Background It is a common ethical challenge for ambulance clinicians to care for patients with impaired decision-making capacities while assessing and determining the degree of decision-making ability and considering ethical values. Ambulance clinicians’ ethical competence seems to be increasingly important in coping with such varied ethical dilemmas. Ethics rounds is a model designed to promote the development of ethical competence among clinicians. While standard in other contexts, to the best of our knowledge, it has not been applied within the ambulance (...) service context. Thus, the aim of this study was to describe ambulance clinicians’ experiences of participating in ethics rounds. Methods This was a qualitative descriptive study, evaluating an intervention. Data were collected through sixteen interviews with ambulance clinicians who had participated in an intervention involving ethics rounds. The analysis was performed by use of content analysis. Results Two themes describe the participants’ experiences: (1) Reflecting freely within a given framework, and (2) Being surprised by new insights. The following categories form the basis of the themes; 1a) Gentle guidance by the facilitator, 1b) A comprehensible structure, 2a) New awareness in the face of ethical problems, and 2b) Shared learning through dialogue. Conclusion Incorporating structured ethics rounds seems to create a continuous development in ethical competence that may improve the quality of care in the ambulance service. Structured guidance and facilitated group reflections offer ambulance clinicians opportunities for both personal and professional development. An important prerequisite for the development of ethical competence is a well-educated facilitator. Consequently, this type of ethics rounds may be considered a useful pedagogical model for the development of ethical competence in the ambulance service. (shrink)

When most people sit down to watch a film, their focus usually stays on the very dynamic images that move onscreen. The dialogue, as a form of diegetic sound, is probably the next piece of the film they concentrate on, but this only imitates actual experience, since most people understand communication by both watching and listening. Christian Metz, in his influential text Film Language: A Semiotics of the Cinema, describes film as “Born of the fusion of several pre-existing forms of (...) expression, which retain some of their own laws (image, speech, music, and noise),” to which he later adds “written materials” as a fifth component.1 Of these five channels of information included in film, music is the most artificial .. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Understanding the Score: Film Music Communicating to and Influencing the AudienceJessica Green (bio)IntroductionWhen most people sit down to watch a film, their focus usually stays on the very dynamic images that move onscreen. The dialogue, as a form of diegetic sound, is probably the next piece of the film they concentrate on, but this only imitates actual experience, since most people understand communication by both watching and listening. Christian (...) Metz, in his influential text Film Language: A Semiotics of the Cinema, describes film as “Born of the fusion of several pre-existing forms of expression, which retain some of their own laws (image, speech, music, and noise),” to which he later adds “written materials” as a fifth component.1 Of these five channels of information included in film, music is the most artificial because in many films the majority of music is nondiegetic. For the audience, it is also the channel most removed from everyday life. While people do interact with images, the spoken word, text, and sound in the normal course of a day, people do not walk around constantly supported by a sensitive soundtrack that follows their emotions and thoughts.Yet despite the artificiality of the musical score in comparison with everyday life, audiences have come to accept film music as an integral part of what it means to watch a film. Films that fail to use much music or fail to use it well often have a problem involving the audience as completely as films that embrace music as a tool that can expose the inner feelings and thoughts of characters and can shape the way that viewers feel about what’s happening on screen. To understand the importance of film music, Stam, Burgoyne, and Flitterman-Lewis further explain why it is important to examine music as a significant channel through which the audience makes meaning of the film: “Metz’s definition of the cinema’s matter of expression as consisting of five tracks—image, dialogue, noise, music, written materials—served to call attention to the soundtrack and thus to undercut the formulaic view of [End Page 81] the cinema as an ‘essentially visual’ medium which was ‘seen’ (not heard) by ‘spectators’ (not auditors).”2 By distinguishing dialogue, noise, and music—all auditory channels of information—as important pieces of film, Stam, Burgoyne, and Flitterman-Lewis support Metz’s assertion “that the cinema possesses various ‘dialects,’ and that each one of these ‘dialects’ can become the subject of a specific analysis.”3 Once audiences and critics consider music as one of the fundamental “dialects” of film, it then makes sense to understand music as an essential part of communication and argument in film.But is the film score more than just a reflection of a character’s sadness or the exciting chase music that exhilarates audiences? While most audiences would certainly be able to cite numerous instances of music reflecting the feelings of characters or the general mood of the film, some people might be surprised by the extent to which film music shapes and affects meaning in film. Stam, Burgoyne, and Flitterman-Lewis define several types of music that can be used in scores: redundant music, which reinforces the emotional tone; contrapuntal music, which runs counter to the dominant emotion; empathetic music, which conveys the emotions of the characters; a-empathetic music, which seems indifferent to the drama; and didactic contrapuntal music, which uses music to distance the audience “in order to elicit a precise, usually ironic, idea in the spectator’s mind.”4 Though these terms can be limiting because music often fulfills more than just one role in a scene, they do demonstrate that music is making an argument or working to convince or persuade the audience, proving that film music is behaving rhetorically. Though film music does often fulfill the basic roles of conveying emotion and suggesting connections or themes in the film, film music also works in more complex roles to affect the meaning in film. Through music’s development of specific leitmotifs, themes, and cues, the calculated use of film music in conjunction with the other channels of information helps to create the narrative and control the way... (shrink)