Infinitive avoidance and splendid isolation: Rousseau and the use of conflicts in education

The impact of Jean-Jacques Rousseau’s educational philosophy can hardly be overestimated. In this article, I re-examine Rousseau’s key text Emile, or On Education and discuss his concept of conflict and the use of conflicts in his imaginary educational philosophy. A detailed analysis suggests that Rousseau was not only an extreme avoider of conflict, by putting Emile in multiple forms of isolation, but that he also postponed any form of social conflict and carefully controlled, directed and manipulated Emile’s personal and social experiences. To realise a new way of upbringing following the ‘natural’ development of the child, I contend that Rousseau excelled in an obsessively controlled and manipulative pedagogy. Liberation from social norms and traditions – by following the unfolding ‘natural development’, which was Rousseau’s overall project – turned into an individual dictate ruled by an omnipresent educational governor: Rousseau. I conclude that Rousseau’s philosophy of education was deliberately anti-social and might well be a fundamental barrier to regaining conflicts in education

Herijking EHS Noord-Holland : een toets vanuit het perspectief van ruimtelijke samenhang

De realisatie van de Ecologische Hoofdstructuur in de Provincie Noord-Holland ligt achter op schema. Hierom hebben Gedeputeerde Staten van Noord-Holland besloten te onderzoeken of via een herbegrenzing een groter deel van de EHS nog is te realiseren. De gebieden die in aanmerking komen voor herbegrenzing zijn beoordeeld op de ruimtelijke samenhang van het gebied zelf én de mate waarin het gebied bijdraagt aan de omgeving. Op basis van de analyses mag geconcludeerd worden dat de beoogde herbegrenzing in Noord-Holland goed is voor de ruimtelijke samenhang van de provinciale EHS. Tevens zijn er twee quick-scan analyses uitgevoerd die een positief beeld laten zien van de herbegrenzingen op het niveau van Natuurdoelen en in relatie tot Natura2000-gebieden

Association between statins and infections among patients with diabetes:a cohort and prescription sequence symmetry analysis

PURPOSE: A previous meta-analysis of randomized trials did not confirm findings from observational studies that suggested that statins reduce the risk of infection. However, animal experiments indicate that statins may be more effective in reducing the risk and/or the severity of infection among patients with diabetes. Hence, we evaluated the effect of statins on antibiotic prescriptions (a proxy for infections) among patients with drug-treated type 2 diabetes using two confounding-reducing observational designs. METHODS: We conducted a prescription sequence symmetry analysis and a cohort study using the IADB.nl pharmacy prescription database. For the prescription sequence symmetry analysis, a sequence ratio was calculated. The matched cohort study, comparing the time to first antibiotic prescription between periods that statins are initiated and non-use periods, was analyzed using stratified Cox regression. RESULTS: Prescription sequence symmetry analysis of 4684 patients with drug-treated type 2 diabetes resulted in an adjusted sequence ratio of 0.86 (95% confidence interval [CI]: 0.81 to 0.91). Corresponding figures for the cohort analysis comparing 9852 statin-initiation with 4928 non-use periods showed similar results (adjusted hazard ratio: 0.88, 95%CI: 0.83 to 0.95). CONCLUSIONS: These findings suggest that statins are associated with a reduced risk of infections among patients with drug-treated type 2 diabetes. © 2016 The Authors. Pharmacoepidemiology and Drug Safety Published by John Wiley & Sons Ltd. © 2016 The Authors. Pharmacoepidemiology and Drug Safety Published by John Wiley & Sons Ltd

Severe Hypertriglyceridaemia as a result of Familial Chylomicronaemia:

Lipoprotein lipase deficiency causes severe hypertriglyceridaemia due to chylomicronaemia, and leads to recurrent and potentially life-threatening pancreatitis. This disorder can only be managed by dietary fat restriction as drugs are ineffective. We review the experience with familial chylomicronaemia in patients who attended the lipid clinics at Groote Schuur Hospital and Red Cross Children's War Memorial Hospital in Cape Town. Criteria for inclusion were an initial plasma triglyceride concentration of >15 mmol/l and a typical type I Fredrickson hyperlipidaemia pattern on plasma lipoprotein electrophoresis. A total of 29 patients were seen over 25 years. The mean age of presentation was 10 years, but ranged from 0 to 43 years. The modes of presentation differed: pancreatitis (N=16), eruptive xanthomata (N=2), coincidental detection of hypertriglyceridaemia (N=2), screening relatives (N=7), and after death from pancreatitis (N=1). Plasma triglycerides responded rapidly and dramatically to dietary fat restriction, and some patients sustained good control of the hyperlipidaemia. The onset of pancreatitis was earlier in patients of Indian ancestry, suggesting a genotype/phenotype interaction within this disorder. Genetic work-up indicated founder effects in the Afrikaner and Indian patients. Lipaemic plasma should be taken seriously at all ages, and necessitates work-up at specialised clinics where the diagnosis of chylomicronaemia or type I hyperlipidaemia facilitates appropriate dietary management that can prevent pancreatitis. South African Medical Journal Vol. 98 (2) 2008: pp. 105-10

Intensive care unit (ICU)-acquired bacteraemia and ICU mortality and discharge:Addressing time-varying confounding using appropriate methodology

Background: Studies often ignore time-varying confounding or may use inappropriate methodology to adjust for time-varying confounding. Aim: To estimate the effect of intensive care unit (ICU)-acquired bacteraemia on ICU mortality and discharge using appropriate methodology. Methods: Marginal structural models with inverse probability weighting were used to estimate the ICU mortality and discharge associated with ICU-acquired bacteraemia among patients who stayed more than two days at the general ICU of a London teaching hospital and remained bacteraemia-free during those first two days. For comparison, the same associations were evaluated with (i) a conventional Cox model, adjusting only for baseline confounders and (ii) a Cox model adjusting for baseline and time-varying confounders. Findings: Using the marginal structural model with inverse probability weighting, bacteraemia was associated with an increase in ICU mortality (cause-specific hazard ratio (CSHR): 1.29; 95% confidence interval (CI): 1.02-1.63)and a decrease in discharge (CSHR: 0.52; 95% CI: 0.45-0.60). By 60 days, among patients still in the ICU after two days and without prior bacteraemia, 8.0% of ICU deaths could be prevented by preventing all ICU-acquired bacteraemia cases. The conventional Cox model adjusting for time-varying confounders gave substantially different results [for ICU mortality, CSHR: 1.08 (95% CI: 0.88-1.32); for discharge, CSHR: 0.68 (95% CI: 0.60-0.77)]. Conclusion: In this study, even after adjusting for the timing of acquiring bacteraemia and time-varying confounding using inverse probability weighting for marginal structura

Severe hypertriglyceridaemia as a result of familial chylomicronaemia:The Cape Town experience

Lipoprotein lipase deficiency causes severe hypertriglyceridaemia due to chylomicronaemia, and leads to recurrent and potentially life-threatening pancreatitis. This disorder can only be managed by dietary fat restriction as drugs are ineffective. We review the experience with familial chylomicronaemia in patients who attended the lipid clinics at Groote Schuur Hospital and Red Cross Children's War Memorial Hospital in Cape Town. Criteria for inclusion were an initial plasma triglyceride concentration of >15 mmol/l and a typical type I Fredrickson hyperlipidaemia pattern on plasma lipoprotein electrophoresis. A total of 29 patients were seen over 25 years. The mean age of presentation was 10 years, but ranged from 0 to 43 years. The modes of presentation differed: pancreatitis (N=16), eruptive xanthomata (N=2), coincidental detection of hypertriglyceridaemia (N=2), screening relatives (N=7), and after death from pancreatitis (N=1). Plasma triglycerides responded rapidly and dramatically to dietary fat restriction, and some patients sustained good control of the hyperlipidaemia. The onset of pancreatitis was earlier in patients of Indian ancestry, suggesting a genotype/phenotype interaction within this disorder. Genetic work-up indicated founder effects in the Afrikaner and Indian patients. Lipaemic plasma should be taken seriously at all ages, and necessitates work-up at specialised clinics where the diagnosis of chylomicronaemia or type I hyperlipidaemia facilitates appropriate dietary management that can prevent pancreatitis

Assessment of Physical Fitness After Bariatric Surgery and Its Association with Protein Intake and Type of Cholecalciferol Supplementation

Background: Several studies showed that there is a relationship between vitamin and mineral status and muscle strength. In particular this is the case for handgrip strength (HS) and vitamin D deficiency. In bariatric surgery there is a risk of decrease in muscle strength after surgery and also vitamin and mineral deficiencies are not uncommon. The aim of this study is to assess the effect of low vitamin 25 (OH) cholecalciferol levels, high dose cholecalciferol supplementation regime and protein intake on physical fitness, measured using handgrip strength (HS) and the shuttle walk run test (SWRT). Methods: For this retrospective study, 100 patients who have had bariatric surgery were included. Group A (n = 50) used 800 IU oral cholecalciferol per day. Group B (n = 50) used 800 IU oral cholecalciferol daily and 50,000 IU liquid cholecalciferol monthly lifelong. Both groups were matched on common variables. To measure physical fitness, we used the HS manometer of Jamar and the Shuttle Walk Run Test (SWRT) to assess physical capacity. Results: No significant differences in HS and SWRT outcomes were found between patients with serum 25 (OH) cholecalciferol \u3c 75 nmol/L or \u3e75 nmol/L. The postoperative HS is significantly influenced by protein intake (p = 0.017) and no significant influence was seen in outcomes of the SWRT (p = 0.447). Conclusion: We have found that serum 25 (OH) cholecalciferol and different cholecalciferol supplementation regimes do not have a significant effect on HS and SWRT before, three and 6 months after surgery. It seems that protein intake plays a more important role in maintaining adequate muscle strength