Four Scottish indulgences at Sens

English interest in the great Cistercian abbey of Pontigny was stimulated by the exiles there of two archbishops of Canterbury, Thomas Becket and Stephen Langton.1 As archbishops of Canterbury, Langton and Edmund of Abingdon made gifts to Pontigny abbey in consideration of the welcome given to Becket.2 Edmund did not die at Pontigny, but was a confrater of the community, and the abbot claimed the body, asserting that Edmund had expressed a wish to be buried there. The process of canonisation was rapid.3 After Edmund's canonisation, Henry III sent a chasuble and a chalice for the first celebration of the feast, and granted money to maintain four candles round the saint's shrine.4 In 1254, en route from Gascony to meet Louis IX in Chartres and Paris,5 Henry visited Pontigny, as his brother Richard of Cornwall, who seems to have pressed for canonisation, had done in 1247.6 Archbishop Boniface of Canterbury ordered the celebration of the feast to be observed throughout his province.7 Pope Alexander IV granted a dispensation to allow Englishwomen to enter the precinct of Pontigny abbey on the feast of the translation of the relics of St Edmund8 (women were normally forbidden to enter a Cistercian monastery). Matthew Paris, the greatest English chronicler of the age, wrote a life of the saint.9 English interest continued into the fourteenth century. In 1331 an English priest was given a licence to visit the shrine,10 but it seems likely that the Hundred Years’ War made pilgrimage to Pontigny difficult.11 The indulgences preserved by the abbey reveal an interest in the shrine throughout the Western Church, granted as they were by prelates from Tortosa to Livonia and Estonia, and from Messina to Lübeck.1

Cost savings associated with improving appropriate and reducing inappropriate preventive care: cost-consequences analysis

<p>Abstract</p> <p>Background</p> <p>Outreach facilitation has been proven successful in improving the adoption of clinical preventive care guidelines in primary care practice. The net costs and savings of delivering such an intensive intervention need to be understood. We wanted to estimate the proportion of a facilitation intervention cost that is offset and the potential for savings by reducing inappropriate screening tests and increasing appropriate screening tests in 22 intervention primary care practices affecting a population of 90,283 patients.</p> <p>Methods</p> <p>A cost-consequences analysis of one successful outreach facilitation intervention was done, taking into account the estimated cost savings to the health system of reducing five inappropriate tests and increasing seven appropriate tests. Multiple data sources were used to calculate costs and cost savings to the government. The cost of the intervention and costs of performing appropriate testing were calculated. Costs averted were calculated by multiplying the number of tests not performed as a result of the intervention. Further downstream cost savings were determined by calculating the direct costs associated with the number of false positive test follow-ups avoided. Treatment costs averted as a result of increasing appropriate testing were similarly calculated.</p> <p>Results</p> <p>The total cost of the intervention over 12 months was $238,388 and the cost of increasing the delivery of appropriate care was$192,912 for a total cost of $431,300. The savings from reduction in inappropriate testing were$148,568 and from avoiding treatment costs as a result of appropriate testing were $455,464 for a total savings of$604,032. On a yearly basis the net cost saving to the government is $191,733 per year (2003$Can) equating to $3,687 per physician or$63,911 per facilitator, an estimated return on intervention investment and delivery of appropriate preventive care of 40%.</p> <p>Conclusion</p> <p>Outreach facilitation is more expensive but more effective than other attempts to modify primary care practice and all of its costs can be offset through the reduction of inappropriate testing and increasing appropriate testing. Our calculations are based on conservative assumptions. The potential for savings is likely considerably higher.</p

Transforming knowledge systems for life on Earth: Visions of future systems and how to get there

© 2020 The Author(s) Formalised knowledge systems, including universities and research institutes, are important for contemporary societies. They are, however, also arguably failing humanity when their impact is measured against the level of progress being made in stimulating the societal changes needed to address challenges like climate change. In this research we used a novel futures-oriented and participatory approach that asked what future envisioned knowledge systems might need to look like and how we might get there. Findings suggest that envisioned future systems will need to be much more collaborative, open, diverse, egalitarian, and able to work with values and systemic issues. They will also need to go beyond producing knowledge about our world to generating wisdom about how to act within it. To get to envisioned systems we will need to rapidly scale methodological innovations, connect innovators, and creatively accelerate learning about working with intractable challenges. We will also need to create new funding schemes, a global knowledge commons, and challenge deeply held assumptions. To genuinely be a creative force in supporting longevity of human and non-human life on our planet, the shift in knowledge systems will probably need to be at the scale of the enlightenment and speed of the scientific and technological revolution accompanying the second World War. This will require bold and strategic action from governments, scientists, civic society and sustained transformational intent