Shakespeare’s Progress from the Narrative Poems to the Sonnets

L’intérêt narratif et dramatique, dominant dans les epyllia, est présent dans les Sonnets, quoique de façon différente. La sexualité, purement érotique dans Vénus et Adonis, liée à une éthique sociale dans le Viol de Lucrèce, devient psychologiquement plus complexe dans les sonnets à la Dame brune. Mais le désir est mis en sourdine dans les poèmes écrits par Shakespeare pour le jeune homme et cette relation fait éclore une plus riche variété d’intérêts et d’émotions. Dans la plupart des sonnets le poète se détourne des figures de rhétorique stéréotypées répandues dans les poèmes narratifs en faveur d’un style métaphorique qui correspond à l’évolution de son langage théâtral. Malgré leur intérêt historique et leurs moments d’éclat, les poèmes narratifs sont surpassés par les Sonnets qui ouvrent des horizons plus vastes sur le monde, le temps et la mort, avec une plus grande intensité et une force poétique accrue.A narrative and dramatic interest, dominant in the epyllia, is present in the Sonnets, though differently. The emphasis on sex, merely erotic in Venus and Adonis, related to a social ethic in the Rape of Lucrece, proves psychologically more complex in the sonnets to the Dark Lady. Desire is muted in the poems written by Shakespeare for the Young Man and this relationship evokes a richer variety of interests and emotions. In most sonnets the poet discards the stereotyped rhetorical figures profusely used in the narrative poems in favour of a metaphorical style in keeping with the evolution of his theatrical language. Despite their historical interest and occasional brilliance, the narrative poems are surpassed by the Sonnets which offer a wider view of world, time and mortality, with greater intensity and heightened poetic force

Internamente Solo: Escuchando y Resistiendo La Soledad de Adultos Mayores en La Araucanía, Chile / Internally Alone: Hearing and Resisting the Loneliness of Seniors in La Araucanía, Chile

Research Question: Which current patterns drive or diminish loneliness among seniors of the Region of the Araucanía in the city of Temuco and surrounding rural communes? Objectives: Understand and interpret the roots and the antidotes of the loneliness phenomenon experienced by seniors in Temuco and surrounding communes in the present moment. Identify and analyze the drivers of pathological elder loneliness in structural, intermediary, and proximal factors. Highlight the perspectives and narratives of seniors, community leaders, and health resources with respect to strategies to reduce the crisis. Background: Currently, the population of seniors has risen and will continue to rise in Chile due to the epidemiological transition of the recently industrialized nation. The burden on state and municipal resources to support an aging population is tremendous and serious. The problem of discriminatory conceptions of health in advanced age, together with the resource burden, has limited the action of health professionals. The ubiquity and tremendous damage of loneliness which have been discovered bring to light the need to pay attention to loneliness as a powerful pathology, which deserves careful attention. Experts increasingly discuss the role of situational factors in loneliness, including internal loneliness. This study intends to theorize loneliness through the emerging dialogue about social infrastructure, hard and soft, with the purpose of situating responses elder loneliness. Considerations of the meaning of life will be used to understand the efficacy of existing and potential social infrastructure. Methodology: A qualitative investigation was conducted in May of 2019, focused on seniors living in Temuco, the urban zone of the region, and certain surrounding rural communes. 11 interviews were conducted with seniors individually or in pairs, with a variety living situations and socioeconomic and cultural profiles. 3 focus groups were conducted with a total of 30 people. Finally, 4 interviews with professionals and local leaders who represent facets of social infrastructure. These interviews were used to thematically analyze the origins and interventions in loneliness suggested by the case studies of seniors. Results: The internal loneliness of seniors within the identified population is provoked by the interruption of the life philosophy held by the senior. This pattern is seen in the relationships between seniors and their children, grandchildren, and outside of the familiar sphere, including in their medical attention. Therefore, this pattern is repeated in three spheres of environmental influence, structural, intermediary, and proximal. Interventions through social infrastructure, hard and soft, are a particularly promising instruments for intervention, such as guaranteeing seniors recreational, emotional, and intellectual resources which promote the realization of their values. Conclusions: The main thrust of the results is that in the region, elder loneliness must be discussed as a public health threat, around which health and community resources have and should mobilize. Specifically, health resources, conceived holistically, must diagnose pathological loneliness and prescribe treatment, through the use of identified social infrastructure. Problema: ¿Cuáles patrones actuales impulsan o disminuyen la soledad entre adultos mayores de Región de La Araucanía, Chile, en la cuidad de Temuco y comunas rurales de alrededor? Objetivo: Comprender e interpretar las raíces y los antídotos del fenómeno de la soledad que experimentan los adultos mayores en Temuco y comunas circundantes, en la actualidad. Identificar y analizar los impulsores de la soledad patológica de anciano en factores estructurales, intermedios, y próximos. Destacar las perspectivas y narrativas de adultos mayores, líderes comunitarias, y recursos de salud con respeto a estrategias para disminuir la crisis. Antecedentes: Actualmente, la población de adultos mayores ha aumentado y va a seguir aumentado en Chile a causa de la transición epidemiológica del país recién industrializado. La cepa en los recursos del estado y de municipalidades apoyar a una población envejeciendo es tremendo y serio. El problema de concepciones discriminatorias de la salud en la vejez, junto con la cepa en los recursos, ha limitado la acción de profesionales de salud. La ubicuidad y daño tremendo de la soledad que han sido descubiertos sacaran a la luz la necesidad prestar atención a la soledad como una patología poderosa, que se merece atención cuidadosa. Expertos discuten cada vez más el papel de los factores situacionales de la soledad, incluso la soledad interna. Este estudio pretende teorizar la soledad a través del diálogo emergente sobre la infraestructura social, dura y blanda, con el fin de situar las respuestas a la soledad de anciano. Consideraciones del sentido de la vida se utilizará entender la eficacia de infraestructura social actual y potencial. Metodología: Se realizó una investigación cualitativo en mayo de 2019, enfocada en adultos mayores viviendo en Temuco, la zona urbana de la región, y ciertos comunas rurales circundantes. Se cumplió 11 entrevistas con adultos mayores, individuales o en pares, con varios situaciones de vida, y perfiles socioeconómicos y culturales. Se llevó a cabo 3 grupos de sondeo, con un total de 30 personas. Finalmente, se realizó 4 entrevistas con profesionales y dirigentes locales que representan elementos de infraestructura social. Estas entrevistas se utilizó para analizar temáticamente los origines e las intervenciones en la soledad surgidas por los casos de estudio de adultos mayores. Resultados: La soledad interna de adultos mayores a dentro de la población identificada se provocó por la injerencia de la filosofía de la vida que sostiene la persona mayor. Se ve este patrón a dentro de relaciones entre adultos mayores y sus hijos, sus nietos, y, afuera del ámbito familiar, incluso en su atención médica. Por eso, este patrón se repitió a través de los tres niveles de influencia ambiental, estructural, intermedio, y próximo. Las intervenciones a través de infraestructura social, dura y blanda, son instrumentos particularmente prometedores para la intervención, como garantizar el acceso de ancianos a recursos recreativos, afectivos, e intelectuales que promuevan la realización de sus valores. Conclusiones: El empuje principal de los resultados es que en la región, hay que discutir la soledad de anciano como una amenaza para la salud pública, alrededor de la cual los recursos de salud y comunitarios tienen y deben movilizarse. Específicamente, recursos de la salud, definida de manera holística, tienen que diagnosticar la soledad patológica y prescribir tratamiento, a través del uso de infraestructura social identificada

Researching the Research: Applying Machine Learning Techniques to Dissertation Classification

This research examines industry-based dissertation research in a doctoral computing program through the lens of machine learning algorithms to determine if natural language processing-based categorization on abstracts alone is adequate for classification. This research categorizes dissertation by both their abstracts and by their full-text using the GraphLab Create library from Apple’s Turi to identify if abstract analysis is an adequate measure of content categorization, which we found was not. We also compare the dissertation categorizations using IBM’s Watson Discovery deep machine learning tool. Our research provides perspectives on the practicality of the manual classification of technical documents; and, it provides insights into the: (1) categories of academic work created by experienced fulltime working professionals in a Computing doctoral program, (2) viability and performance of automated categorization of the abstract analysis against the fulltext dissertation analysis, and (3) natual language processing versus human manual text classification abstraction

State of Utah v. Theodore Samuel Pacheco : Brief of Appellant

\u3cp\u3eCardiovascular disease is the most common cause of death in Western countries. Physician adherence to guidelines is often suboptimal, resulting in impaired patient outcome and prognosis. Multiple studies have been conducted to evaluate patterns and the influencing factors of patient adherence, but little is known about factors influencing physician guideline adherence. This review aims to identify factors influencing physician guideline adherence relevant to cardiology and to provide insights and suggestions for future improvement. Physician adherence was measured as adherence to standard local medical practice and applicable guidelines. Female gender and older age had a negative effect on physician guideline adherence. In addition, independent of the type of heart disease, physicians without cardiologic specialization were linked to physician noncompliance. Also, guideline adherence in primary care centers was at a lower level compared with secondary or tertiary care centers. The importance of guideline adherence increases as patients age, and complex diseases and comorbidity arise. Appropriate resources and interventions, taking important factors for nonadherence in account, are necessary to improve guideline adoption and adherence in every level of the chain. This in turn should improve patient outcome.\u3c/p\u3

Can Disease Management Target Patients Most Likely to Generate High Costs? The Impact of Comorbidity

CONTEXT: Disease management programs are increasingly used to manage costs of patients with chronic disease. OBJECTIVE: We sought to examine the clinical characteristics and measure the health care expenditures of patients most likely to be targeted by disease management programs. DESIGN: Retrospective analysis of prospectively obtained data. SETTING: A general medicine practice with both faculty and residents at an urban academic medical center. PARTICIPANTS: Five thousand eight hundred sixty-one patients enrolled in the practice for at least 1 year. MAIN OUTCOMES: Annual cost of diseases targeted by disease management. MEASUREMENTS: Patients’ clinical and demographic information were collected from a computer system used to manage patients. Data included diagnostic information, medications, and resource usage over 1 year. We looked at 10 common diseases targeted by disease management programs. RESULTS: Unadjusted annual median costs for chronic diseases ranged between $1,100 and$1,500. Congestive heart failure ($1,500), stroke ($1,500), diabetes ($1,500), and cancer ($1,400) were the most expensive. As comorbidity increased, annual adjusted costs increased exponentially. Those with comorbidity scores of 2 or more accounted for 26% of the population but 50% of the overall costs. CONCLUSIONS: Costs for individual chronic conditions vary within a relatively narrow range. However, the costs for patients with multiple coexisting medical conditions increase rapidly. Reducing health care costs will require focusing on patients with multiple comorbid diseases, not just single diseases. The overwhelming impact of comorbidity on costs raises significant concerns about the potential ability of disease management programs to limit the costs of care

A cluster randomized trial to improve adherence to evidence-based guidelines on diabetes and reduce clinical inertia in primary care physicians in Belgium: study protocol [NTR 1369]

Contains fulltext : 70617.pdf (publisher's version ) (Open Access)ABSTRACT: BACKGROUND: Most quality improvement programs in diabetes care incorporate aspects of clinician education, performance feedback, patient education, care management, and diabetes care teams to support primary care physicians. Few studies have applied all of these dimensions to address clinical inertia. AIM: To evaluate interventions to improve adherence to evidence-based guidelines for diabetes and reduce clinical inertia in primary care physicians. DESIGN: Two-arm cluster randomized controlled trial. PARTICIPANTS: Primary care physicians in Belgium. INTERVENTIONS: Primary care physicians will be randomly allocated to 'Usual' (UQIP) or 'Advanced' (AQIP) Quality Improvement Programs. Physicians in the UQIP will receive interventions addressing the main physician, patient, and office system factors that contribute to clinical inertia. Physicians in the AQIP will receive additional interventions that focus on sustainable behavior changes in patients and providers. OUTCOMES: Primary endpoints are the proportions of patients within targets for three clinical outcomes: 1) glycosylated hemoglobin < 7%; 2) systolic blood pressure differences </=130 mmHg; and 3) low density lipoprotein/cholesterol < 100 mg/dl. Secondary endpoints are individual improvements in 12 validated parameters: glycosylated hemoglobin, low and high density lipoprotein/cholesterol, total cholesterol, systolic blood pressure, diastolic blood pressure, weight, physical exercise, healthy diet, smoking status, and statin and anti-platelet therapy. PRIMARY AND SECONDARY ANALYSIS: Statistical analyses will be performed using an intent-to-treat approach with a multilevel model. Linear and generalized linear mixed models will be used to account for the clustered nature of the data, i.e., patients clustered withinimary care physicians, and repeated assessments clustered within patients. To compare patient characteristics at baseline and between the intervention arms, the generalized estimating equations (GEE) approach will be used, taking the clustered nature of the data within physicians into account. We will also use the GEE approach to test for differences in evolution of the primary and secondary endpoints for all patients, and for patients in the two interventions arms, accounting for within-patient clustering. TRIAL REGISTRATION: number: NTR 1369