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ⅢImmigrants to English-speaking countries, even those with advanced communicative skills in English, can experience misunderstanding in their workplace communication (Yates, 2005). Although such miscommunication is not restricted to those from other language backgrounds, users of English as a second or subsequent language who move to English-speaking countries as adults face particular challenges in correctly interpreting and conveying meaning. As Trosborg (2003, pp. 252-253) notes, for those from other language backgrounds, the workplace context may present challenges related not only to working in another language and culture, but also in a business culture which may well be different from the one with which they are familiar. Part of the onus for successful communication must, of course, rest with native English speakers (NESs), and increasing their awareness of cross-cultural communication is certainly crucial. However, the often lower status newcomers to a situation cannot always depend on interacting with sympathetic interlocutors but should and can be empowered to understand the intricacies of the communicative contexts in which they are now being called on to operate.There are few descriptions that are rich enough to furnish the specifics of how adults get other people to do things in workplace situations, and many teachers feel that they do not have enough information about how NESs undertake everyday speech acts to be able to teach their learners (Yates & Wigglesworth, 2005). In particular, mitigation skills-the use of linguistic and other means to soften the impact of an utteranceappear difficult to learn from exposure alone (Bardovi-Harlig & Hartford, 1996), but they have considerable impact on how a speaker is perceived by interlocutors (Holmes, 1984). Mitigation skills vary considerably not only across languages but also across different Englishspeaking cultures, so it is crucial to understand more about how such skills are managed in NES interactions in order to help teachers address these skills more specifically in the classroom. This article reports on a BRIEF REPORTS AND SUMMARIES 791 THE AUTHORSGillian Wigglesworth is Head of the School of Languages at the University of Melbourne, Melbourne, Australia. Her research focuses on language acquisition, both first and second, and language testing and assessment, and she is widely published in these areas. She has worked for many years with ESL teachers through her involvement with the Adult Migrant English Program Research Centre.Lynda Yates is a senior lecturer in TESOL and applied linguistics at La Trobe University and a senior researcher with the Adult Migrant English Program Research Centre. She has taught in a wide range of settings in the United Kingdom, Egypt, France, Armenia, and Australia, and conducts research in areas related to adult language learning and teaching and the professional development of teachers.

(Kachru, 1992), including countries such as India, Pakistan and Sri Lanka, where a different variety of English is spoken (AMC, 2009(AMC, , 2011(AMC, , 2012a(AMC, , 2012b.In addition to the challenges of working in an unfamiliar medical system, these doctors can also face considerable difficulties in daily communications with patients, families, and colleagues (Hall, Keely, Dojeiji, Byszewski, & Marks, 2004;McDonnell & Usherwood, 2008;Tipton, 2005). In addition to the more obvious language difficulties with vocabulary, grammar, pronunciation, and an understanding of accents and colloquialisms, they can also struggle with the less salient but vitally important interpersonal features of language use, such as how to build rapport and show empathy (Hall et al., 2004;McDonnell & Usherwood, 2008;Pilotto, Duncan, & Anderson-Wurf, 2007). Moreover, many may not be familiar with the demands of the patientcentred models of care expected in developed medical environments in Canada and Australia, but less common in developing countries where medical facilities are very stretched (Dahm, 2011b;Khalil & Bhopal, 2009).In this article we focus on the communication challenges facing doctors who trained in medical environments very different from those found in Canada and Australia using a language other than English, in order to inform communications training designed specifically for doctors from language backgrounds other than English, and to illustrate how a close analysis of professional discourse can be transferred to ESL classes preparing for work environments beyond the medical world. We draw on clinical role-plays performed by practicing locally trained native English-speaking (NES) doctors and nonnative English-speaking (NNES) IMGs to identify the communication features of the kind of patient-centred approach to medical communication that will be expected of them. Although specific features and approaches to communication in Canada and Australia likely differ in some minor respects, our aims are to highlight features that are relevant in both cultures and to illustrate how discourse data can be used to identify culturally appropriate ways of communicating in a medical setting in order to provide an accurate evidence base from which culturally appropriate medical communication courses for IMGs may be developed.

Using discourse analytical methods, this article examines the interactional accomplishment of trust. Focusing on a case study drawn from a corpus of 28 surgical consultations collected in a gastro-intestinal clinic, it traces the trust-building process in a specific, communicatively challenging encounter where the patient is seeking a second opinion following an operation that she deems unsuccessful. Discourse analytical findings make visible the doctor’s strategic interactional work to build interpersonal trust with the patient and to regain her trust in the surgical profession. This work extends beyond interaction with the patient to include dictation of a letter to the referring doctor in the patient’s presence. Close analysis of the encounter reveals how this co-constructed consultation letter is deployed to strengthen the fragile patient–doctor trust engendered thus far. The article therefore provides insights into the discursive processes of trust building that could potentially be of considerable practical relevance to the medical profession.

A beef carcass instrument grading system that improves accuracy and consistency of marbling score (MS) evaluation would have the potential to advance value-based marketing efforts and reduce disparity in quality grading among USDA graders, shifts, and plants. The objectives of this study were to use output data from the Video Image Analysis-Computer Vision System (VIA-CVS, Research Management Systems Inc., Fort Collins, CO) to develop an appropriate method by which performance of video image analysis MS output could be evaluated for accuracy, precision, and repeatability for purposes of seeking official USDA approval for using an instrument in commerce to augment assessment of quality grade, and to use the developed standards to gain approval for VIA-CVS to assist USDA personnel in assigning official beef carcass MS. An initial MS output algorithm was developed (phase I) for the VIA-CVS before 2 separate preliminary instrument evaluation trials (phases II and III) were conducted. During phases II and III, a 3-member panel of USDA expert graders independently assigned MS to 1,068 and 1,242 stationary carcasses, respectively. Mean expert MS was calculated for each carcass. Additionally, a separate 3-member USDA expert panel developed a consensus MS for each carcass in phase III. In phase II, VIA-CVS stationary triple-placement and triple-trigger instrument repeatability values (n = 262 and 260, respectively), measured as the percentage of total variance explained by carcasses, were 99.9 and 99.8%, respectively. In phases II and III, 95% of carcasses were assigned expert MS for which differences between individual expert MS, and for which the consensus MS in phase III only, was < or = 96 MS units. Two differing approaches to simple regression analysis, as well as a separate method-comparability analysis that accommodates error in both dependent and independent variables, were used to assess accuracy and precision of instrument MS predictions vs. mean expert MS. Method-comparability analysis was more appropriate in assessing the bias and precision of instrument MS predictions. Ether-extractable fat percentages (n = 257; phase II) differed among MS (P < 0.05) but were not suitable to predict or validate assigned MS. The performance and reproducibility of expert MS assignment in future evaluations was considered, and an official USDA performance standard was established, to which an instrument must conform to be approved for official on-line MS assessment. The VIA-CVS subsequently was approved to assign MS to carcasses on-line after completion of a 2006 USDA instrument approval trial conducted according to methods developed during completion of this study.