Fécamp et l’architecture en Normandie

Cet article tente de replacer l’abbatiale de Fécamp dans le contexte général de l’architecture romane et gothique en Normandie et, lorsque c’est nécessaire, en Angleterre. Au préalable, il convient de faire un bref rappel de la séquence complexe de campagnes de construction et des indices permettant leur datation, sur lesquels les informations sont déjà bien établies. À tous les stades de son histoire, l’architecture présente un caractère conservateur marqué, allant parfois jusqu’à l’archaïsme délibéré, comme s’il y avait toujours eu une forte conscience du passé, que ce soit celui des ducs normands, de l’abbaye, ou encore celui de l’abbatiale elle-même. Néanmoins, les architectes et les maçons étaient souvent très éclectiques, de sorte que la construction joue un rôle très important dans l’introduction de nouvelles idées et de formes gothiques françaises dans le répertoire normand. L’abbatiale, et en particulier les structures construites entre 1168 et 1219, s’est avérée avoir un rôle très important à jouer dans le duché, non seulement dans son environnement immédiat, mais aussi, et ce d’une manière plus surprenante, en basse Normandie. Il est intéressant de noter qu’en 1160, dans la France capétienne, au moment où les grandes lignes de l’architecture gothique étaient dictées par les grandes cathédrales, ce rôle a été assumé en Normandie par Fécamp et Saint Étienne à Caen, toutes deux de vénérables abbayes bénédictines en lien étroit avec le palais ducal.In this paper I have tried to place the abbey church of Fecamp in the broad context of romanesque and gothic architecture in Normandy and, where relevant, England. As a necessary prelude to doing so, I briefly survey the complex sequence of building campaigns, and the evidence for their dating, most of which is already well-established. At all stages, the architecture has a distinctly conservative, even deliberately archaic quality, as if there is always a strong awareness of the past, the past of the Norman dukes, the past of the abbey, and the past of the abbey church itself. Nevertheless, the architects and masons were often very eclectic, so that the building plays a very important role in the introduction of new French gothic ideas and forms into the Norman repertoire. The abbey church, especially the fabric built between 1168 and 1219, proved very influential within the duchy, not only within the immediate area, but also, perhaps more surprisingly, in Lower Normandy. It is interesting to note that, while in Capetian France, after 1160, the direction of gothic architecture was set by the great cathedrals, in Normandy that role was taken by Fecamp and St Étienne at Caen, both venerable Benedictine abbeys with close links with the ducal house

Intersecting Challenges: Mothers and Child Protection Law in BC

This paper is concerned with how courts in British Columbia adjudicate applications by the state to remove children permanently from their parents, usually their mothers. Overwhelmingly, these cases are about single mothers who experience mental disability and addiction, domestic violence, and poverty. Indigenous women are over-represented in our sample. The intergenerational effects of the child protection system also are clear as many of the mothers in our study were themselves raised in state care. The paper highlights the degree to which judges blame women for the precarious circumstances in which they live, which are often a product of austerity measures adopted by states. Courts describe these circumstances as being a function of poor “lifestyle choices”, thus obscuring the role of the state in protecting women from violence, providing safe housing and supporting mothers and children with disabilities. Particularly troubling is the finding that courts are appear to be more willing to sever the relationship between mothers and their children where those children are themselves identified as having “special needs”. Judges are quick to assume that a child will be “better off” in state care even in the face of evidence that the child protection system in British Columbia has woefully failed both children and their mothers

Intersecting Challenges: Mothers and Child Protection Law in BC

This paper is concerned with how courts in British Columbia adjudicate applications by the state to remove children permanently from their parents, usually their mothers. Overwhelmingly, these cases are about single mothers who experience mental disability and addiction, domestic violence, and poverty. Indigenous women are over-represented in our sample. The intergenerational effects of the child protection system also are clear as many of the mothers in our study were themselves raised in state care. The paper highlights the degree to which judges blame women for the precarious circumstances in which they live, which are often a product of austerity measures adopted by states. Courts describe these circumstances as being a function of poor “lifestyle choices”, thus obscuring the role of the state in protecting women from violence, providing safe housing and supporting mothers and children with disabilities. Particularly troubling is the finding that courts are appear to be more willing to sever the relationship between mothers and their children where those children are themselves identified as having “special needs”. Judges are quick to assume that a child will be “better off” in state care even in the face of evidence that the child protection system in British Columbia has woefully failed both children and their mothers

Delays and loss to follow-up before treatment of drug-resistant tuberculosis following implementation of Xpert MTB/RIF in South Africa: A retrospective cohort study.

BACKGROUND: South Africa has a large burden of rifampicin-resistant tuberculosis (RR-TB), with 18,734 patients diagnosed in 2014. The number of diagnosed patients has increased substantially with the introduction of the Xpert MTB/RIF test, used for tuberculosis (TB) diagnosis for all patients with presumptive TB. Routine aggregate data suggest a large treatment gap (pre-treatment loss to follow-up) between the numbers of patients with laboratory-confirmed RR-TB and those reported to have started second-line treatment. We aimed to assess the impact of Xpert MTB/RIF implementation on the delay to treatment initiation and loss to follow-up before second-line treatment for RR-TB across South Africa. METHODS AND FINDINGS: A nationwide retrospective cohort study was conducted to assess second-line treatment initiation and treatment delay among laboratory-diagnosed RR-TB patients. Cohorts, including approximately 300 sequentially diagnosed RR-TB patients per South African province, were drawn from the years 2011 and 2013, i.e., before and after Xpert implementation. Patients with prior laboratory RR-TB diagnoses within 6 mo and currently treated patients were excluded. Treatment initiation was determined through data linkage with national and local treatment registers, medical record review, interviews with health care staff, and direct contact with patients or household members. Additional laboratory data were used to track cases. National estimates of the percentage of patients who initiated treatment and time to treatment were weighted to account for the sampling design. There were 2,508 and 2,528 eligible patients in the 2011 and 2013 cohorts, respectively; 92% were newly diagnosed with RR-TB (no prior RR-TB diagnoses). Nationally, among the 2,340 and 2,311 new RR-TB patients in the 2011 and 2013 cohorts, 55% (95% CI 53%-57%) and 63% (95% CI 61%-65%), respectively, started treatment within 6 mo of laboratory receipt of their diagnostic specimen (p < 0.001). However, in 2013, there was no difference in the percentage of patients who initiated treatment at 6 mo between the 1,368 new RR-TB patients diagnosed by Xpert (62%, 95% CI 59%-65%) and the 943 diagnosed by other methods (64%, 95% CI 61%-67%) (p = 0.39). The median time to treatment decreased from 44 d (interquartile range [IQR] 20-69) in 2011 to 22 d (IQR 2-43) in 2013 (p < 0.001). In 2013, across the nine provinces, there were substantial variations in both treatment initiation (range 51%-73% by 6 mo) and median time to treatment (range 15-36 d, n = 1,450), and only 53% of the 1,448 new RR-TB patients who received treatment were recorded in the national RR-TB register. This retrospective study is limited by the lack of information to assess reasons for non-initiation of treatment, particularly pre-treatment mortality data. Other limitations include the use of names and dates of birth to locate patient-level data, potentially resulting in missed treatment initiation among some patients. CONCLUSIONS: In 2013, there was a large treatment gap for RR-TB in South Africa that varied significantly across provinces. Xpert implementation, while reducing treatment delay, had not contributed substantially to reducing the treatment gap in 2013. However, given improved case detection with Xpert, a larger proportion of RR-TB patients overall have received treatment, with reduced delays. Nonetheless, strategies to further improve linkage to treatment for all diagnosed RR-TB patients are urgently required

Real-World Assessment as an Integral Component of an Undergraduate Science Communication Program

This paper discusses Australia’s oldest and largest undergraduate science communication program: that offered at the Centre for the Public Awareness of Science at the Australian National University. We outline the history of the program, and explain the pedagogy that drove its development. In particular, we address the assessment of student learning, which focuses on ‘real-world’ tasks. The four main assessment approaches discussed are 1) online blogs and opinion pieces; 2) a student conference, 3) research publication, and 4) work-integrated learning. These assessment approaches specifically target skills required by graduates to achieve both within the university and professionally. The different approaches require students to employ diverse communication techniques and strategies appropriate to their chosen audience. Students also gain practical experience outside of the university context, allowing them to recognise the relevance of their studies within an industry, private or government environment. Although these assessment practices are embedded in a specific science communication curriculum, we suggest that they can be incorporated within any science discipline major

"We had to manage what we had on hand, in whatever way we could": Adaptive responses in policy for decentralised drug-resistant tuberculosis care in South Africa

Karina Kielmann - ORCID: 0000-0001-5519-1658 https://orcid.org/0000-0001-5519-1658Replaced AM with VoR 2021-02-19.In 2011, the South African National TB Programme launched a policy of decentralized management of drug-resistant tuberculosis (DR-TB) in order to expand the capacity of facilities to treat patients with DR-TB, minimize delays to access care and improve patient outcomes. This policy directive was implemented to varying degrees within a rapidly evolving diagnostic and treatment landscape for DR-TB, placing new demands on already-stressed health systems. The variable readiness of district-level systems to implement the policy prompted questions not only about differences in health systems resources but also front-line actors’ capacity to implement change in resource-constrained facilities. Using a grounded theory approach, we analysed data from indepth interviews and small group discussions conducted between 2016 and 2018 with managers (n = 9), co-ordinators (n = 15), doctors (n = 7) and nurses (n = 18) providing DR-TB care. Data were collected over two phases in district-level decentralized sites of three South African provinces. While health systems readiness assessments conventionally map the availability of ‘hardware’, i.e. resources and skills to deliver an intervention, a notable absence of systems ‘hardware’ meant that systems ‘software’, i.e. health care workers (HCWs) agency, behaviours and interactions provided the basis of locally relevant strategies for decentralized DR-TB care. ‘Software readiness’ was manifest in four areas of DR-TB care: re-organization of service delivery, redressal of resource shortages, creation of treatment adherence support systems and extension of care parameters for vulnerable patients. These strategies demonstrate adaptive capacity and everyday resilience among HCW to withstand the demands of policy change and innovation in stressed systems. Our work suggests that a useful extension of health systems ‘readiness’ assessments would include definition and evaluation of HCW ‘software’ and adaptive capacities in the face of systems hardware gaps.The work presented in this paper was supported by the Joint Health Systems Research Initiative, jointly supported by the Department for International Development (DFID), the Economic and Social Research Council (ESRC), the Medical Research Council (MRC) and the Wellcome Trust (Grant# MR/N015924/1). This UK funded award is part of the EDCTP2 programme supported by the European Union. Ethical approval for the project was obtained through the University of Cape Town Human Research Ethics Committee (HREC REF 350/2016). HC is supported by a Wellcome Trust Fellowship. The authors wish to thank and acknowledge Dr. Norbert Ndjeka (SA NDOH), the provinces of the W Cape, E Cape, KZN for all their input and assistance.https://doi.org/10.1093/heapol/czaa14736pubpub

The role of emergent champions in policy implementation for decentralised drug-resistant tuberculosis care in South Africa

From BMJ via Jisc Publications RouterHistory: received 2022-02-24, accepted 2022-11-07, ppub 2022-12, epub 2022-12-09Peer reviewed: TrueAcknowledgements: This paper draws on data from a 4-year project that aimed to gain an understanding of the policy context, patient care pathways and models of decentralisation of DR-TB care in three South African provinces. The authors would like to thank and acknowledge Dr Norbert Ndjeka (SA NDOH), key informants, staff and participants interviewed and the provinces of the Western Cape, Eastern Cape, KwaZulu-Natal for all their time, critical insights and assistance.Publication status: PublishedFunder: Medical Research Council; FundRef: http://dx.doi.org/10.13039/501100000265; Grant(s): MR/N015924/1Karina Kielmann - ORCID: 0000-0001-5519-1658 https://orcid.org/0000-0001-5519-1658Objective: Champions are recognised as important to driving organisational change in healthcare quality improvement initiatives in high-income settings. In low-income and middle-income countries with a high disease burden and constrained human resources, their role is highly relevant yet understudied. Within a broader study on policy implementation for decentralised drug-resistant tuberculosis care in South Africa, we characterised the role, strategies and organisational context of emergent policy champions. Design: Interviews with 34 healthcare workers in three South African provinces identified the presence of individuals who had a strong influence on driving policy implementation forward. Additional interviews were conducted with 13 participants who were either identified as champions in phase II or were healthcare workers in facilities in which the champions operated. Thematic analyses using a socio-ecological framework further explored their strategies and the factors enabling or obstructing their agency. Results: All champions occupied senior managerial posts and were accorded legitimacy and authority by their communities. ‘Disease-centred’ champions had a high level of clinical expertise and placed emphasis on clinical governance and clinical outcomes, while ‘patient-centred’ champions promoted pathways of care that would optimise patients’ recovery while minimising disruption in other spheres of their lives. Both types of champions displayed high levels of resourcefulness and flexibility to adapt strategies to the resource-constrained organisational context. Conclusion: Policymakers can learn from champions’ experiences regarding barriers and enablers to implementation to adapt policy. Research is needed to understand what factors can promote the sustainability of champion-led policy implementation, and to explore best management practices to support their initiatives.pubpu

The role of emergent champions in policy implementation for decentralised drug-resistant tuberculosis care in South Africa.

OBJECTIVE: Champions are recognised as important to driving organisational change in healthcare quality improvement initiatives in high-income settings. In low-income and middle-income countries with a high disease burden and constrained human resources, their role is highly relevant yet understudied. Within a broader study on policy implementation for decentralised drug-resistant tuberculosis care in South Africa, we characterised the role, strategies and organisational context of emergent policy champions. DESIGN: Interviews with 34 healthcare workers in three South African provinces identified the presence of individuals who had a strong influence on driving policy implementation forward. Additional interviews were conducted with 13 participants who were either identified as champions in phase II or were healthcare workers in facilities in which the champions operated. Thematic analyses using a socio-ecological framework further explored their strategies and the factors enabling or obstructing their agency. RESULTS: All champions occupied senior managerial posts and were accorded legitimacy and authority by their communities. 'Disease-centred' champions had a high level of clinical expertise and placed emphasis on clinical governance and clinical outcomes, while 'patient-centred' champions promoted pathways of care that would optimise patients' recovery while minimising disruption in other spheres of their lives. Both types of champions displayed high levels of resourcefulness and flexibility to adapt strategies to the resource-constrained organisational context. CONCLUSION: Policymakers can learn from champions' experiences regarding barriers and enablers to implementation to adapt policy. Research is needed to understand what factors can promote the sustainability of champion-led policy implementation, and to explore best management practices to support their initiatives