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These ‘virtual bone biopsies’ have the potential to revo- lutionise the clinical assessment of bone health purchase vantin 100 mg without a prescription virus 79, an increasingly important clinical objective in an aging population susceptible to osteoporosis 100 mg vantin for sale antimicrobial 2013. Although these tomography-based models simulate the architecture pre- cisely purchase vantin in united states online antibiotics for sinus infection didn't work, the magnitude and variation of tissue-level material properties still need to be determined purchase vantin 100 mg visa infection after wisdom tooth extraction. Another imaging development is laser scanning confocal microscopy to image individual living cells noninvasively. The deformation of osteo- blasts and chondrocytes has been observed using this method. Confocal microscopy has also been used to image microdamage in bone tissue showing modes of microcrack arrest within the complex microstructure of bone tissue. High-resolution imaging systems will allow us to determine tissue struc- tures from the highest hierarchy of the organ to the lowest of the genome. These digital images are ideally suited for analysing physical forces and linking continuum level tissue stresses to deformation-induced gene acti- vation in the DNA molecule. Advances in dynamic systems theory and applied mathematics will play a critical role in explaining the behaviour of otherwise intractable models. As the complete genomes of organisms become mapped, functional genomics will combine with biomechanics to answer questions such as: what is the regulatory role of mechanics in skeletal gene expression? Can we define the mechanical forces needed to culture complete skeletal organs in the laboratory? Orthopaedics and reconstructive surgery will be completely revolutionised. The rapid growth of the field has produced an interdisciplinary commu- nity of engineers, biologists, mathematicians, and physicians who hope to answer scientific questions of the highest import. These questions will bridge the boundary between physics and biology – between forces and cells – to understand how organic forms are shaped by the mechanical world and how living systems actually ‘extract order from their environment,’ first posed by Erwin Schrödinger in 1943 in his famous lectures What Is Life? Winslow2 and Peter Hunter3 1 Laboratory of Physiology, University of Oxford, OX13PT, UK 2 Department of Biomedical Engineering, JHU, Baltimore, MD 21205-2195, USA 3 Engineering Science Department, University of Auckland, New Zealand 8. It will beat, ‘consume’ energy or experience the lack of it, respond to stress or drug administra- tion, grow and age – in short, it will behave like the real thing. Because the virtual heart may be stopped without harm at any point in time, and dissected, inspected, resurrected, etc. We shall address this in more detail below, together with other enticing aspects of virtual organ development. In particular, we will try to: • review the need for virtual organs in the context of contemporary bio- medical research; • introduce the ideas behind the ‘Physiome Project’ – a world-wide research effort, similar to the Genome Project, to describe human bio- logical function using analytical computer models; • provide insights into some of the more technical aspects of the virtual heart; and finally • address the utility and benefit of this new tool for biomedical research, drug and device development, and the wider society. In order to understand the dimensions of the making of the virtual heart – let’s stand back, for a minute, and consider the difficulties of stud- ying and describing any unknown complex system. You are given the assignment, should you accept it, to report on the use of cars by humans. You could visit earth, hire a mechanical workshop in a remote area, car-jack a few specimens, and dissect them. You would observe that cars differ in their colour, shape, size and spec. Some may even contain a bar, cinema or swimming pool, but, perhaps, limousines are excluded from your exploration. On closer examination you would notice small ID- numbers imprinted on various strategic body parts. For example that they all require one or the other kind of fuel to work. Or, you could stay in orbit and look down at the movement and inter- actions of cars. You would soon find that in some parts of the planet cars stick to the left side of the road, while elsewhere they prefer the right. You would The making of the virtual heart 129 also see that there are complicated rules of ‘who goes first’ at crossings, although they would not appear to be perfect. Conversely, you might observe that – most of the time – all cars are stationary! Your conclu- sions could range from ‘cars are all different’ to ‘they are all the same’, or from ‘cars are made for driving’ to ‘they are for parking’. You could develop a model concept of car use by humans, based on apparent traffic rules. This would be a challenging task as you would have to understand the Highway Code from the observed behaviour of other road users! However, you might come up with a reasonably close model of national traffic rules. And you would not need to give detailed descriptions of individual compo- nents of a car to do so. If, however, all cars would stop as a consequence of an oil crisis, governmental budget, or other major disaster – you would realise that there is no way of fully understanding the rules of auto-motion without address- ing how an engine works. No two cells in the heart are exactly the same, but they are all made of rather similar components. Also, it is possible to study and model the general ‘traffic rules’ for the spread of the electrical signal that controls cardiac contraction and pumping, without addressing the workings of the individual cells that produce the electrical wave. However, this knowledge alone would be of little help for diagnosis and treatment of major energy crises like myocardial ischaemia, or heart attack. What does exist for sure, though, is the challenge to understand in detail how the human heart works. And, similar to the above scenario, among the many different ways to advance this venture, there are at least two main directions: the top-down and the bottom-up route. Accordingly, bio-scientists tend to get pigeonholed into two schools of thought. Reductionists might say that the division between the two schools of thought simply runs along the split between ‘thorough’ and ‘not-so-thor- ough’. Integrationists would probably claim that the divide is nearer the categories ‘geeky’ and ‘not-so-geeky’. The two contrasting views were expressed at a higher level of sophis- tication during a recent Novartis Foundation meeting on The limits of reductionism in biology by Professor Lewis Wolpert and Professor Gabriel A. This leaves us with the question of whether or not the two directions are irreconcilable. The logic of life will neither be recognised without precise understand- ing of the manifold of components that give rise to biological function, nor without a clear conception of the dynamic interactions between individ- ual components. Likewise, the logic of life lies exclusively neither in the most incredible detail, nor in the most sweeping synopsis. It is the central part of modern Dialectics – ‘the soul of all knowledge which is truly scientific’ – as taught by Hegel (Encyclopaedia of the philo- sophical sciences, 1830) and Engels (Dialectics of nature, 1879). And, to go back in time even further, ‘combined opposites’ – Yin and Yang – are central to old Chinese philosophy and ancient popular wisdom. Thus, common sense would suggest that neither of the two – Integrationism and Reductionism (and this shall be the last time we affront the reader with an ‘-ism’) – is self-sufficient, and both are obligatory to the quest for knowledge. This view lays the basis of probably the most exciting new develop- ment in bio-medical research – the Physiome Project. It was publicly initiated at the 33rd World Congress of the International Union of Physiological Sciences, 1997 in St.

Care should be taken to avoid generating air currents with the hand movement as this may stimulate the corneal reflex which may simulate the visuopalpebral reflex purchase vantin 100mg on-line virus webquest. It is probable that this reflex requires cortical processing: it is lost in persistent vegetative states buy generic vantin 100 mg on line virus in michigan. Loss of this reflex may occur in Balint’s syndrome purchase vantin with a visa antibiotic 875mg 125mg, ascribed to inability to recognize the nearness of the threatening object purchase vantin 200mg free shipping antibiotics for dogs and cats. The final common (efferent) pathway for these responses is the facial nerve nucleus and facial (VII) nerve, the afferent limbs being the trigeminal (V), optic (II), and auditory (VIII) nerves respectively. Electrophysiological study of the blink reflex may demonstrate peripheral or central lesions of the trigeminal (V) nerve or facial (VII) nerve (afferent and efferent pathways, respectively). It has been reported that in the evaluation of sensory neuronopathy the finding of an abnormal blink reflex favors a nonparaneoplastic etiology, since the blink reflex is normal in paraneoplastic sensory neuronopathies. Journal of Clinical Neuro-ophthalmology 1992; 12: 47-56 Cross References Balint’s syndrome; Blinking; Corneal reflex; Glabellar tap reflex Body Part as Object In this phenomenon, apraxic patients use a body part when asked to pan- tomime certain actions, such as using the palm when asked to demon- strate the use of a hair brush or comb, or fingers when asked to demonstrate use of scissors or a toothbrush. Ideomotor apraxia in patients with Alzheimer’s disease: why do they use their body parts as objects? Neuro- psychiatry Neuropsychology and Behavioral Neurology 2001; 14: 45-52 Cross References Apraxia “Bon-Bon Sign” Involuntary pushing of the tongue against the inside of the cheek, the “bon-bon sign,” is said to be typical of the stereotypic orolingual move- ments of tardive dyskinesia, along with chewing and smacking of the mouth and lips, and rolling of the tongue in the mouth. These signs may help to distinguish tardive dyskinesia from chorea, although periodic pro- trusion of the tongue (flycatcher, trombone tongue) is common to both. Cross References Chorea, Choreoathetosis; Trombone tongue Bouche de Tapir Patients with facioscapulohumeral (FSH) dystrophy have a peculiar and characteristic facies, with puckering of the lips when attempting to whistle. The pouting quality of the mouth, unlike that seen with other types of bilateral (neurogenic) facial weakness, has been likened to the face of the tapir (Tapirus sp. Cross References Facial paresis Bovine Cough A bovine cough lacks the explosive character of a normal voluntary cough. It may result from injury to the distal part of the vagus nerve, particularly the recurrent laryngeal branches which innervate all the muscles of the larynx (with the exception of cricothyroid) with result- ant vocal cord paresis. Because of its longer intrathoracic course, the left recurrent laryngeal nerve is more often involved. A bovine cough may be heard in patients with tumors of the upper lobes of the lung (Pancoast tumor) due to recurrent laryngeal nerve palsy. Bovine cough may also result from any cause of bulbar weakness, such as motor neu- rone disease, Guillain-Barré syndrome, and bulbar myopathies. New England Journal of Medicine 1997; 337: 1370-1376 Cross References Bulbar palsy; Diplophonia; Signe de rideau Bradykinesia Bradykinesia is a slowness in the initiation and performance of voluntary movements, one of the typical signs of parkinsonian - 58 - Broca’s Aphasia B syndromes, in which situation it is often accompanied by difficulty in the initiation of movement (akinesia, hypokinesia) and reduced ampli- tude of movement (hypometria) which may increase with rapid repet- itive movements (fatigue). It may be overcome by reflexive movements or in moments of intense emotion (kinesis paradoxica). Bradykinesia in parkinsonian syndromes reflects dopamine depletion in the basal ganglia. It may be improved by levodopa and dopaminergic agonists, less so by anticholinergic agents. Slowness of voluntary movement may also be seen with psy- chomotor retardation, frontal lobe lesions producing abulia, and in the condition of obsessive slowness. Cross References Abulia; Akinesia; Fatigue; Hypokinesia; Hypometria; Kinesis paradoxica; Parkinsonism; Psychomotor retardation Bradylalia Bradylalia is slowness of speech, typically seen in the frontal-subcorti- cal types of cognitive impairment, with or without extrapyramidal fea- tures, or in depression. Cross References Palilalia; Tachylalia Bradyphrenia Bradyphrenia is a slowness of thought, typically seen in the frontal- subcortical types of cognitive impairment, e. Such patients typically answer questions correctly but with long response times. Cross References Abulia; Dementia Bragard’s Test - see LASÈGUE’S SIGN Broca’s Aphasia Broca’s aphasia is the classic “expressive aphasia,” in distinction to the “receptive aphasia”of Wernicke; however, there are problems with this simple classification, since Broca’s aphasics may show compre- hension problems with complex material, particularly in relation to syntax. Considering each of the features suggested for the clinical classi- fication of aphasias (see Aphasia), Broca’s aphasia is characterized by: ● Fluency: slow, labored, effortful speech (nonfluent) with phonemic paraphasias, agrammatism, and aprosody; the patient knows what s/he wants to say and usually recognizes the paraphasic errors (i. Silent reading may also be impaired (deep dyslexia) as reflected by poor text comprehension. Aphemia was the name originally given by Broca to the language disorder subsequently named “Broca’s aphasia. Broca’s aphasia is sometimes associated with a right hemiparesis, especially affecting the arm and face; there may also be bucco-lingual-facial dyspraxia. Classically Broca’s aphasia is associated with a vascular lesion of the third frontal gyrus in the inferior frontal lobe (Broca’s area), but in practice such a circumscribed lesion is seldom seen. More commonly there is infarction in the perisylvian region affecting the insula and operculum (Brodmann areas 44 and 45), which may include underly- ing white matter and the basal ganglia (territory of the superior branch of the middle cerebral artery). The terms “small Broca’s aphasia,” “mini-Broca’s aphasia,” and “Broca’s area aphasia,” have been reserved for a more circumscribed clinical and neuroanatomical deficit than Broca’s aphasia, wherein the damage is restricted to Broca’s area or its subjacent white matter. There is a mild and transient aphasia or anomia which may share some of the characteristics of aphemia/phonetic disintegration (i. Broca’s area aphasias: apha- sia after lesions including the frontal operculum. Neurology 1990; 40: 353-362 Mohr JP, Pessin MS, Finkelstein S, Funkenstein HH, Duncan GW, Davis KR. London: Imperial College Press, 2003: 84-89 Cross References Agrammatism; Agraphia; Alexia; Aphasia; Aphemia; Aprosodia, Aprosody; Paraphasia; Wernicke’s aphasia Brown-Séquard Syndrome The Brown-Séquard syndrome is the consequence of anatomical or, more usually, functional hemisection of the spinal cord (spinal hemisec- tion syndrome), producing the following pattern of clinical findings: ● Motor: Ipsilateral spastic weakness, due to corticospinal tract involvement - 60 - Bruit B Segmental lower motor neurone signs at the level of the lesion, due to root and/or anterior horn cell involvement. Spinal cord lesions producing this syndrome may be either extramedullary (e. Lancet 2000; 356: 61-63 Cross References Dissociated sensory loss; Myelopathy; Proprioception; Spasticity; Weakness Brudzinski’s (Neck) Sign Brudzinski described a number of signs, but the one most often used in clinical practice is the neck sign, which is sometimes evident in cases of meningeal irritation, for example due to meningitis. Passive flexion of the neck to bring the head onto the chest is accompanied by flexion of the thighs and legs. As with nuchal rigidity and Kernig’s sign, Brudzinski’s sign may be absent in elderly or immunosuppressed patients with meningeal irritation. London: Imperial College Press, 2003: 365-366 Cross References Kernig’s sign; Meningism; Nuchal rigidity Bruit Bruits arise from turbulent blood flow causing arterial wall vibrations that are audible at the body surface with the unassisted ear or with a stethoscope (diaphragm rather than bell, better for detecting higher frequency sounds). They are associated with stenotic vessels or fistulae where there is arteriovenous shunting of blood. Dependent on the clin- ical indication, various sites may be auscultated: eye for orbital bruit in carotico-cavernous fistula; head for bruit of AV fistula; but proba- bly the most frequently auscultated region is the carotid bifurcation, high up under the angle of the jaw, in individuals thought to have had - 61 - B Bruxism a transient ischemic attack or ischemic stroke. Examination for carotid bruits in asymptomatic individuals is probably best avoided, other than in the clinical trial setting, since the optimal management of asymptomatic carotid artery stenosis has yet to be defined. Practical Neurology 2002; 2: 221-224 Bruxism Bruxism is forcible grinding or gnashing of the teeth. This is common in children, and as a parasomnia, said to occur in 5-20% of the popu- lation during nonREM sleep. Dysfunction of efferent and/or afferent thalamic and stri- atopallidal tracts has been suggested as the neural substrate. If necessary, a rubber device or bite may be worn in the mouth to protect the teeth.

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Even in his last months of life order vantin with a visa antibiotic over the counter, when surely he must have been aware that his In the development of low-friction arthroplasty buy cheap vantin on line antimicrobial fabric treatment, health was failing buy vantin 100mg with visa antibiotic 7169, he did not cease to work and Sir John was always ready to admit serendipity plan for the future and was ready to travel to and good luck as well as help from his colleagues discount vantin 200mg free shipping infection in blood, Japan when invited by one of his disciples. What he never dis- aspect and would easily recall patients’ details cussed is the superhuman effort and single- from years before in a chance meeting in the long mindedness needed to achieve the aim he so corridors of the hospital. He will be missed by so many, including those Starting with a single clinical observation of a he has worked with and those he has treated and squeaking femoral head replacement, he repeated whose lives he has shaped. He was a man of many experiments on lubrication of joints and dis- talents, yet single-minded in his effort. Not discouraged, he continued with the low-friction arthroplasty must be the living Moore and Thompson femoral head replacements monument to a truly great man and benefactor articulating on a Teflon shell; the shell moved of humanity. It was at this stage that the concept of “low fric- tional torque arthroplasty” was conceived and he developed a small diameter femoral head replacement, which articulated with a thick shell of Teflon; the Teflon failed. Yet the short-term clinical results had been so spectacular that he was con- vinced of the soundness of this concept. From then onwards, with the fortuitous introduction of high-density polyethylene, all his efforts were directed toward a perfect mechanical solution to a biological problem. Furlong, who specialized in tendon repair, and finally by the Austrian School of Orthopedics. On demobilization he returned to the tutorship and was appointed honorary assistant orthopedic surgeon to the General Infirmary at Leeds in 1946 and surgeon to St. James’ Hospital, Leeds, Thorp Arch Children’s Orthopedic Hospital and to Batley, Dewsbury and Selby Voluntary Hospitals. His continuing interest in tendon surgery led to the publication in 1946 of his paper on “Recon- struction of Biceps Brachii by Pectoral Muscle Transplantation”—a work acclaimed by orthope- dic surgeons in this country and in France. The same year he was invited to become a member of what was then known as the LBK Orthopedic Club—later to be renamed the Holdsworth Club after its founder Sir Frank Holdsworth. He was elected secretary and he maintained a lively inter- John Mounsten Pemberton est in the club, where his astringent pertinent con- CLARK tributions were always welcome. In 1948 he confined his hospital work to the 1906–1982 Infirmary at Leeds and Pinderfields at Wakefield, where a center for the treatment of poliomyelitis J. He was invited to take charge officer days) was born in Leicester on November of this unit. His work at School and Leeds University, where he qualified Pinderfields Hospital, together with his consul- in 1931. After house appointments at the General tancy at the Leeds Education Authority, gave him Infirmary, Leeds, he went into general practice a vast experience in the treatment of in Dewsbury in order to pay off a student debt poliomyelitis, of club foot and of cerebral palsy, incurred to allow him to finish the course. This resulted in his nomination by Sir FRCS examination and returned to Leeds Infir- Herbert Seddon to advise Israel on the develop- mary as resident orthopedic officer under the ment of a similar poliomyelitis center, and he direction of R. Broomhead in 1938, and subse- attended that country on many occasions over the quently was appointed superintendent of the Chil- next 20 years. He was much in demand as a lec- dren’s Orthopaedic Hospital at Thorp Arch. His became FRCS in 1939 and was appointed the first mastery of the English language and literature tutor in orthopedic surgery at the University of made it inevitable that he was invited to join the Leeds in the same year. He also joined the Terri- editorial board of The Journal of Bone and Joint torial Army and served throughout the 1939–1945 Surgery and he wrote many papers on the treat- war, first in France, where he had experience of ment of poliomyelitis and tendon surgery. He forward surgery and passed through Dunkirk, and edited the Science of Fractures in Sir Harry Platt’s then in Malta, Italy and Austria, being awarded Modern Orthopedic Series and in retirement the MBE for his services. Pasco there came under the influence of chief interests, the treatment of club foot, of H. Seddon (later Sir Herbert), sent there by which he had previously developed a method of the Ministry of Health as civilian adviser, who medial release, which has been continued by his inspired him to develop a profound and lasting disciples in Leeds and the Leeds region. In 1968 the University of Leeds conferred 63 Who’s Who in Orthopedics on him a personal chair of orthopedic surgery and 1934. Cloward started his practice of neurology musicologist, being proficient with clarinet and and neurosurgery in Honolulu, Territory of piano. He was in Honolulu when the erature was wide and throughout his life he dis- Japanese attacked Pearl Harbor on December 7, played a great interest in all forms of art. A 1941, and was assigned by the War Department connoisseur of wine and food, he loved convers- to remain in Honolulu for the duration of the war ing with his friends about books, music and art. For his services to superintendent at Pinderfields Hospital, and this civilians and the military during the war, he led to great happiness—probably the happiest received a commendation from President years of his life. The posterior lumbar inter- body fusion (PLIF) was first performed in 1943 and in 1945 was reported to the Hawaii Territor- ial Medical Association. His first paper on the technique of the operation was published in the Journal of Neurosurgery (1953). Cloward pub- lished his original operation for treatment of cervical disc disease by anterior discectomy and interbody fusion. Cloward was an exceptionally skilled and innovative technical neurosurgeon and rightfully deserves the title “Michelangelo of Neuro- surgery. The very fact that he could perform this difficult procedure in the early 1940s bespeaks his technical genius. CLOWARD token, because of his technical superiority and 1908–2000 the excellent results he obtained with his PLIF procedure, only a few surgeons were willing to Ralph B. Cloward was also a genius in devising descendants of original Mormon pioneers. He instrumentation and has had over 100 of his received his primary school education in Utah, instruments cataloged by Codman and Shurtleff. Cloward’s academic associations are exten- of Hawaii and Utah, and graduated with a BS sive. He was clinical professor of neurosurgery, degree from the University of Utah in 1930. Burns School of Medicine, University of The first 2 years of his medical education were Hawaii, Honolulu. He completed his head of the Department of Neurological Surgery medical education at Rush Medical College (Uni- at the University of Chicago Medical School, versity of Chicago), graduating in the class of Albert M. Billing Hospital, and the University of 64 Who’s Who in Orthopedics Chicago Clinics in 1954–1955. Over the years, he has been a visiting professor at the University of Oregon Medical School, the University of South- ern California at Los Angeles, and Rush Medical College, The Rush Presbyterian–St. Cloward was a fellow of the American College of Surgeons and is certified by the American Board of Neurological Surgeons (1941). He was an honorary member of the Asian–Australasian Society of Neurologi- cal Surgeons and served as guest lecturer at the recent Sixth Congress in Hong Kong. Cloward had published 83 original articles in national and international medical journals on neurosurgical subjects and was the author of numerous monographs. He had also made three documentary surgical movies, filmed by the John Robert COBB famous Hollywood surgical motion-picture pho- tographer Billy Burke, on the subjects of lumbar 1903–1967 vertebral body fusion, anterior cervical fusion, and anterior cervical cordotomy. He had a long American heritage, member of the Mormon Church, was a playing one of his ancestors having come over on the member of the Honolulu Symphony Orchestra Mayflower. His father believed in discipline along (1926–1928), and for 1 year (1927) was a member with study and consequently sent him to the of the Royal Hawaiian Hotel Band in Honolulu.

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If you es- tablish rapid and clear eye-contact discount vantin american express antimicrobial cutting board, you’ll be more ea- sily trusted discount 200mg vantin visa human eye antibiotics for dogs. X During the interview discount 200 mg vantin overnight delivery infection zombie movie, firm eye contact with little move- ment indicates that you’re interested in what is being said purchase vantin 100mg antimicrobial natural products. On the other hand, if your eyes wander all over the place and only briefly make contact with the eyes of the interviewee, low self-esteem, deceit or boredom HOW TO CONDUCT INTERVIEWS / 71 can be indicated. Conversely, watch the eyes of your interviewees which will tell you a lot about how the interview is progressing. Try not to sit directly opposite them – at an angle is better, but not by their side as you will have to keep turning your heads which will be un- comfortable in a long interview. By watching the eye movements and body language of the interviewees, and by listening to what they’re saying, you’ll soon know when you’ve established rapport. If, however, you notice the interviewees becoming uncomfortable in any way, respect their feelings and move on to a more general topic. Sometimes you might need to offer to turn off the recorder or stop taking notes if you touch upon a particularly sensitive issue. Negotiate a length of time for the interviews and stick to it, unless the interviewees are happy to continue. Make sure you thank them for their help and leave a contact number in case they wish to speak to you at a later date. You might find it useful to send a transcript to the inter- viewees – it is good for them to have a record of what has been said and they might wish to add further information. Do not disclose information to third parties unless you have received permission to do so (see Chapter 13). ASKING QUESTIONS AND PROBING FOR INFORMATION As the interview progresses, ask questions, listen carefully 72 / PRACTICAL RESEARCH METHODS to responses and probe for more information. When you probe, you need to think about obtaining clar- ification, elaboration, explanation and understanding. There are several ways to probe for more detail, as the fol- lowing list illustrates. PROBING FOR MORE DETAIL X That’s interesting; can you explain that in more de- tail? You’ll find that most people are uncomfortable during silences and will elaborate on what they’ve said rather than experience discomfort. Also, you may find it helpful to summarise what people have said as a way of finding out if you have understood them and to determine whether they wish to add any further information. Another useful tactic is to repeat the last few words a per- son has said, turning it into a question. The following piece of dialogue from an interview illustrates how these techniques can be used so that the researcher does not in- fluence what is being said. HOW TO CONDUCT INTERVIEWS / 73 Janet: ‘Well, often I find it really difficult because I just don’t think the information’s available. I wer- en’t exactly naughty at school, I just didn’t really bother, you know, I didn’t really like it that much, if I’m honest with you. SUMMARY X Practise with the recording equipment before the inter- view takes place. It might be useful to conduct some pilot interviews so that you can become familiar with the recording equipment. X Develop an interview schedule, starting with general, 74 / PRACTICAL RESEARCH METHODS non-personal issues. X Check the recording equipment works and make sure you have enough tapes, batteries, paper, pens, etc. X Check that you have a suitable venue in which to carry out the interview, free from noise and interruptions. X Make sure you know how to get to the interview and arrive in good time. X Negotiate a length of time for the interview and stick to it, unless the interviewee is happy to continue. X Check recording equipment is working without draw- ing attention to it. X Achieve closure, thank them and leave a contact num- berincasetheywishtogetintouchwithyouabout anything that has arisen. HOW TO CONDUCT INTERVIEWS / 75 X Respect their confidentiality – do not pass on what has been said to third parties unless you have requested permission to do so. They are popular within the fields of market research, political research and educational research. The focus group is facilitated by a moderator who asks questions, probes for more detail, makes sure the discussion does not digress and tries to ensure that everyone has an input and that no one person dominates the discussion. If you are interested in running focus groups for your re- search you will need to acquire a basic understanding of how people interact in a group setting and learn how to deal with awkward situations (see Table 8). However, the best way to become a successful moderator is through experience and practice. If possible, try to sit in on a focus group run by an experienced moderator. Once you have done this, hold your own pilot focus group, either with friends or ac- tual research participants. You might find it useful to video tape this focus group so that you can assess your body lan- guage, see how you deal with awkward situations, analyse how you ask questions, and so on. Don’t be disappointed if your first few groups do not go according to plan. In all focus groups you need to explain the purpose of the group, what is expected of participants andwhatwillhappentotheresults. Negotiatealength for the discussion and ask that everyone respects this as it can be very disruptive having people come in late, or leave early. Usually one and a half hours is an ideal length, although some focus groups may last a lot longer. Assure the participants about anonymity and confidenti- ality, asking also that they respect this and do not pass on what has been said in the group to third parties. You may find it useful to produce and distribute a Code of Ethics (see Chapter 13). Asking questions General, easy to answer questions should be asked first. As moderator, listen carefully to everything people say, acknowledging that you are listening by mak- ing good eye contact and taking notes regarding issues to which you may return later. Make sure that no one person dominates the discussion as this will influence your data. Some moderators prefer to use a list of questions as their interview schedule, whereas others prefer to use a list of topics (see Chapter 7 for more information on developing an interview schedule). The overall aim is a free-flowing discussion within the subject area, and once this happens the input from the moderator may be considerably less than it would be in a one-to-one interview. You will find that in most focus groups, most people will talk some of the time, although to varying de- grees. In some groups, some people may need gentle per- suasion to make a contribution.

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