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Tensions between an idea of philosophy and the practice of the essay are explored in relation to the work of Montaigne in the sixteenth century and Hume in the eighteenth. The comparison between the two lays a basis for thinking about the contrast between philosophy as a way of life and its opposite. The changing and equivocal character of the philosophical essay is further explored with reference to Adorno’s “Essay as Form” and Howard Caygill’s recently published collection, Force and Understanding.

For all the promise of and need for clinical drug-induced liver injury (DILI) risk screening systems, demonstrating the predictive value of these systems versus readily available physicochemical properties and inherent dosing information has not been thoroughly evaluated. Therefore, we utilized a systematic approach to evaluate the predictive value of in vitro safety assays including bile salt export pump transporter inhibition and cytotoxicity in HepG2 and transformed human liver epithelial along with physicochemical properties. We also evaluated the predictive value of in vitro ADME assays including hepatic partition coefficient (Kp) and its unbound counterpart because they provide insight on hepatic accumulation potential. The datasets comprised of 569 marketed drugs with FDA DILIrank annotation (most vs less/none), dose and physicochemical information, 384 drugs with Kp and plasma protein binding data, and 279 drugs with safety assay data. For each dataset and combination of input parameters, we developed random forest machine learning models and measured model performance using the receiver operator characteristic area under the curve (ROC AUC). The median ROC AUC across the various data and parameters sets ranged from 0.67 to 0.77 with little evidence of additive predictivity when including safety or ADME assay data. Subsequent machine learning models consistently demonstrated daily dose, fraction sp3 or ionization, and cLogP/D inputs produced the best, simplest model for predicting clinical DILI risk with an ROC AUC of 0.75. This systematic framework should be used for future assay predictive value assessments and highlights the need for continued improvements to clinical DILI risk annotation.

Background Opioid agonist treatment (OAT) is an effective intervention for opioid dependence. Extended-release buprenorphine injections (BUP-XR) may have additional potential benefits over sublingual buprenorphine. This single-arm trial evaluated outcomes among people receiving 48 weeks of BUP-XR in diverse community healthcare settings in Australia, permitting examination of outcomes when BUP-XR is delivered in standard practice. Methods Participants were recruited from a network of specialist public drug treatment services, primary care and some private practices in three states. Following a minimum 7 days on 8–32 mg of sublingual buprenorphine (±naloxone), participants received monthly subcutaneous BUP-XR injections administered by a healthcare practitioner and completed monthly research interviews. The primary endpoint was retention in treatment at 48 weeks. Findings Participants (n = 100) were 28% women, mean age 44 years with a long history of OAT (median 5.8 years); heroin was the most common opioid of concern (58%). Treatment retention at 24 and 48 weeks was 86% and 75%, respectively. Participants with past-month injecting drug use (OR 0.23; 95%CI: 0.09–0.61) or heroin use (OR 0.23; 95%CI: 0.08–0.65) at baseline had lower odds of being retained in treatment to 48 weeks. Reductions in multiple forms of extra-medical drug use were observed. Improvements in quality of life, participation in employment, and treatment satisfaction measures were also observed. Interpretation This real-world implementation study of BUP-XR demonstrated high retention and treatment satisfaction. This study provides important additional data on the uptake and experience of clients, with relevance for policy makers, health service planners, administrators, and practitioners. Funding Indivior. Trial registration ClinicalTrials.gov Identifier: NCT03809143

Background The Centers for Medicare and Medicaid Services (CMS) penalizes hospitals for higher than expected 30-day mortality rates using methods without accounting for condition severity risk adjustment. For patients with stroke, CMS claims did not quantify stroke severity until recently, when the National Institutes of Health Stroke Scale (NIHSS) reporting began. Objective Examine the predictive ability of claim-based NIHSS to predict 30-day mortality and 30-day hospital readmission in patients with ischemic stroke. Design Retrospective cohort study of Medicare claims data. Patients Medicare beneficiaries with ischemic stroke (N=43,241) acute hospitalization between October 2016 and November 2017. Measurements All-cause 30-day mortality and 30-day hospital readmission. NIHSS score was derived from ICD-10 codes and stratified into the following: minor to moderate, moderate, moderate to severe, and severe categories. Results Among 43,241 patients with ischemic stroke with NIHSS from 2,659 US hospitals, 64.6% had minor to moderate stroke, 14.3% had moderate, 12.7% had moderate to severe, and 8.5% had a severe stroke,10.1% died within 30 days, 12.1% were readmitted within 30 days. The NIHSS exhibited stronger discriminant property (C-statistic 0.83, 95% CI: 0.82-0.84) for 30-day mortality compared to Elixhauser (0.74, 95% CI: 0.73-0.75). A monotonic increase in the adjusted 30-day mortality risk occurred relative to minor to moderate stroke category: hazard ratio [HR]=2.92 (95% CI=2.59-3.29) for moderate stroke, HR=5.49 (95% CI=4.90-6.15) for moderate to severe stroke, and HR=7.82 (95% CI=6.95-8.80) for severe stroke. After accounting for competing risk of mortality, there was a significantly higher readmission risk in the moderate stroke (HR=1.11, 95% CI=1.03-1.20), but significantly lower readmission risk in the severe stroke (HR=0.84, 95% CI=0.74-0.95) categories. Limitation Timing of NIHSS reporting during hospitalization is unknown. Conclusions Medicare claim-based NIHSS is significantly associated with 30-day mortality in Medicare patients with ischemic stroke and significantly improves discriminant property relative to the Elixhauser comorbidity index.

INTRODUCTION: Several studies have documented children gain more weight during the summer season. Despite high obesity rates, little research has included American Indian/Alaskan Native children and few studies have been longitudinal. This observational study examines seasonal weight variability over 3.5 years among ethnically diverse children including 2,184 American Indian/Alaskan Native children. METHODS: Children’s height and weight were measured before and after the summer 2012–2015 and analyzed in 2019–2020, including children with ≥2 consecutive measurements (N=7,890, mean age=8.4 [SD=2.8] years). Mixed effects models tested whether percentage of the 95th BMI percentile and BMI differed by season (summer versus rest of year) and ethnicity. RESULTS: American Indian/Alaskan Native (23.7%), Hispanic (19.8%), and Black (17.8%) children had significantly higher baseline obesity rates than White children (7.1%). The percentage of the 95th BMI percentile significantly increased during the summer compared with the rest of the year, with the strongest effects for children who were obese (b=2.69, 95% CI=1.35 to 4.03, p

Attention deficit hyperactivity disorder and stimulant use disorder commonly co-exist, and appropriate treatments have not been well established.To provide guidance for treatment of co-existing attention deficit hyperactivity disorder and stimulant use disorder.A systematic review of published English articles using MEDLINE, EMBASE, CINAHL, PsycINFO and Cochrane, utilising consistent search terms.Randomised controlled trials, comparing any treatment arm with a control group, for participants meeting Diagnostic and Statistical Manual of Mental Disorders or equivalent criteria for both attention deficit hyperactivity disorder and stimulant use disorder.Eight trials were identified for inclusion in this review. Four of eight studies showed improvement in attention deficit hyperactivity disorder outcome measures compared with placebo. Two of six studies that reported substance use outcomes showed improvement in treatment arms compared with placebo. Studies to show effect tended to be those with the highest treatment dosage.Evidence for the efficacy of treatment of patients with comorbid stimulant use disorder and attention deficit hyperactivity disorder is limited. Promising outcomes need replication in further studies utilising higher treatment dosage.

Background Rehabilitation outcomes for patients with total knee arthroplasty (TKA) after hospital discharge are not well understood. Purpose The purpose of this retrospective cohort study was to describe outpatient physical therapy (PT) after TKA and compare short-term (2 months) functional and clinical outcomes of patients following TKA who were discharged from the hospital to home and received (a) outpatient PT immediately (OP) or (b) home health PT before outpatient PT (HH). Methods The medical records of 109 men and women postoperative TKA discharged home were abstracted for the 6-minute walk test (6MWT), Knee Osteoarthritis and Outcome Score (KOOS), and knee range of motion (ROM) preoperatively and after discharge from all postoperative PT. Patients received outpatient clinic-based PT immediately after discharge from the hospital (OP) (n = 87) or home health PT before continued rehabilitation in an outpatient setting (HH) (n = 22). Results Despite demographic differences between OP and HH preoperatively, adjusted models revealed no significant differences among KOOS, 6MWT, or knee ROM between OP and HH upon completion of postoperative PT. Patients in OP completed PT on average 20 days sooner (p = .0007), although the amount of time in outpatient PT (p = .55) and the number of outpatient PT visits (p = .68) were similar between groups. Conclusion Gains in function were achieved by patients in OP and HH independent of the postoperative PT setting, although OP achieved gains sooner.

International audience; The frequency of and risk factors for shaken baby syndrome remain poorly documented for several reasons: the real number of "benign" cases of shaken baby syndrome are not known; information sources used are diverse, there have been changes over time in the definition of this pathology and few population-based epidemiological studies are available. Estimate the frequency of fatal shaken baby syndrome and determine its risk factors through research carried out on fatal cases in three regions of France while comparing them to data from international publications. A retrospective epidemiological study of all cases of fatal shaken baby syndrome affecting infants younger than 1 year of age who were examined by the courts during a 5-year period in a defined geographical area. Shaken baby syndrome cases were compared with infanticide cases for risk factors and a comparison was made of family characteristics with those of the general population. Thirty-seven cases of shaken baby syndrome were recorded (a rate of 2.9 for 100,000 live births). As in other studies, we found a strong predominance of male victims (78%), young age (median age: 4 months) and a high rate of prematurity (22%). Conversely, results on family educational and socioeconomical levels differ from those reported in numerous studies. Parent perpetrators of shaken baby syndrome belong to higher social classes than those of other types of homicide and socially reflect the population they come from. Our study suggests 1) that epidemiological studies on shaken baby syndrome should include both medical and judicial information sources and 2) that primary prevention strategies (especially in maternity wards) should target all social classes.

International audience; Dans le cadre d’une étude menée dans les tribunaux de trois régions françaises, 31 cas de bébés secoués dans un contexte familial sont repérés. L’analyse de ces dossiers judiciaires permet d’identifier trois environnements familiaux distincts : un environnement « jeune », au profil homogène caractérisé par un niveau socio-économique plutôt faible et une certaine immaturité du couple parental ; un environnement plus difficile à caractériser où l’enfant décède à la suite d’un secouement unique consécutif au débordement explosif d’un des parents ; un environnement « violent » où l’enfant a été systématiquement maltraité à plusieurs reprises, environnement caractérisé par l’important investissement professionnel des parents et une composition familiale socialement conventionnelle. Cette analyse peut permettre aux professionnels de l’enfance d’ajuster au mieux leur prévention du syndrome du bébé secoué (SBS).

International audience; OBJECTIVES: To measure the extent and analyse the mechanisms of underestimation of neonaticides (infanticides in the first 24 h of life) and to identify characteristics of neonaticidal mothers. DESIGN: A retrospective study was carried out in 26 courts in three French regions covering 34.6% of all births in France. Included in the study were all cases of infants dying on their day of birth during a 5-year period (1996-2000) that were submitted to courts by the state prosecutor. Complete court case data cover 1996-2007. WHO-International Classification of Diseases cause of death codes assigned in the mortality statistics were compared to causes assigned by the courts. Analysis was carried out on the psychiatric assessments of the mothers. RESULTS: 27 cases of neonaticides were analysed. 17 mothers were identified. We observed sizeable underestimation of neonaticides in official mortality statistics (0.39 per 100 000 births vs 2.1 in our study). Mothers' median age was 26 years; one third had at least three children. More than half lived with the child's father. Two thirds were employed and did not differ significantly from women in the general population regarding occupation. These women appeared to have low self-esteem, be immature and dependent, but did not have frank mental illness. There was no true case of 'denial of pregnancy'. Contraception was not used. CONCLUSION: This study has implications for prevention in terms of contraception and appropriate targeting of vulnerable women. It encourages the development of case-control studies on maternal risk factors within the framework of the French birth cohort currently being established.

Hazlitt wrote about Charles Mathews, a popular entertainer in the early 19th century on a number of occasions. Hazlitt was fascinated by performers and performances of all kinds. No other writer of his period who is still read wrote so much about drama. One value of his criticism is the documentary record it gives of the range of performers at work on the London stage in the early years of the 19th century. Hazlitt wrote drama reviews on a regular basis from 1813 onwards, initially for the Morning Chronicle, then for the Champion and the Examiner, and from 1820 in monthly articles for the London Magazine. His tone in these pieces merges criticism with the talk of the town. Some are of the moment, keeping his readers up-to-date with the latest news about what was happening in London theatres. Others take a longer-term view of the state of drama in early 19th England. Hazlitt came to enjoy watching Mathews at work, but his first, marginal mention of him is brief and critical. In 1816, when Matthews played two parts in an adaptation of a French sentimental drama called "Accusation, or the Anglade Family" Hazlitt thought Matthews had been miscast, an essentially comic performer trying to play roles that called for pathos (Howe 5: 281). By 1818, Matthews had reinvented himself as a performer of one-man shows rather than a stage actor. He sang, recited, and performed monologues. These drew upon his talent for mimicry and ventriloquism. He was a quick-change artist who established a set of stock comic characters. He also included in his repertoire the imitation of the contemporary stars of the London stage What Hazlitt admired about Mathews, apart from his rapport, with his audience, was the capacity of one man to populate a stage with a multitude of different voices and characters. In his most considered account of Mathews' work, written for the London Magazine in May, 1820, Hazlitt thought that Mathews was something other than an actor. His strength was in a "certain general tact and versatility of comic: power" (18: 320). He noticed, too, that Mathews was a more complex figure than his comic entertainments might imply. He had a presence apart from his impersonations and feats of ventriloquism: "You would say he is a clever performer; you would guess he is a cleverer man." (320). What he also discerned in the midst of Mathews' comic bravura was a disappointed man someone who wanted to be taken seriously as the actor that he wasn't. Hazlitt was not alone in his interest, in Mathews. There were many other contemporary accounts and reminiscences. Some of them give a more immediate sense than Hazlitt's reviews of what was happening on stage during the course of a performance, as in this press notice of an 1820 entertainment put on by Mathews called 'Country Cousins'": [B]y means of pasteboard figures, which are moved by springs, and which he in turn animates by inserting himself into them without being perceived, he actually manages to have two, three, or four characters upon the stage at the same moment-in fact, he acts alone, a complete farce; and sustains to admiration the parts of Alderman Huckabuck; Tabitha, an old maid; Snap, a servant; Canzonelli, a singing master ... and Dickey Gossip, a barber ... (Matthews 2: 451-2 ) (1) Animating pasteboard figures were just, one part of a show that could include songs and sketches, as well as moments when Mathews would throw his voice so that it appeared that someone offstage was speaking. These parts of his performance were given the jokey, learned name of "monopolylogues". It was this kind of performance that Hazlitt understood as ventriloquism. Occasionally, Mathews would do what is now thought of as ventriloquism and engage in a comic dialogue with a doll. Hazlitt liked what others admired in Mathews' performances: their mercurial quality, the rapidity with which he could move from one voice and character to another. It was this capacity that set him apart from other performers. …

The 24-week extension of AIDS Clinical Trials Group Protocol 359, a study of human immunodeficiency virus (HIV)‐infected, indinavir-experienced patients, was designed to study the durability of “salvage” treatment regimens. Patients received saquinavir in combination with either ritonavir or nelfinavir and, in addition, delavirdine, adefovir, or both. Patients who demonstrated a virologic response at weeks 12‐16 were eligible to continue therapy in the extension through week 48. Of the 105 eligible subjects who were enrolled in the extension, 86 (82%) completed 48 weeks, and 49 (57%) of those 86 had HIV RNA levels 500 copies/ mL at week 48. For these 86 subjects who completed 48 weeks, the median change in CD4 cell count from baseline was +72 cells/mm 3 . Greater body weight, higher CD4 cell count, and greater degree of phenotypic susceptibility to indinavir and saquinavir at baseline were significantly associated with durable virologic suppression. These results show that some patients who experience treatment failure can demonstrate durable virologic and immunologic responses with salvage antiretroviral regimens. Current treatment guidelines recommend starting therapy for human immunodeficiency virus (HIV) infection with 2 nucleoside analogue reverse-transcriptase inhibitors in combination with 1 or 2 protease inhibitors or a nonnucleoside analogue reversetranscriptase inhibitor [1, 2]. However, 20%‐63% of patients from clinical cohorts experience virologic treatment failure while receiving combination antiretroviral therapy [3‐7]. Recent prospective studies have attempted to identify strategies for treatment of the treatment-experienced patient [8‐13], but these studies have focused primarily on 8‐24-week virologic responses to treatment. The durability of virologic and immunologic re

The emergence of Creative Writing as a significant presence in British higher education has coincided with major changes in universities themselves. Amongst these has been the requirement that universities should be publicly accountable in a new way. Universities no longer just do things like teaching and research. They have to accompany their activity with statements about what they do and why they do it. What is to count as research in any field is not exempt from these requirements. Their pressure, for good or ill, has been evident in debates about what is to count as research in Creative Writing and, therefore, about what it might mean to do a Ph.D. in the subject, if it is a subject.

Objectives Using judicial files on neonaticides, (1) to examine the frequency of the association between neonaticide and denial of pregnancy; (2) to assess the accuracy of the concept of denial of pregnancy; (3) to examine its usefulness in programs to prevent neonaticides. Methods Quantitative and qualitative analyses of data collected from judicial files during a population-based study carried out in 26 courts in 3 regions of France over a 5-year period. Results There were 32 cases of neonaticides identified; 24, perpetrated by 22 mothers, were solved by police investigation. Aged 26 years on average, the mothers had occupations that resembled those of the general population and 17 had jobs, 13 were multiparous and 11 lived in a couple relationship. No effective contraception was used by women in 20 cases. Psychopathology was rare but mothers shared a personality profile marked by immaturity, dependency, weak self esteem, absence of affective support, psychological isolation and poor communication with partners. No pregnancy was registered nor prenatal care followed. Two (perhaps 3) pregnancies were undiscovered until delivery. No typical denial of pregnancy was observed in the other cases. Pregnancies were experienced in secrecy, with conflicting feelings of desire and rejection of the infant and an inability to ask for help. Those around the mothers, often aware of the pregnancy, offered none. In the absence of parallel clinical data, it is not possible to calculate the frequency of the association between neonaticide and denial of pregnancy. Conclusions The term ‘denial of pregnancy’ cannot fully reflect the complexity of emotions and feelings felt by all perpetrators of neonaticide and is used differently by different professionals. The term itself and its excessive generalization contribute to pathologizing women while absolving those around them and has little operational value in preventing neonaticides. The authors suggest rethinking the terms presently used to describe the phenomenon of pregnancy denial.

Taking Heidegger’s thought about listening to language as a starting point the argument explores some contrasting ideas about reading literature and the ways in which it might interact with the practice of creative writing. While recommending a kind of reading based in criticism rather than critique, the essay goes on to an assessment of some of the obstacles that stand in the way of realising this possibility.

OBJECTIVES: Test the hypothesis of an underestimation of infant homicides in mortality statistics in France; identify its causes; examine data from the judicial system and their contribution in correcting this underestimation. METHODS: A retrospective, cross-sectional study was carried out in 26 courts in three regions of France of cases of infant deaths submitted to the courts, 1996-2000, with follow-up of their files until case closing (1996-2008). For each case, cause of death established by the courts was compared with ICD cause of death as coded in official mortality statistics. RESULTS: We examined 247 cases. Shortcomings in investigations were noted (autopsies: 75% of cases; fundus examination: 11%; diagnosis of sudden infant death syndrome SIDS without autopsy: 41%). Eighty deaths were considered homicides by the courts. Homicide rates in the court study are 2-3.6 times higher than those in mortality statistics. Nearly 1/3 of "accidental" deaths and 1/4 of deaths from unknown cause in mortality statistics are homicides. Mechanisms of underascertainment are: physicians' inappropriate death certification and underreporting of suspicious cases; inadequate investigation of cases; incomplete communication of final medical and forensic results to the mortality statistics department. CONCLUSIONS: In a country where neither transportation of the body to a hospital nor autopsy is obligatory, judicial data can make an important contribution to correcting mortality statistics. PRACTICE IMPLICATIONS: This study led to the first French protocol for investigating sudden unexpected deaths in infancy (SUDI). The protocol includes a physician "training" section focused on understanding the symptomatology and risk factors of violence, as well as the quality of death certification. Language: en

Opinions of algerian physicians concerning medical care: a fragile occupational identity This paper is aimed at understanding, restitute and analyse the different discourses of Algerian physicians on care activities of three sanitary institutions (hospital paediatric wards, «peripheral» structures and private offices). The paper is focusing on meanings attributed by health practitioners, whose status can be different (specialised and general practitioners), to the various strains within care activities, but concerning also the various social relationships elaborated together with consumers and coworkers. We are attempting to show how much care activities are baffled and trapped, how deviated they are in contact with social reality. All the doctors' frame or reference concerning illlness, medicine, focusing on the technical and scientific dimension, is questioned as it is fully disconnected from the daily medical practice characterized by its feature of «daily do it yourself» and as it reveals a deeply impaired professional identity of the physicians., Résumé. Cet article se propose de comprendre, de restituer et d'analyser les différents discours des médecins algériens sur l'activité de soins assurée dans trois institutions sanitaires (services hospitaliers de pédiatrie, structures « périphériques » et cabinets privés). Il est centré sur les significations attribuées par les praticiens de la santé de statuts différents (spécialistes et médecins généralistes) aux multiples tensions au centre de l'activité de soins, mais aussi aux différentes relations sociales construites avec les usagers et les collègues de travail. Nous essayons de montrer la façon dont l'activité de soins est mise en défaut et subit un processus de détournement au contact de la réalité sociale. Tout le système de référence des médecins sur la maladie et la médecine, focalisé sur la dimension technique et scientifique est remis en question, étant en total décalage avec la pratique médicale au quotidien caractérisée par ce « bricolage au quotidien » et révélant cette identité professionnelle profondément altérée des médecins., El juicio de los médicos argelinos sobre la actividad médica : una identitad profesional frágil Este artículo se propone comprender, restituir y analizar los diferentes discursos de los médicos argelinos en cuanto a l' actividad médica brindada en tres instituciones (los servicios hospitalarios de pediatría, las estructuras « periféricas » y los consultorios privados). Se concentra sobre las significaciones que los profesionales de la salud de jerarquías diferentes (especialistas y médicos clínicos) le atribuyen a las múltiples tensiones inhérentes a la actividad médica como también sobre las diferentes relaciones sociales que se establecen con los usuarios y los colegas de trabajo.Tratamos de mostrar de que manera esta actividad se ve afectada y por ende desvirtuada, al entrar en contacto con la realidad social. El sistema referencial de los médicos con respecto a la enfermedad y a la medicina, completamente focalizado sobre la dimensión técnica y científica, se ve cuestionado porque no corresponde en nada a la práctica médica cotidiana, que se caracteriza por la « improvisasión cotidiana », y porque révéla una identidad profesional médica profundamente alterada., Mebtoul Mohamed, Cook Jon, Grangaud Jean-Paul, Tursz Anne. Les jugements des médecins algériens sur l'activité de soins : une identité professionnelle fragile. In: Sciences sociales et santé. Volume 16, n°2, 1998. pp. 5-25.

Daniel Lévy-Bruhl, J. Cook, B. Legonou, Y. Jaffré, P. Amévigbe, G. Sanou, N. Guérin: Methodological approaches in studying the acceptability of vaccination: example of three investigations conducted in West Africa. Immunization program directors in three West African countries asked the help of social scientists to better understand non-utilization of immunization services. Semi-structured interviews carried out in homes sought to identify how parental models of childhood illnesses, especially concepts of their causes and prevention, affect immunization levels. These studies are examples of applied social science research providing, in a matter of months, information useful to health personnel for the management of their programs., Résumé : Afin de mieux appréhender les motifs de non-utilisation des services de vaccination, les responsables de programmes de vaccination de trois pays d'Afrique de l'Ouest ont fait appel aux méthodes des sciences sociales. Des entretiens semi-structures menés auprès des familles ont tenté de préciser comment les modèles parentaux des maladies de l'enfance et surtout les concepts sur leurs causes et leur prévention influencent la couverture vaccinale infantile. Ces études représentent des exemples de recherche appliquée en sciences sociales permettant en quelques mois de fournir aux cadres de la santé des informations utiles à la gestion de leurs programmes., Daniel Lévy-Bruhl, et al. : Un enfoque metodológico en el estudio de la aceptabilidad de la vacunación : très encuestas llevadas a cabo en Africa del Oeste. Con el fin de comprender mejor los motivos de la no utilización de los servicios de vacunación, los responsables de los programas de vacunación de très paises de Africa del Oeste recurieron a la metodo- logfa de las ciencias sociales. Entrevistas semiestructuradas fueron llevadas a cabo con las familias. Intentaron precisar de qué manera los modelos parentales de las enfermedades de la infancia y sobretodo los conceptos relacionados con sus causas y su prevención influyen en la cobertura de la vacunación infantil. Dichos estudios representan ejemplos de la investigación aplicada en ciencias sociales que permite a los responsables de la salud adquirir en solo unos meses la información necesaria para la aplicación de sus programas., Lévy-Bruhl Daniel, Cook Jon, Legonou B., Jaffré Yannick, Amévigbe P., Sanou G., Guérin N. Approches méthodologiques dans l'étude de l'acceptabilité de la vaccination : exemple de trois enquêtes menées en Afrique de l'Ouest. In: Sciences sociales et santé. Volume 11, n°2, 1993. Aspects des systèmes de santé dans les pays du Sud, sous la direction de Bernard Hours et Jérôme Dumoulin. pp. 9-25.

The university’s corporate culture is conditioned by the duality of its intellectual culture. The opposition of science and the humanities fuels a logic of “either/or” rather than “both/and” and encourages the two disciplines to compete for authority within the university’s authoritative structure. A university’s importance is defined by its exclusiveness, an exclusiveness maintained, historically, by the exclusion of different social groups. This attitude is mirrored in an attitude towards knowledge - the cult of the expert and of specialization, the belief that specialized forms of knowledge require esoteric codes and, therefore, that any advance in knowledge will be expressed in such codes. Distinguishing between the informal, practical and collaborative practices of “community knowledge” and their negation in the formal structures of “university knowledge” the chapter argues that the interactions across this boundary are an important concern for any group considering the future of universities. The sciences and the humanities share a capacity for problem-solving. Problem-solving is not a skill that can be learnt in isolation from the historical and philosophical context which is its necessary condition, nor is it a skill that can be taught by learning a set of specific rules. Problem-solving is an attempt to mediate between skill and knowledge. Narrative may be seen as one form of problem-solving which pervades social life. The chapter advocates a history of knowledge as an integral subject, available to students in both the humanities and the sciences and thereby holding the two cultures in a single frame. The history of knowledge stimulates intellectual curiosity by rejecting the idea that knowledge is monolithic. The sciences and the humanities can also be held in the same frame by the study of information theory, a subject which may provide the component of a common language for the exchange of experience and ideas across the boundaries of the two cultures. The chapter argues for a form of intellectual opportunism, for cultivating the capacity to experiment with a difficult language in a way that produces a hypothesis useful to the learner. For these proposals to be effective, we need to revise the metaphor of the university itself. The metaphor of the university as an encyclopaedia is suggested, a metaphor intended to evoke “the whole circle of learning”, an environment, the play of chance and invention, consultation and participation. The technological basis for this new encyclopaedia would be the computer as an instrument capable of providing an arbitrary, flexible system of classification which would offer large-scale access to - and rapid updating of - the knowledge base of the Encyclopaedia. The encyclopaedia would develop the potential of its eighteenth century forbear as a focus for information, debate, group thinking, and reflection.

The chapters in Part II are connected by three main themes: Diderot, dialogue and translation. Diderot is discussed in terms of his exemplary force as a non-specialist, encyclopaedic intellectual. The importance of his contributions to an epistomology of skill and to an understanding of dialogue is stressed. The present chapter goes on to summarize the value of dialogue as a form which can tolerate incompatible perspectives in a way that deepens reflective understanding of why we have the beliefs we do. This has both political and educational consequences. Dialogue is presented as a basic form of democracy and as a crucial metaphor for understanding the nature of skills. The discussion of translation extends these themes, giving, an example of the relationship between identity and skill, both for the translator of texts, and for the other kinds of “translation” involved in acting. These are issues which are contributing to the development of an international PhD programme in Culture and Technology.

Background Total knee arthroplasty (TKA) is a commonly performed surgical procedure in the US. It is important to have a comprehensive inpatient TKA program which maximizes outcomes while minimizing adverse events. The purpose of this study was to describe a TKA program – the Joint Replacement Program (JRP) – and report post-surgical outcomes. Methods 74 candidates for a primary TKA were enrolled in the JRP. The JRP was designed to minimize complications and optimize patient-centered outcomes using a team approach including the patient, patient's family, and a multidisciplinary team of health professionals. The JRP consisted of a pre-operative class, standard pathways for medical care, comprehensive peri-operative pain management, aggressive physical therapy (PT), and proactive discharge planning. Measures included functional tests, knee range of motion (ROM), and medical record abstraction of patient demographics, length of stay, discharge disposition, and complications over a 6-month follow-up period. Results All patients achieved medical criteria for hospital discharge. The patients achieved the knee flexion ROM goal of 90° (91.7 ± 5.4°), but did not achieve the knee extension ROM goal of 0° (2.4 ± 2.6°). The length of hospital stay was two days for 53% of the patients, with 39% and 7% discharged in three and four days, respectively. All but three patients were discharged home with functional independence. 68% of these received outpatient physical therapy compared with 32% who received home physical therapy immediately after discharge. Two patients (< 3%) had medical complications during the inpatient hospital stay, and 9 patients (12%) had complications during the 6-month follow-up period. Conclusion The comprehensive JRP for TKA was associated with satisfactory clinical outcomes, short lengths of stay, a high percentage of patients discharged home with outpatient PT, and minimal complications. This JRP may represent an efficient, effective and safe protocol for providing care after a TKA.