The Narrative Turn in the French Novel of the 1970s

The most important French literary movement of the 1950s and 1960s, the nouveau roman, radically questioned the idea of the novel as storytelling, claiming that narratives create a false illusion of the world’s intelligibility. However, in the 1970s storytelling finds its way back into the French novel – a shift that has been characterized as the “return of the narrative”. In my article, I argue that the “narrative turn” in the French novel of the 1970s can be seen as a turn towards a fundamentally hermeneutic view of the narrative mediatedness of our relation to the world. From a hermeneutic perspective, the nouveaux romanciers – insofar as they reject the narrative in order to disclose the discontinuous, fragmentary and chaotic nature of reality – hang onto the positivistic idea that “real” is only that which is independent of human meaning-giving processes. By contrast, the hermeneutists, such as Paul Ricoeur, consider also the human experience of the world to be real, and largely narrative in form. This view is shared by the principal novelists associated with the narrative turn, such as Michel Tournier to whom man is a “mythological animal”. However, after the nouveau roman , narratives have lost their innocence: they no longer appear as “natural” but are conscious of their own narrativity, historicity, and the way they represent only one possible – inevitably ethically and politically charged – perspective into reality. By making storytelling thematic and by telling “counter-stories” that question prevailing models of sense-making, Tournier and other “new storytellers” strive to promote critical reflection on the stories on the basis of which we orient to the world and narrate our lives – both as individuals and as communities

Exploring the Possible: Philosophical Reflection, Historical Imagination, and Narrative Agency (Invited)

This article suggests that narrative studies would benefit from (hermeneutically informed) philosophical reflection on the basic assumptions underlying different conceptions of narrative, a sense of history in conceptualizing narrative and experience, and nuanced reflection on the significance of narrative for agency and our sense of the possible. It argues for conceptualizing narrative as an interpretative, dialogical, and performative activity of cultural sense-making that is integral to how we understand our past, present, and future possibilities. It proposes three ways in which acknowledging the historicity of experience allows us to explore how narratives shape historical imagination. Arguing for approaching literary narratives as explorations of human possibilities, the article ends by showing, through an analysis of Michel Houellebecq’s Submission (2015), how narrative fiction can contribute to our sense of the possible and to our understanding of narrative agency

Chapter 7 From Appropriation to Dialogic Exploration

In recent years there has been a huge amount of both popular and academic interest in storytelling as something that is an essential part of not only literature and art but also our everyday lives as well as our dreams, fantasies, aspirations, historical self-understanding, and political actions. The question of the ethics of storytelling always, inevitably, lurks behind these discussions, though most frequently it remains implicit rather than explicit. This volume explores the ethical potential and risks of storytelling from an interdisciplinary perspective. It stages a dialogue between contemporary literature and visual arts across media (film, photography, performative arts), interdisciplinary theoretical perspectives (debates in narrative studies, trauma studies, cultural memory studies, ethical criticism), and history (traumatic histories of violence, cultural history). The collection analyses ethical issues involved in different strategies employed in literature and art to narrate experiences that resist telling and imagining, such as traumatic historical events, including war and political conflicts. The chapters explore the multiple ways in which the ethics of storytelling relates to the contemporary arts as they work with, draw on, and contribute to historical imagination. The book foregrounds the connection between remembering and imagining and explores the ambiguous role of narrative in the configuration of selves, communities, and the relation to the non-human. While discussing the ethical aspects of storytelling, it also reflects on the relevance of artistic storytelling practices for our understanding of ethics. Making an original contribution to interdisciplinary narrative studies and narrative ethics, this book both articulates a complex understanding of how artistic storytelling practices enable critical distance from culturally dominant narrative practices, and analyzes the limitations and potential pitfalls of storytelling

Macroporous Scaffolds for Bone Engineering. Studies on Cell Culture and Ectopic Bone Formation

Bone engineering is a rapidly developing area of reconstructive medicine where bone inducing factors and/or cells are combined with a scaffold material to regenerate the structure and function of the original tissue. The aim of this study was to compare the suitability of different macroporous scaffold types for bone engineering applications. The two scaffold categories studied were a) the mechanically strong and stable titanium fiber meshes and b) the elastic and biodegradable porous polymers. Furthermore, bioactive modifications were applied to these basic scaffold types, and their effect on the osteogenic responses was evaluated in cell culture and ectopic bone formation studies. The osteogenic phenotype of cultured cell-scaffold constructs was heightened with a sol-gel derived titania coating, but not with a mixed titania-silica coating. The latter coating also resulted in delayed ectopic bone formation in bone marrow stromal cell seeded scaffolds. However, the better bone contact in early implantation times and more even bone tissue distribution at later times indicated enhanced osteoconductivity of both the coated scaffold types. Overall, the most promising bone engineering results were obtained with titania coated fiber meshes. Elastic and biodegradable poly(ε-caprolactone/D,L-lactide) based scaffolds were also developed in this study. The degradation rates of the scaffolds in vitro were governed by the hydrophilicity of the polymer matrix, and the porous architecture was controlled by the amount and type of porogen used. A continuous phase macroporosity was obtained using a novel CaCl2 • 6H2O porogen. Dynamic culture conditions increased cell invasion, but decreased cell numbers and osteogenicity, within the scaffolds. Osteogenic differentiation in static cultures and ectopic bone formation in cell seeded scaffolds were enhanced in composites, with 30 wt-% of bioactive glass filler.Siirretty Doriast

Chapter 7 From Appropriation to Dialogic Exploration

In recent years there has been a huge amount of both popular and academic interest in storytelling as something that is an essential part of not only literature and art but also our everyday lives as well as our dreams, fantasies, aspirations, historical self-understanding, and political actions. The question of the ethics of storytelling always, inevitably, lurks behind these discussions, though most frequently it remains implicit rather than explicit. This volume explores the ethical potential and risks of storytelling from an interdisciplinary perspective. It stages a dialogue between contemporary literature and visual arts across media (film, photography, performative arts), interdisciplinary theoretical perspectives (debates in narrative studies, trauma studies, cultural memory studies, ethical criticism), and history (traumatic histories of violence, cultural history). The collection analyses ethical issues involved in different strategies employed in literature and art to narrate experiences that resist telling and imagining, such as traumatic historical events, including war and political conflicts. The chapters explore the multiple ways in which the ethics of storytelling relates to the contemporary arts as they work with, draw on, and contribute to historical imagination. The book foregrounds the connection between remembering and imagining and explores the ambiguous role of narrative in the configuration of selves, communities, and the relation to the non-human. While discussing the ethical aspects of storytelling, it also reflects on the relevance of artistic storytelling practices for our understanding of ethics. Making an original contribution to interdisciplinary narrative studies and narrative ethics, this book both articulates a complex understanding of how artistic storytelling practices enable critical distance from culturally dominant narrative practices, and analyzes the limitations and potential pitfalls of storytelling

Oncological Safety of Skin-Sparing Mastectomy and Immediate Breast Reconstruction in Extensive Ductal Carcinoma In Situ

Introduction: Skin-sparing mastectomy (SSM) with immediate breast reconstruction is the ideal treatment for interested and suitable patients with extensive ductal carcinoma in situ (DCIS). There is no guideline to indicate on how large DCIS the procedure can be performed safely. The primary target of this study was to define the oncological safety of SSM in extensive pure DCIS. The secondary target was to find predictive factors for DCIS upstaging to invasive disease.Materials and methods: A total of 71 consecutive patients with extensive pure DCIS and undergoing SSM with immediate latissimus dorsi (LD) breast reconstruction were retrospectively evaluated. Results: The median size of DCIS lesion in preoperative imaging was 60 mm, the median weight of mastectomy specimen was 350 g, and the median resection margin (RM) was 2.0 mm. A total of 20 patients (28%) had an RM less than 0.5 mm and nine patients (13%) had ink positive margins. Six patients having positive RM underwent reoperation. A total of 29 patients (41%) presented invasive cancer foci in final histopathological assessment and nine patients (13%) had an axillary metastasis. Adjuvant therapy was given to 23 patients presenting invasive cancer. There were no local recurrences or distant metastases (0%, 95% confidence interval 0-0.051) during the mean follow-up of 71 mo. None of the factors evaluated predicted upstaging to invasive disease.Conclusions: SSM with immediate breast reconstruction in patients with extensive DCIS is oncologically safe even when the margins are close or positive. Additional invasive foci and solitary axillary lymph node metastases are frequent but do not worsen the outcome. (c) 2022 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).Peer reviewe

Same-day mastectomy and axillary lymph node dissection is safe for most patients with breast cancer

Background and Objective The aim of this study was to evaluate the safety of same-day mastectomy, with or without a sentinel node biopsy (SNB) and/or axillary lymph node dissection (ALND). Methods In this retrospective study, we reviewed 913 consecutive women who underwent a simple mastectomy for breast cancer between the years 2014 and 2019 and were treated either with same-day surgery (SDS) or an overnight stay (OS) regime. We reviewed all surgical complications, any unplanned return to care (RTC) and the rehospitalization rate for 30 postoperative days. Results A total of 259 patients (28%) were treated with SDS and 654 patients (72%) with an OS regime. There was no difference in RTC (odds ratio: 0.79 [95% confidence interval: 0.53-1.18], p = 0.26) or any major complications between the groups. None of the investigated subgroups, such as patients with previous neoadjuvant therapy, diabetes, obesity (up to a body mass index of 40 kg/m(2)), the American Society of Anaesthesiologist Class of 3, or elderly patients aged 75-84 years, showed an increased complication rate when treated with the SDS regime. Conclusion A same-day simple mastectomy is safe with SNB and/or ALND. It can be performed safely for most patients with stable co-morbidities.Peer reviewe

Health sector spending and spending on HIV/AIDS, tuberculosis, and malaria, and development assistance for health : progress towards Sustainable Development Goal 3

Background Sustainable Development Goal (SDG) 3 aims to "ensure healthy lives and promote well-being for all at all ages". While a substantial effort has been made to quantify progress towards SDG3, less research has focused on tracking spending towards this goal. We used spending estimates to measure progress in financing the priority areas of SDG3, examine the association between outcomes and financing, and identify where resource gains are most needed to achieve the SDG3 indicators for which data are available. Methods We estimated domestic health spending, disaggregated by source (government, out-of-pocket, and prepaid private) from 1995 to 2017 for 195 countries and territories. For disease-specific health spending, we estimated spending for HIV/AIDS and tuberculosis for 135 low-income and middle-income countries, and malaria in 106 malaria-endemic countries, from 2000 to 2017. We also estimated development assistance for health (DAH) from 1990 to 2019, by source, disbursing development agency, recipient, and health focus area, including DAH for pandemic preparedness. Finally, we estimated future health spending for 195 countries and territories from 2018 until 2030. We report all spending estimates in inflation-adjusted 2019 US$, unless otherwise stated. Findings Since the development and implementation of the SDGs in 2015, global health spending has increased, reaching$7.9 trillion (95% uncertainty interval 7.8-8.0) in 2017 and is expected to increase to $11.0 trillion (10.7-11.2) by 2030. In 2017, in low-income and middle-income countries spending on HIV/AIDS was$20.2 billion (17.0-25.0) and on tuberculosis it was $10.9 billion (10.3-11.8), and in malaria-endemic countries spending on malaria was$5.1 billion (4.9-5.4). Development assistance for health was $40.6 billion in 2019 and HIV/AIDS has been the health focus area to receive the highest contribution since 2004. In 2019,$374 million of DAH was provided for pandemic preparedness, less than 1% of DAH. Although spending has increased across HIV/AIDS, tuberculosis, and malaria since 2015, spending has not increased in all countries, and outcomes in terms of prevalence, incidence, and per-capita spending have been mixed. The proportion of health spending from pooled sources is expected to increase from 81.6% (81.6-81.7) in 2015 to 83.1% (82.8-83.3) in 2030. Interpretation Health spending on SDG3 priority areas has increased, but not in all countries, and progress towards meeting the SDG3 targets has been mixed and has varied by country and by target. The evidence on the scale-up of spending and improvements in health outcomes suggest a nuanced relationship, such that increases in spending do not always results in improvements in outcomes. Although countries will probably need more resources to achieve SDG3, other constraints in the broader health system such as inefficient allocation of resources across interventions and populations, weak governance systems, human resource shortages, and drug shortages, will also need to be addressed. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.Peer reviewe

Global, regional, and national burden of neurological disorders, 1990-2016 : a systematic analysis for the Global Burden of Disease Study 2016

Background Neurological disorders are increasingly recognised as major causes of death and disability worldwide. The aim of this analysis from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 is to provide the most comprehensive and up-to-date estimates of the global, regional, and national burden from neurological disorders. Methods We estimated prevalence, incidence, deaths, and disability-adjusted life-years (DALYs; the sum of years of life lost [YLLs] and years lived with disability [YLDs]) by age and sex for 15 neurological disorder categories (tetanus, meningitis, encephalitis, stroke, brain and other CNS cancers, traumatic brain injury, spinal cord injury, Alzheimer's disease and other dementias, Parkinson's disease, multiple sclerosis, motor neuron diseases, idiopathic epilepsy, migraine, tension-type headache, and a residual category for other less common neurological disorders) in 195 countries from 1990 to 2016. DisMod-MR 2.1, a Bayesian meta-regression tool, was the main method of estimation of prevalence and incidence, and the Cause of Death Ensemble model (CODEm) was used for mortality estimation. We quantified the contribution of 84 risks and combinations of risk to the disease estimates for the 15 neurological disorder categories using the GBD comparative risk assessment approach. Findings Globally, in 2016, neurological disorders were the leading cause of DALYs (276 million [95% UI 247-308]) and second leading cause of deaths (9.0 million [8.8-9.4]). The absolute number of deaths and DALYs from all neurological disorders combined increased (deaths by 39% [34-44] and DALYs by 15% [9-21]) whereas their age-standardised rates decreased (deaths by 28% [26-30] and DALYs by 27% [24-31]) between 1990 and 2016. The only neurological disorders that had a decrease in rates and absolute numbers of deaths and DALYs were tetanus, meningitis, and encephalitis. The four largest contributors of neurological DALYs were stroke (42.2% [38.6-46.1]), migraine (16.3% [11.7-20.8]), Alzheimer's and other dementias (10.4% [9.0-124]), and meningitis (7.9% [6.6-10.4]). For the combined neurological disorders, age-standardised DALY rates were significantly higher in males than in females (male-to-female ratio 1.12 [1.05-1.20]), but migraine, multiple sclerosis, and tension-type headache were more common and caused more burden in females, with male-to-female ratios of less than 0.7. The 84 risks quantified in GBD explain less than 10% of neurological disorder DALY burdens, except stroke, for which 88.8% (86.5-90.9) of DALYs are attributable to risk factors, and to a lesser extent Alzheimer's disease and other dementias (22.3% [11.8-35.1] of DALYs are risk attributable) and idiopathic epilepsy (14.1% [10.8-17.5] of DALYs are risk attributable). Interpretation Globally, the burden of neurological disorders, as measured by the absolute number of DALYs, continues to increase. As populations are growing and ageing, and the prevalence of major disabling neurological disorders steeply increases with age, governments will face increasing demand for treatment, rehabilitation, and support services for neurological disorders. The scarcity of established modifiable risks for most of the neurological burden demonstrates that new knowledge is required to develop effective prevention and treatment strategies. Copyright (C) The Author(s). Published by Elsevier Ltd.Peer reviewe

Evidence of clinical competence by simulation, a hermeneutical observational study

Making the transition from theory to practise easier in nursing education through simulation is widely implemented all over the world, and there is research evidence of the positive effects of simulation. The pre understanding for this study is based on a definition of clinical competence as encountering, knowing, performing, Maturing and developing, and the hypothesis is that these categories should appear in simulated situations. The aim of the study was to explore the forms and expressions of clinical competence in simulated situations and furthermore to explore if and how clinical competence could be developed by simulation. An observational hermeneutic study with a hypothetic-deductive approach was used in 18 simulated situations with 39 bachelor degree nursing students. In the situations, the scenarios, the actors and the plots were described. The story told was "the way from suffering to health" in which three main plots emerged. The first was, doing as performing and knowing, which took the shape of knowing what to do, acting responsibly, using evidence and equipment, appearing confident and feeling comfortable, and sharing work and information with others. The second was, being as encountering the patient, which took the shape of being there for him/her and confirming by listening and answering. The third plot was becoming as maturing and developing which took the shape of learning in co-operation with other students. All the deductive categories, shapes and expressions appeared as dialectic patterns having their negative counterparts. The study showed that clinical competence can be made evident and developed by simulation and that the challenge is in encountering the patient and his/her suffering. (C) 2015 Elsevier Ltd. All rights reserved.Peer reviewe