Curriculum Making as the Enactment of Dwelling in Places

This article uses an account of dwelling to interrogate the concept of curriculum making. Tim Ingold's use of dwelling to understand culture is productive here because of his implicit and explicit interest in intergenerational learning. His account of dwelling rests on a foundational ontological claim-that mental construction and representation are not the basis upon which we live in the world-which is very challenging for the kinds of curriculum making with which many educators are now familiar. It undermines assumptions of propositional knowledge and of the use of mental schemas to communicate and share. At the level of critique, then, dwelling destabilizes contemporary ideas of curriculum as textual, pre-specified content for transmission or pre-defined objectives or standardized activity. The positive claims of dwelling are equally challenging, for these are that the world is a domain of relational entanglement in which an organism can be no more than a point of growth for an emergent ‘environment', and meaning only inheres in these relations. The paper articulates how differentiation (of learner, salient meanings, knowledge, skill and place) are possible in such an ontology, and how curriculum making can be understood from this perspective as being the remaking of relationships between these

Measurements of dense fuel hydrodynamics in the NIF burning plasma experiments using backscattered neutron spectroscopy

The hydrodynamics of the dense confining fuel shell is of great importance in defining the behaviour of the burning plasma and burn propagation regimes of inertial confinement fusion experiments. However, it is difficult to probe due to its low emissivity in comparison to the central fusion core. In this work, we utilise the backscattered neutron spectroscopy technique to directly measure the hydrodynamic conditions of the dense fuel during fusion burn. Experimental data is fit to obtain dense fuel velocities and apparent ion temperatures. Trends of these inferred parameters with yield and velocity of the burning plasma are used to investigate their dependence on alpha heating and low mode drive asymmetry. It is shown that the dense fuel layer has an increased outward radial velocity as yield increases showing burn has continued into re-expansion, a key signature of hotspot ignition. Comparison with analytic and simulation models show that the observed dense fuel parameters are displaying signatures of burn propagation into the dense fuel layer, including a rapid increase in dense fuel apparent ion temperature with neutron yield

On the Dynamics of the Evolution of the HIV Infection

We use a cellular automata model to study the evolution of HIV infection and the onset of AIDS. The model takes into account the global features of the immune response to any pathogen, the fast mutation rate of the HIV and a fair amount of spatial localization. Our results reproduce quite well the three-phase pattern observed in T cell and virus counts of infected patients, namely, the primary response, the clinical latency period and the onset of AIDS. We have also found that the infected cells may organize themselves into special spatial structures since the primary infection, leading to a decrease on the concentration of uninfected cells. Our results suggest that these cell aggregations, which can be associated to syncytia, leads to AIDS.Comment: 4 pages, 3 postscript figure

Involvement of patients or their representatives in quality management functions in EU hospitals:implementation and impact on patient-centred care strategies

OBJECTIVE: The objective of this study was to describe the involvement of patients or their representatives in quality management (QM) functions and to assess associations between levels of involvement and the implementation of patient-centred care strategies. DESIGN: A cross-sectional, multilevel STUDY DESIGN: that surveyed quality managers and department heads and data from an organizational audit. SETTING: Randomly selected hospitals (n = 74) from seven European countries (The Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey). PARTICIPANTS: Hospital quality managers (n = 74) and heads of clinical departments (n = 262) in charge of four patient pathways (acute myocardial infarction, stroke, hip fracture and deliveries) participated in the data collection between May 2011 and February 2012. MAIN OUTCOME MEASURES: Four items reflecting essential patient-centred care strategies based on an on-site hospital visit: (1) formal survey seeking views of patients and carers, (2) written policies on patients' rights, (3) patient information literature including guidelines and (4) fact sheets for post-discharge care. The main predictors were patient involvement in QM at the (i) hospital level and (ii) pathway level. RESULTS: Current levels of involving patients and their representatives in QM functions in European hospitals are low at hospital level (mean score 1.6 on a scale of 0 to 5, SD 0.7), but even lower at departmental level (mean 0.6, SD 0.7). We did not detect associations between levels of involving patients and their representatives in QM functions and the implementation of patient-centred care strategies; however, the smallest hospitals were more likely to have implemented patient-centred care strategies. CONCLUSIONS: There is insufficient evidence that involving patients and their representatives in QM leads to establishing or implementing strategies and procedures that facilitate patient-centred care; however, lack of evidence should not be interpreted as evidence of no effect

Large-cell neuroendocrine carcinoma of the cervix

Large cell neuroendocrine carcinoma (LCNEC) of the uterine cervix is a rare and aggressive malignancy with poor prognosis even in its early stage, despite multimodality treatment strategy. Here, we report a case of a woman with clinical polypoid stage IB LCNEC of the cervix, which was detected in her 6-week postpartum checkup. A literature review was also conducted to evaluate current therapeutic approaches and potential new strategies

Localisation of an occult thyrotropinoma with 11^{11}C-methionine PET-CT before and after somatostatin analogue therapy

A 75-year-old woman presented to her local endocrine service with tiredness, palpitations, and enlargement of a longstanding goitre. Unexpectedly, her thyrotropin (thyroid-stimulating hormone [TSH]) concentration was not suppressed (6·3 mU/L; reference range 0·35–5·5) despite raised concentrations of thyroid hormones (free thyroxine [T$_{4}$] 89·1 pmol/L [reference range 10–19·8]; free triiodothyronine [T$_{3}$] 11·7 pmol/L [3·0–6·5]). After exclusion of laboratory assay interference, a thyrotropin-releasing hormone test showed an attenuated response (TSH at 0 min was 6·1 mU/L, at 20 min was 6·8 mU/L, and at 60 min was 8·5 mU/L), raising suspicion of a thyrotropinoma (also known as TSHoma). However, pituitary MRI was normal. The patient was referred to our centre for further assessment. On repeat MRI, the pituitary gland showed mild asymmetry (right larger than left; figure A). Functional imaging with 11C-methionine ($^{11}$C-Met) PET-CT revealed intense tracer uptake (denoting active peptide synthesis) on the right side of the sella (red hot spot in figure A). Treatment with a depot somatostatin analogue (SSA) led to resolution of symptoms and normalisation of thyroid function (TSH 0·6 mU/L, free T$_{4}$ 12·5 pmol/L, and free T$_{3}$ 3·8 pmol/L). Repeat $^{11}$C-Met PET-CT showed absence of the right-sided focal hot spot (figure B). 14 months into treatment, the patient had several hypoglycaemic episodes, which resolved after discontinuation of SSA. However, thyrotoxicosis recurred (TSH 4·3 mU/L, free T$_{4}$ 38·1 pmol/L, free T$_{3}$ 11·6 pmol/L), and repeat $^{11}$C-Met PET-CT revealed the reappearance of the right-sided hot spot (figure C). During pituitary surgery, a microthyrotropinoma was resected from the right side of the gland (figure D). The patient remains in clinical and biochemical remission more than 12 months after surgery and has normal pituitary function

Development and validation of an index to assess hospital quality management systems

The study, "Deepening our Understanding of Quality Improvement in Europe (DUQuE)" has received funding from the European Community's Seventh Framework Programme (FP7/2007-2013) under grant agreement n° 241822. Funding to pay the Open Access publication charges for this article was provided by European Community's Seventh Framework Programme (FP7/2007-2013) under grant agreement no. 241822.Objective: The aim of this study was to develop and validate an index to assess the implementation of quality management systems (QMSs) in European countries. Design: Questionnaire development was facilitated through expert opinion, literature review and earlier empirical research. A cross-sectional online survey utilizing the questionnaire was undertaken between May 2011 and February 2012. We used psychometric methods to explore the factor structure, reliability and validity of the instrument. Setting and participants. As part of the Deepening our Understanding of Quality improvement in Europe (DUQuE) project, we invited a random sample of 188 hospitals in 7 countries. The quality managers of these hospitals were the main respondents. Main Outcome Measure. The extent of implementation of QMSs. Results: Factor analysis yielded nine scales, which were combined to build the Quality Management Systems Index. Cronbach's reliability coefficients were satisfactory (ranging from 0.72 to 0.82) for eight scales and low for one scale (0.48). Corrected item-total correlations provided adequate evidence of factor homogeneity. Inter-scale correlations showed that every factor was related, but also distinct, and added to the index. Construct validity testing showed that the index was related to recent measures of quality. Participating hospitals attained a mean value of 19.7 (standard deviation of 4.7) on the index that theoretically ranged from 0 to 27. Conclusion: Assessing QMSs across Europe has the potential to help policy-makers and other stakeholders to compare hospitals and focus on the most important areas for improvement