, we have designed paediatric scenarios that could potentially present to an adult hospital and involve the multidisciplinary emergency team. In order to improve patient safety, scenarios include the use of the paediatric trolley to promote familiarity and identify latent errors for evaluation².It has been important to involve the stakeholders in the design of this course as they have markedly influenced the direction of flow of the simulated cases. We are piloting this course in June 2019 and will collect feedback from delegates attending as well as faculty, which includes our radiology and paediatric transfer service colleagues who are attending to contribute to debrief discussions. We will repeat this course 3 times yearly and modify it based on feedback and new cases that present to our hospital.ReferencesMcQueen AA, Mitchell DL, Joseph-Griffin MA, 2011. ‘Not Little Adults’: Pediatric Considerations in Medical Simulation. 780–788. Available from: http://www.sciencedirect.com/science/article/pii/S0011502911002197.EICH, C., TIMMERMANN, A., RUSSO, S. G., NICKEL, E. A., MCFADZEAN, J., ROWNEY, D. and SCHWARZ, S. K. W., 2007. Simulator-based training in paediatric anaesthesia and emergency medicine – Thrills, skills and attitudes. British Journal of Anaesthesia. 98 (4), pp. 417–419. Available from: https://www.sciencedirect.com/science/article/pii/S0007091217354909.

BackgroundThe acute common care stem (ACCS) training programme exposes junior doctors to a wide array of acute medical specialities and includes spending 6-months in each of acute medicine, emergency medicine, anaesthetics and intensive care. The trainees undertaking this programme will end up being consultants in acute specialities, regularly facing deteriorating patients, who require time-critical interventions. It is vitally important that these skills are obtained during their training. Previous years of ACCS trainees have highlighted the difficulty in completing some key skills due to lack of time, exposure and opportunity. We report a one-day fully immersive simulation course designed and piloted in our institution, aiming to expose trainees to these vital skills.Summary of WorkThe course used a programme of spiral learning, with technical skill sessions in the morning, giving the candidates a grounding in the skills and their indications. The afternoon consisted of 4 high-fidelity simulated-patient scenarios that exposed candidates to the practical aspects of the procedures, and crucially, the opportunity to exercise their decision-making skills. The key procedures included intraosseous needle insertion, transcutaneous pacing, electrical cardioversion and surgical chest drain insertion. To simulate intraosseous needle insertion, our team devised a close-to-life model that could be inserted into the arm of a wireless mannequin. This allowed candidates to perform the skill without the need to ‘break away’ and use another model, thus increasing immersion in the scenario. We asked candidates to complete pre and post-course questionnaires to measure change in self-assessed confidence (Likert 0–10) [1] related to performing these skills.Summary of ResultsTwenty-one candidates have completed the course, to date with participation in a minimum of 2 scenarios each. An unpaired (two tail) t-test analysis of results indicated statistically significant increases in confidence scores regarding performing intraosseous needle insertion (3.7 to 8.42/10 improvement) and cardioversion/transcutaneous pacing (5.3 to 8.6/10 improvement). Course usefulness was rated 9.6/10, with candidates scoring scenarios and workshops at least 9.52/10 in satisfaction.Discussion and ConclusionsWe have demonstrated that high fidelity simulation, used in combination with more traditional teaching, can vastly improve perceived confidence of trainees with regards to skill acquisition. Courses of this format give trainees the opportunity to map core skills to their curriculum and complete workplace-based assessments, closing an educational gap that has the potential to put patients at risk. This means no trainee would be left behind and unable to progress due to a lack of opportunity or exposure.ReferenceLikert R. A technique for the measurement of attitudes. Archives of Psychology 1932; 140: 1–55.

This randomized controlled clinical trial compared three doses of tranexamic acid (TA) in primary cardiac surgery in terms of blood loss and transfusion requirements. Patients presenting for primary coronary artery bypass grafting (CABG) and/or valve replacement were randomly assigned to one of three TA regimens: 20 mg.kg-1 (LD), 50 mg.kg-1 (MD), and 100 mg.kg-1 (HD). All participants and staff were blinded to the allocation. Haemoglobin (Hgb), haematocrit and platelet count were determined preoperatively, after bypass, at CCA arrival, and 12 and 24 hr after surgery. Coagulation parameters were measured before and after surgery. Blood loss was measured intraoperatively and for 24 hr postoperatively following a standardized protocol. Blood products were administered in a standardized fashion. Two hundred twenty patients completed the trial over 10 months: 74 in LD, 75 in MD and 72 in HD dose groups. All patients groups were comparable; similar procedures were performed in each group. No differences were identified for blood loss intra-operatively (490 +/- 232 ml, 523 +/- 413 ml, 488 +/- 357 ml, respectively), 24 hr post-operatively (543 +/- 223 ml, 544 +/- 231, 458 +/- 210 ml, respectively), and overall (1032 +/- 358 ml, 1067 +/- 502 ml, 946 +/- 459 ml, respectively). Blood product administration was similar in the three groups. No differences in postoperative complications were found. This study demonstrates the equivalency of the three doses of TA in primary cardiac surgical procedures. The use of low dose (20 mg.kg-1) TA results in comparable outcomes, without additional complications.